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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.

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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.

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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.

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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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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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You’ll be surprised at how much better you will feel — and how much sharper your thinking is if you add walking to your daily regimen. METRO photo

By David Dunaief, M.D.

Dr. David Dunaief

What does it take to get us out of our seats? We know that exercise is good for our long-term physical and mental health, but it’s still elusive for many of us. It’s just too tempting to let the next episode of our new favorite series autoplay or to answer those last few emails.

Many of us tried to get out of gym class as kids and, as adults, we “want” to exercise, but we “don’t have time.” I once heard that the couch is as bad as the worst deep-fried food; it perpetuates inactivity. Even sleeping burns more calories than sitting and watching TV.

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.

The New York Times’ Science Times carried an article a few years ago about Esther Tuttle. At the time, Esther was 99 years old, sharp as a tack and was independently mobile, with no mobility aids required. She continued to stay active by walking in the morning for 30 minutes and then walking again in the afternoon. The skeptic might say that this is a nice story, but its value is anecdotal at best.

Well, evidence-based medicine backs up her claim that walking is a rudimentary and 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 brain function?

Walking also has a powerful effect on preserving brain function and even growing certain areas of the brain (1). Walking 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. Whoa!

Participants who had an increase in brain tissue volume also had 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 who were dementia free at the start of the trial. The mean participant age was 78. Imagine if you started younger?

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

Even better news is that, if you’re pressed for time or if you’re building up your stamina, you can split a mile into two half-mile increments. How long does it take you to walk a half-mile? You’ll be surprised at how much better you will feel — and how much sharper your thinking is.

How does walking affect mood?

Researchers performed a meta-analysis of other 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). That’s only half of what the Centers for Disease Control recommend. 

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

How do I reset my sitting ‘habit?’

A particular challenge I hear these days is that working from home reduces much of the opportunity to walk. There’s less walking down the hall to a meeting or to refill your water bottle. Instead, everything is only a few steps away. It’s as if our work environment is actually working against us.

If you need a little help getting motivated, here is a terrific strategy to get you off the couch or away from your computer: 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. She also looks for opportunities to have a good old-fashioned phone call, rather than a video call, so she can walk around while she’s talking or listening. Of course, this is one person, but it might give you some ideas that will work for you.

Walking has other benefits as well. We’ve all heard about the importance of doing weight-bearing exercise to 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.

So, remember, 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.

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Walking improves bone health and brain volume

By David Dunaief, M.D.

Dr. David Dunaief

What does it take to get Americans off the sofa? We know that exercise is good for our long-term physical and mental health, but it’s still elusive for the majority of us. It’s just too tempting to let the next episode of our new favorite series autoplay or to answer those last 12 emails.

As kids, many of us tried to get out of gym class, and as adults, we “want” to exercise, but we “don’t have time.” I once heard that the couch is as bad as the worst deep-fried food. It perpetuates inactivity. Even sleeping burns more calories than sitting watching TV, for example.

I think part of the problem might be that we don’t know what type of exercise is best and how long and frequently to do it. 

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

Jane Brody has written in The New York Times’ Science Times about Esther Tuttle. Esther was 99 years old, sharp as a tack and was independently mobile, with no aids needed. She continued to stay active by walking in the morning for 30 minutes and then walking again in the afternoon. The skeptic might say that this is a nice story, but its value is anecdotal at best. 

Well, evidence-based medicine backs up her claim that walking is a rudimentary and simple way to get exercise that shows incredible benefits. One mile of walking a day will help keep the doctor away. 

Walking has a powerful effect on preserving brain function and even growing certain areas of the brain (1). Walking 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 had 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 who had a mean age of 78 and were dementia free at the start of the trial. Imagine if you started earlier?

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

Even better news is that, if you’re pressed for time or if you’re building up your stamina, you can split a mile into two half-mile increments. How long does it take you to walk a half-mile? You’ll be surprised at how much better you will feel — and how much sharper your thinking is.

This is a terrific strategy to get you off the couch or away from your computer. Set an alarm for specific points throughout the day and use that as a prompt to get up and walk, even if it’s only for 15 minutes. The miles will add up quickly. In addition to the mental acuity benefits, this may also help with your psychological health, giving you a mental break from endless Zoom calls and your eyes a break from endless screens.

If you ratchet up the exercise to running, a study showed that mood also improves, mollifying anger (3). The act of running actually increases your serotonin levels, a hormone that, when low, can make people agitated or angry. So, exercise may actually help you get your aggressions out.

Walking has other benefits as well. We’ve all heard about the importance of doing weight-bearing exercise to 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. 

So, remember, 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) 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.

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High blood pressure can be lowered in part by exercise. METRO photo
Collaborate with your physician on lifestyle changes that improve risks

By David Dunaief, M.D.

Dr. David Dunaief

Hypertension, also known as high blood pressure, is commanding a lot of attention in the U.S, where it’s pervasive, affecting approximately 45 percent of adults over 18 (1). Over the last decade, new and extended studies have given us better clarity about treatments, stratifying approaches to ensure the best outcomes for patients.

Since 2017, hypertension severity has been categorized into three stages, each with its recommended treatment regimen. One of the most interesting shifts with this recategorization was the recategorization of what we used to call “prehypertension” into what we now call “elevated” blood pressure and “hypertension stage 1.” 

Elevated blood pressure is defined as systolic blood pressure (the top number) of 120-129 mmHg and diastolic blood pressure (the bottom number) of less than 80 mmHg, while Stage 1 includes systolic blood pressure of 130-139 mmHg or diastolic blood pressure of 80-89 mmHg (2). A simple chart of all levels can be found on The American Heart Association’s website at www.heart.org.

The consequences of both prehypertension and hypertension are significant, even though there are often no symptoms. For example, they increase the risk of cardiovascular disease and heart attack dramatically.

In an analysis of the Framingham Heart Study, researchers found a 3.5-fold increase in the risk of heart attack and a 1.7-fold increase in the risk of cardiovascular disease among those with prehypertension (3). This is why it’s crucial to treat it in these early stages, even before it reaches the more severe levels of hypertension.

Another study, the Women’s Health Initiative, which followed more than 60,000 postmenopausal women for an average of 7.7 years, showed an increase in heart attack deaths, heart attacks and strokes compared to those with normal blood pressure (less than 120/80 mmHg). In the Strong Heart Study, prehypertension independently increased the risk for cardiovascular events at 12 years significantly (4).

This can have a dramatic impact on quality of life.

Treating elevated blood pressure

In my view, it would be foolish not to treat elevated blood pressure. Updated recommendations for treatment, according to the Joint National Commission (JNC) 8, the association responsible for guidelines on the treatment of hypertension, are lifestyle modifications (5).

Lifestyle changes include a Mediterranean-type diet or the DASH (Dietary Approaches to Stop Hypertension) diet. It’s important to focus on fruits, vegetables, reduction in sodium to a maximum of 1500 mg (2/3 of a teaspoon on a daily basis), exercise, weight loss and no more than moderate amounts of alcohol (1 or fewer drinks for women and 2 or fewer drinks for men on a daily basis) (6). Some studies have also shown that a diet rich in potassium helps to reduce blood pressure (7). Fortunately, foods like fruits, vegetables, beans and legumes have significant amounts of potassium. However, do not take potassium supplements unless instructed for other reasons by a physician; high potassium can be very dangerous and may precipitate a heart attack.

The danger in treating elevated blood pressure comes only when medication is used, due to side effects. For example, the Trial of Preventing Hypertension (TROPHY), suggests the use of a hypotensive agent, the blood pressure drug Atacand (candesartan) to treat prehypertensive patients (8)(9). The drug reduced the incidence of hypertension significantly compared to placebo over two years. However, after stopping therapy, the following two years showed only a small benefit over placebo. Still, the authors implied that this may be a plausible treatment. The study was funded by Astra-Zeneca, the makers of the drug. 

In an editorial, Jay I. Meltze, M.D., a clinical specialist in hypertension at Columbia University’s College of Physicians and Surgeons, noted that the results were interpreted in an unusually favorable way (10). 

Elevated blood pressure is an asymptomatic disorder that has been shown to respond well to lifestyle changes — why create symptoms with medication? Therefore, I don’t recommend treating elevated blood pressure patients with medication. Thankfully, the JNC8 agrees.

Treating Stage 1 hypertension

For those with Stage 1 hypertension, but with a low 10-year risk of cardiovascular events, these same lifestyle modifications should be implemented for three-to-six months. At this point, a reassessment of risk and blood pressure should determine whether the patient should continue with lifestyle changes or needs to be treated with medications (11). It’s important to note that risk should be assessed by your physician. I am encouraged that the role of lifestyle modifications in controlling hypertension has been recognized. When patients and physicians collaborate on a lifestyle approach that drives improvements, the side effects are only better overall health.

References: 

 (1) cdc.gov. (2) heart.org. (3) Stroke 2005; 36: 1859–1863. (4) Hypertension 2006;47:410-414. (5) Am Fam Physician. 2014 Oct 1;90(7):503-504. (6) J Am Coll Cardiol. 2018 May, 71 (19) 2176–2198. (7) Archives of Internal Medicine 2001;161:589-593. (8) N Engl J Med. 2006;354:1685-1697. (9) J Am Soc Hypertens. Jan-Feb 2008;2(1):39-43. (10) Am J Hypertens. 2006;19:1098-1100. (11) Hypertension. 2021 Jun;77(6):e58-e67.

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.

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Metro photo
Moderate exercise is better for weight maintenance than weight loss

By David Dunaief, M.D.

Dr. David Dunaief

It’s that time of year again, when exercise product commercials flood the airways. If you have “lose weight” on your list of 2022 resolutions, it’s helpful to consider what the research tells us about the relationship between exercise and weight loss.

Unfortunately, exercise without dietary changes may not actually help many people lose weight, no matter what the intensity or the duration (1). If it does help, it may only modestly reduce fat mass and weight for the majority of people. However, it may be helpful with weight maintenance.

Ultimately, it may be more important to reconsider what you are eating than to succumb to the rationalization that you can eat with abandon and work it off later.

Don’t give up on exercise just yet, though. There is good news: Exercise does have benefits for a wide range of conditions, including chronic kidney disease, cognitive decline, diabetes, cardiovascular disease, osteoporosis, fatigue, insomnia and depression.

Exercise may not result in weight loss

The well-known weight-loss paradigm is that when more calories are burned than consumed, we will tip the scale in favor of weight loss. The greater the negative balance with exercise, the greater the 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, although there was great variability in weight.

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 — or, in other words, a moderately intense pace. 

The good news is that the women were in better aerobic shape by the end of the study. Also, women who had lost weight at the four-week mark 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 there was a disappointing amount of weight loss with exercise alone (4). In six months, patients lost a mean of 1.6 kilograms, or 3.5 pounds, and at 12 months, participants lost 1.7 kilograms, or about 3.75 pounds.

Exercise and weight maintenance

However, exercise may be valuable in weight maintenance, according to observational studies. Premenopausal women who exercised at least 30 minutes a day were significantly less likely to regain lost weight (5). When exercise was added to diet, women were able to maintain 30 percent more weight loss than with diet alone after a year in a prospective study (6).

Exercise and disease

Walking the dog several times a week is a good moderate exercise. METRO Photo

As just one example of exercise’s impact on disease, let’s look at chronic kidney disease (CKD), which affects 15 percent of adults in the United States, according to the Centers for Disease Control and Prevention (7).

Trial results showed that walking regularly could reduce the risk of kidney replacement therapy and death in patients who have moderate to severe CKD, stages 3 to 5 (8). Yes, this includes stage 3, which most likely is asymptomatic. There was a 21 percent reduction in the risk of kidney replacement therapy and a 33 percent reduction in the risk of death when walkers were compared to non-walkers.

Walking had an impressive impact, and results were based on a dose-response curve. In other words, 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 per week saw 44 and 59 percent reductions in death and kidney replacement. These are substantial results. The authors concluded that the effectiveness of walking on CKD was independent of kidney function, age or other diseases.

Therefore, while there are many benefits to exercise, food choices will have a greater impact on our weight and body composition. 

However, exercise can help maintain weight loss and is extremely beneficial for preventing progression of chronic diseases, such as CKD.

So, by all means, exercise, but also focus on consuming nutrient-dense foods instead of calorically dense foods that you may not be able to exercise away.

References:

(1) uptodate.com. (2) J Strength Cond Res. 2015 Feb;29(2):297-304. (3) ACSM.org. (4) Am J Med. 2011;124(8):747. (5) Obesity (Silver Spring). 2010;18(1):167. (6) Int J Obes Relat Metab Disord. 1997;21(10):941. (7) cdc.gov. (8) 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. 

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Walking may reduce the need for dialysis. METRO photo
Simple lifestyle changes can have an impact

By David Dunaief, M.D.

Dr. David Dunaief

On the heels of National Kidney Month in March, let’s look more closely at strategies for reducing chronic kidney disease (CKD). Those at highest risk for CKD include patients with diabetes, high blood pressure and those with first-degree relatives who have advanced disease. But those are only the ones at highest risk.

CKD is tricky because, similar to high blood pressure and dyslipidemia (high cholesterol), it tends to be asymptomatic, at least initially. Only in the advanced stages do symptoms become distinct, though there can be vague symptoms in moderate stages such as fatigue, malaise and loss of appetite.

What are the CKD stages?

CKD is classified into five stages based on the estimated glomerular filtration rate (eGFR), a way to determine kidney function. Stages 1 and 2 are the early stages, while stages 3a and 3b are the moderate stages, and finally stages 4 and 5 are the advanced stages. Stage 5 is end-stage renal disease, or kidney failure.

Who should be screened?

According to the U.S. Preventive Services Task Force and the American College of Physicians, those who are at highest risk should be screened including, as I mentioned above, patients with diabetes or hypertension (1)(2). 

In an interview on Medscape.com, “Proteinuria: A Cheaper and Better Cholesterol?” two high-ranking nephrologists suggest that first-degree relatives to advanced CKD patients should also be screened and that those with vague symptoms of fatigue, malaise and/or decreased appetite may also be potential screening candidates (3). This broadens the asymptomatic population that may benefit from screening.

Slowing CKD progression

Fortunately, there are several options available, ranging from preventing CKD with specific exercise to slowing the progression with lifestyle changes and medications.

How much exercise?

Here we go again, preaching the benefits of exercise. But what if you don’t really like exercise? It turns out that the results of a study show that walking reduces the risk of death and the need for dialysis by 33 percent and 21 percent respectively (4). And although some don’t like formal exercise programs, most people agree that walking is enticing.

The most prevalent form of exercise in this study was walking. Even more intriguing, the results are based on a dose-response curve. In other words, those who walked more often saw greater results. So, the participants who walked one-to-two times per week had a significant 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. There were 6,363 participants for an average duration of 1.3 years.

How much protein to consume?

When it comes to CKD, more protein is not necessarily better, and may even be harmful. In a meta-analysis (a group of 10 randomized controlled trials) of Cochrane database studies, results showed that the risk of death or treatment with dialysis or kidney transplant was reduced by 32 percent in those who consumed less protein compared to unrestricted protein (5). According to the authors, as few as two patients would need to be treated for a year in order to prevent one from either dying or reaching the need for dialysis or transplant.

Sodium: How much is too much?

Good news! 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 was shown to be beneficial, something all of us can achieve.

Medications have a place

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 anti-hypertensives — high blood pressure medications — that work on the RAAS system of the kidneys, 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 medication. 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 the physician is a really good motivator or has very highly motivated patients.

While these two classes of medications, ACE inhibitors and ARBs, are good potential options for protecting the kidneys, they are not the only options. You don’t necessarily have to rely on drug therapies, and there is no downside to lifestyle modifications. Lowering sodium modestly, walking frequently, and lowering your protein consumption may all be viable options, with or without medication, since medication compliance was woeful. Screening for asymptomatic, moderate CKD may lack conclusive studies, but screening should occur in high-risk patients and possibly be on the radar for those with vague symptoms of lethargy as well as aches and pains. Of course, this is a discussion to have with your physician.

References:

(1) uspreventiveservicestaskforce.org (2) aafp.org. (3) Medscape.com. (4) Clin J Am Soc Nephrol. 2014;9(7):1183-9. (5) Cochrane Database Syst Rev. 2009;(3):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. 

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