Follow me on twitter @drportnay for daily thoughts, comments on recent news items and retweets

Tuesday, November 18, 2014

Wednesday, October 15, 2014

Testosterone and Heart Disease

There has been much written lately about the potential link between testosterone therapy and heart disease.

Some study's have shown an increased risk of heart problems but others have not. A group of American Endocrinologists recently called for a retraction of one of these papers that showed an increased risk. 

A European Medicines Agency (EMA) has reviewed the evidence and has concluded that testosterone does not increase the risk of heart disease in patients with confirmed hypogonadism

The FDA's final review is still pending. But until that time, the EMA's review is reassuring that testosterone treatment is probably safe for men symptomatic hypogonadism. 

Mediterranean Diet: May Reverse Metabolic Syndrome

Metabolic syndrome is a cluster of conditions — increased blood pressure, a high blood sugar level, excess body fat around the waist and abnormal cholesterol levels — that occur together and has been shown to greatly increase the risk of heart disease, stroke and diabetes.

A recent analysis of the PREMIMED trial showed that patients with established metabolic syndrome who adhered to a Mediterranean diet were more likely to reverse their disease. 

The PRIMIMED study placed patient on either:
-  Mediterranean diet—one supplemented with about 1 L of extra-virgin olive oil a week, and one supplemented with 30 g/day of walnuts, hazelnuts, and almonds
- diet low in fat intake from all sources.

The researchers found that more of the patients with Metabolic syndrome on the Mediterranean diet had full remission of the disease 

As may of you know, I am a big proponent of the Mediterranen Diet. The Mediterranean diet emphasizes eating fruits, vegetables, and seeds, many of which contain minerals, polyphenols, and other phytochemicals that combat oxidative stress, inflammation, and insulin resistance,

Monday, October 6, 2014

Heart Healthy Lifestyle Reduces Risk of MI 86%

Researchers from Sweden recently reported that five lifestyle factors were each independently associated with a lower risk of MI in men.
  • Frequent physical activity (walking or cycling at least 40 minutes per day
  • Mediterranean style diet (fruits, veggies, reduced-fat dairy, whole grains, and fish)
  • Moderate alcohol consumption
  • Not smoking 
  • Waist less than 37.4 inches
When all five of these behaviors were adhered too, the risk of MI was reduced by 86% compared with individuals who did not adhere to any of these behaviors. 

In addition
  • Diet and alcohol cut the risk by 35%
  • Diet, alcohol, and not smoking cut the risk by 64%
  • Diet, alcohol, not smoking and exercise cut the risk by 76%
So what does this show - that by adhering to the 5 above behaviors, we can dramatically reduce our risk of suffering an MI  

Thursday, July 31, 2014

Just Run Baby

A new study published in the Journal of the American College of Cardiology states that even 5-10 minutes of running a day can lead to substantial lowering of all-cause and cardiovascular (CV) mortality.

Overall, runners gained about 3 years of life over their non-running counterparts and had a 30% lower risk of all-cause and a 45% lower risk of CV mortality. 

The investigators observed a significant reduction in risk in those that ran less than six miles per week, ran slower than six miles per hour and even among those that ran just 1-2 times per week. 

This is great news. You can get significant benefits from just a 5-15 minute run. (Now that time is not the issue, what will be your excuse for not exercising :)

High Intake of Fruit and Veggies Linked With Decreased CV Mortality

A new study by Harvard School of Public Health Researches are reporting that there is a dose-response relationship between fruit and veggie intake and decrease in Cardiovascular (CV) mortality.

With each additional portion of fruits or veggies there was a ~ 4% reduction in risk of CV death up to five servings. 

Therefore, five or more servings of fruits and veggies was associated witha 25% risk reduction. Each serving of fruit provided a 5% average reduction in risk and each addition veggie serving was associated with a 4% reduction in risk.

So - make sure you eat your fruits and veggies. Remember, these food are an integral component of of the Mediterranean Style Diet.  

Friday, June 13, 2014

Sleep apnea and the heart

Many of you who have heard me speak publicly, seen me in the office or read my blog know that I remain very concerned about the effects of sleep apnea on cardiovasacular health. I have written about this before:

Could your sleep be hurting your heart?

Women, Sleep and Heart Disease

Sleep apnea treatment helps your gold game

Do you have sleep apnea?

Two new important studies published in the June 12th edition of the New England Journal of Medicine continue to add to the growing body of evidence regarding the danger that sleep apnea poses to cardiovascular health and the importance of weightloss and continuous positive airway pressure (CPAP) treatment.

The first study reports that in obese patients with moderate to severe sleep apnea, weight loss is the most important intervention and reduces inflammation, insulin resistance, dyslipidemia, and blood pressure. Also, the addition of CPAP to weightloss led to a significant further reduction in blood pressure.

The second study also showed that CPAP is effective for lowering blood pressure in patients with moderate to severe sleep apnea. CPAP was much more effective that using just oxygen therapy at night.

Sleep apnea can:
- make it very hard to lose weight
- raise your high blood pressure
- make you legs swell
- increase your risk of developing atrial fibrillation
- make you feel very short of breath
- increase your chances of heart failure
- increase your chances of heart attack
- increase your chance of developing pulmonary hypertension
- increase your chances of stroke

The two most important interventions to treat this serious condition remain aggressive weightloss and CPAP.

If you have any of the following signs or symptoms, please consult your physician
- excessive daytime sleepiness
- waking up feeling unrefreshed after sleep
- memory and concentration problems
- heart burn at night
- swelling in the legs
- night time gasping or choking spells

Tuesday, June 10, 2014

Fruit Juice vs Soda - From NPR and Nutrition

I just read a fascinating article on NPR. In this article, NPR reports on a new study published in the journal Nutrition that compares the fructose content of fruit juice to that of common sodas. Some might be surprised to known that there is almost as much fructose in fruit juice as there is in soda. In fact, there is more fructose in Minute Maid 100% Apple Juice than Coke, Pepsi, and Dr Pepper.

In this day and age when we are all hopefully trying to live healthier, please understand that just because something is "natural" it is not necessarily healthier. This is especially true for all those parents out there with young children, for those patients trying to lose weight and for those patient with diabetes. 

My simple solution: eat your fruit and drink water.

Thursday, June 5, 2014

More good news for the Mediterranean Diet

As many of you know, I'm a big fan of the heart heathy benefits of adhering to a Mediterranean Diet. 

Now, new research shows that that individuals who adhered to the Mediterranean diet supplemented with extra virgin oil had significant regression of the carotid vessel-wall volume compared with those who ate a control diet low in saturated fat.

While this does not mean these patients had a reduction in hard clinical events (less heart attacks, strokes...), it does add to the ever growing body of evidence that eating a Mediterranean style diet and frequent exercise are the heart healthiest way to live. 

Sunday, June 1, 2014

Get/Stay Fit Month: Tweet from Dr Ted Portnay (@drportnay)

As you can read below, I have dedicated June to be get/stay fit month (#getstayfitmonth). There is no time like the present to start make positive changes in your overall health. Starting to get fit is not easy. It's painful. It takes time. It's uncomfortable. But it's worth it. 

Staying fit its hard too. It's takes a commitment and persistence to not get lazy and take the easy way out. 

I know this. I too struggle to get/stay fit. 

Therefore, all month I will be tweeting my quest to get/stay fit. I welcome you to follow along. I welcome you to share your achievements. 

Dr Ted Portnay (@drportnay) tweeted at 8:43am - 1 Jun 14:

June is #getstayfitmonth. All month I'll be tweeting my quest to #getstayfit runkeeper.com/activity?userI… (https://twitter.com/drportnay/status/473082384897028096)

To Age Well, Walk - NYTimes.com

To Age Well, Walk - NYTimes.com
Here's a great article from the New York Times. 

For years, I have been preaching the overall health benefits of heart health eating and frequent exercise. I have been very persistent in my education with my elderly patient population about the importance of frequent exercise. I teach that exercise has been linked with less heart disease, decreased cognitive decline, improved balance and improvements in bone health. 

As you will read below, a new study has shown that exercise in the frail and elderly can significant decrease the chance of developing disabilities. 

So please, get our there and exercise. (Remember, June is #getstayfitmonth)

To Age Well, Walk

Mildred Johnston walking along a path in Kanapaha Veterans Memorial Park in Gainesville, Fla. Ms. Johnston participated in a large study that showed the benefits of walking for older people.Rob C. Witzel for The New York TimesMildred Johnston walking along a path in Kanapaha Veterans Memorial Park in Gainesville, Fla. Ms. Johnston participated in a large study that showed the benefits of walking for older people.
Phys Ed

Gretchen Reynolds on the science of fitness.

Regular exercise, including walking, significantly reduces the chance that a frail older person will become physically disabled, according to one of the largest and longest-running studies of its kind to date.

The results, published on Tuesday in the journal JAMA, reinforce the necessity of frequent physical activity for our aging parents, grandparents and, of course, ourselves.

While everyone knows that exercise is a good idea, whatever your age, the hard, scientific evidence about its benefits in the old and infirm has been surprisingly limited.

"For the first time, we have directly shown that exercise can effectively lessen or prevent the development of physical disability in a population of extremely vulnerable elderly people," said Dr. Marco Pahor, the director of the Institute on Aging at the University of Florida in Gainesville and the lead author of the study.

Countless epidemiological studies have found a strong correlation between physical activity in advanced age and a longer, healthier life. But such studies can't prove that exercise improves older people's health, only that healthy older people exercise.

Other small-scale, randomized experiments have persuasively established a causal link between exercise and healthy aging. But the scope of these experiments has generally been narrow, showing, for instance, that older people can improve their muscle strength with weight training or their endurance capacity with walking.

So, for this latest study, the Lifestyle Interventions and Independence for Elders, or LIFE, trial, scientists at eight universities and research centers around the country began recruiting volunteers in 2010, using an unusual set of selection criteria. Unlike many exercise studies, which tend to be filled with people in relatively robust health who can easily exercise, this trial used volunteers who were sedentary and infirm, and on the cusp of frailty.

Ultimately, they recruited 1,635 sedentary men and women aged 70 to 89 who scored below a nine on a 12-point scale of physical functioning often used to assess older people. Almost half scored an eight or lower, but all were able to walk on their own for 400 meters, or a quarter-mile, the researchers' cutoff point for being physically disabled.

Then the men and women were randomly assigned to either an exercise or an education group.

Those in the education assignment were asked to visit the research center once a month or so to learn about nutrition, health care and other topics related to aging.

The exercise group received information about aging but also started a program of walking and light, lower-body weight training with ankle weights, going to the research center twice a week for supervised group walks on a track, with the walks growing progressively longer. They were also asked to complete three or four more exercise sessions at home, aiming for a total of 150 minutes of walking and about three 10-minute sessions of weight-training exercises each week.

Every six months, researchers checked the physical functioning of all of the volunteers, with particular attention to whether they could still walk 400 meters by themselves.

The experiment continued for an average of 2.6 years, which is far longer than most exercise studies.

By the end of that time, the exercising volunteers were about 18 percent less likely to have experienced any episode of physical disability during the experiment. They were also about 28 percent less likely to have become persistently, possibly permanently disabled, defined as being unable to walk those 400 meters by themselves.

Most of the volunteers "tolerated the exercise program very well," Dr. Pahor said, but the results did raise some flags. More volunteers in the exercise group wound up hospitalized during the study than did the participants in the education group, possibly because their vital signs were checked far more often, the researchers say. The exercise regimen may also have "unmasked" underlying medical conditions, Dr. Pahor said, although he does not feel that the exercise itself led to hospital stays.

A subtler concern involves the surprisingly small difference, in absolute terms, in the number of people who became disabled in the two groups. About 35 percent of those in the education group had a period of physical disability during the study. But so did 30 percent of those in the exercise group.

"At first glance, those results are underwhelming," said Dr. Lewis Lipsitz, a professor of medicine at Harvard Medical School and director of the Institute for Aging Research at Hebrew SeniorLife in Boston, who was not involved with the study. "But then you have to look at the control group, which wasn't really a control group at all." That's because in many cases the participants in the education group began to exercise, study data shows, although they were not asked to do so.

"It wouldn't have been ethical" to keep them from exercise, Dr. Lipsitz continued. But if the scientists in the LIFE study "had been able to use a control group of completely sedentary older people with poor eating habits, the differences between the groups would be much more pronounced," he said.

Over all, Dr. Lipsitz said, "it's an important study because it focuses on an important outcome, which is the prevention of physical disability."

In the coming months, Dr. Pahor and his colleagues plan to mine their database of results for additional followup, including a cost-benefit analysis.

The exercise intervention cost about $1,800 per participant per year, Dr. Pahor said, including reimbursement for travel to the research centers. But that figure is "considerably less" than the cost of full-time nursing care after someone becomes physically disabled, he said. He and his colleagues hope that the study prompts Medicare to begin covering the costs of group exercise programs for older people.

Dr. Pahor cautioned that the LIFE study is not meant to prompt elderly people to begin solo, unsupervised exercise. "Medical supervision is important," he said. Talk with your doctor and try to find an exercise group, he said, adding, "The social aspect is important."

Mildred Johnston, 82, a retired office worker in Gainesville who volunteered for the LIFE trial, has kept up weekly walks with two of the other volunteers she met during the study.

"Exercising has changed my whole aspect on what aging means," she said. "It's not about how much help you need from other people now. It's more about what I can do for myself." Besides, she said, gossiping during her group walks "really keeps you engaged with life."

A version of this article appears in print on 05/28/2014, on page A12 of the NewYork edition with the headline: Exercise for Older Adults Helps Reduce Their Risk Of Disability, Study Says 

Wednesday, May 28, 2014

Follow-up to my earlier blog post

Eating Fruits and Veggies Reduces Stroke Risk

Researchers are reporting that after reviewing 20 past studies (this includes more than 760,000 individuals) for every 200 grams of fruit consumed a day, the stoke risk decreased by 32% and for every 200 grams of veggies consumed per day, the risk for stoke dropped by 11%.

So as I stated earlier today, please focus on eating a well balanced diet - one filled with lots of fruits and veggies.

The Truth About Supplements

There is no proof that they work!

There I have said it. It is a fact that many of my patients and friend don't want to hear. However, at this time, there is no clinical randomized, trial results that show any benefit to any of the many supplements that are advertised and written about on the web.

Many of my patients have heard me discuss this with them in the past. 

When I was in medical school and starting my residency, there were many patient taking Vitamin C and Vitamin E. Both of these have been shown not to prevent heart disease. (Vitamin E may actually increase the risk of heart disease). 

When I was in fellowship, there were many patient taking folic acid (folate) and Vitamin B complexes. Both of these have been shown not to prevent heart disease. 

Despite all that has been written about Vitamin D, a recent study has shown that Vitamin D is no linked with heart disease

Many, many people are using fish oil (Omega-3 fatty acids) to reduce their risk of heart disease. Guess what? A recent study just found no benefit of Omega-3 fatty acids in reducing/preventing heart disease. 

Resveratol, a compound found in red wine, gapes and dark chocolate, does increase longevity or reduce the risk of heart disease. 

So what can you do?  Eat well and exercise. 

Studies have consistently shown that staying active and getting lots of exercise and  eating a well balanced diet, one high in fresh fruits, vegetables, nuts and beans (Mediterranean Style, DASH, Vegetarian, Vegan) reduces your risk of heart disease. 

Therefore, stop supplementing and just start living a healthy, active, well balanced life. 

Tuesday, May 27, 2014

Get ready for it... June is #MobileFit Month!

As many of you know, I love fitness and I love gadgets. Therefore, what could be better than a fitness gadgets. This June, iMore and Connectedly will be focusing on apps and accessories to help motive, track and improve your fitness. Read below for more info.
The iPhone Blog Get ready for it... June is #MobileFit Month!

We're looking forward to making June the month we dedicate to the intersection of technology and fitness. We're going to explore and highlight fitness, diet and health apps for your platform. We're going to explore accessories that help you get the most of your workout. We'll look at connected devices that will help you achieve your fitness goals. June is where we all get #MobileFit.
You'll find great content focused on fitness all month across iMore, Android Central, CrackBerry and Windows Phone Central. This year, #MobileFit will be hosted by Connectedly – our newest community dedicated to the next era of connected devices. Things like smartwatches and wearables are leading the current charge to the next generation of health and fitness, which is why we want to use Connectedly, and their forums, as our basecamp for fitness. You'll still find platform specific content on the site of your choice, but Connectedly is where we'll be hosting content that is more platform agnostic – like which pair of headphones will help you kick ass during your weekend. There you'll also find our #MobileFit Month forum where you can discuss anything and everything related to Mobile Fit during the month of June.
Mobile Fit doesn't officially start until June, but we figured we'd get the word out so you can get ready. We wanted to share a few of our plans for the month with you and solicit some community feedback to make Mobile Fit all about you.

Fitbit Challenge

This month we're going to be doing a fun challenge for those who have a Fitbit activity tracker. We'll be setting up an activity group where we all compete with one another to be super active. Those that get active in the group will walk (or run) away with some cool new gear. This challenge starts on June 1st, which is this coming Sunday. This gives you time to pick up the Fitbit of your choice before the challenge starts. Already have a Fitbit? Then join the group!
Don't worry, this isn't the only way to win anything during Mobile Fit. We've got a ton of smaller prizes and contests we will be doing throughout the month.
So you don't miss anything, be sure to visit and bookmark connectedly.com/mobilefit, which will serve as the main event page for #mobilefit month and will pull in all related content from across participating sites.

Get social

Could you tell that #MobileFit was going to be our hashtag for the month? We want to see how you use technology to stay fit. Use the hashtag throughout the month to show us and others how you use tech to stay fit and healthy.
We can't wait to get fit with you.

Thursday, January 2, 2014

Please be careful in the snow

After the Blizzard of 2010, I wrote a blog about the dangers of shoveling snow.

Please read. 


Please be careful tomorrow. We here in the Fairfield County, Connecticut are expected to get frigid temps and a significant snow accumulation.