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Being active is the magic pill for a healthy life. Stock photo
Inactivity may increase mortality and disease risk

By David Dunaief, M.D.

Dr. David Dunaief

With the advent of summer weather, with its heat and humidity, who wants to think about exercise? Instead, it’s tempting to lounge by the pool or even inside with air conditioning.

First, let me delineate between exercise and inactivity; they are not complete opposites. When we consider exercise, studies tend to focus on moderate to intense activity. However, light activity and being sedentary, or inactive, tend to get clumped together. But there are differences between light activity and inactivity.

Light activity may involve cooking, writing and strolling (1). Inactivity involves sitting, as in watching TV or in front of a computer screen. Inactivity utilizes between 1 and 1.5 metabolic equivalent units — better known as METS — a way of measuring energy. Light activity, however, requires greater than 1.5 METS. Thus, in order to avoid inactivity, we don’t have to exercise in the dreaded heat. We need to increase our movement.

What are the potential costs of inactivity? According to the World Health Organization, over 3 million people die annually from inactivity. This ranks inactivity in the top five of potential underlying mortality causes (2).

How much time do we spend inactive? In an observational study of over 7,000 women with a mean age of 71 years old, 9.7 waking hours were spent inactive or sedentary. These women wore an accelerometer to measure movements. Interestingly, as body mass index and age increased, the amount of time spent sedentary also increased (3).

Inactivity may increase the risk of mortality and plays a role in increasing risks for diseases such as heart disease, diabetes and fibromyalgia. It can also increase the risk of disability in older adults.

Surprisingly, inactivity may be worse for us than smoking and obesity. For example, there can be a doubling of the risk for diabetes in those who sit for long periods of time, compared to those who sit the least (4).

Let’s look at the evidence.

Does exercise overcome inactivity?

We tend to think that exercise trumps all; if you exercise, you can eat what you want and, by definition, you’re not sedentary. Right? Not exactly. Diet is important, and you can still be sedentary, even if you exercise. In a meta-analysis — a group of 47 studies — results show that there is an increased risk of all-cause mortality with inactivity, even in those who exercised (5). In other words, even if you exercise, you can’t sit for the rest of the day. The risk for all-cause mortality was 24 percent overall.

However, those who exercised saw a blunted effect with all-cause mortality, making it significantly lower than those who were inactive and did very little exercise: 16 percent versus 46 percent increased risk of all-cause mortality. So, it isn’t that exercise is not important, it just may not be enough to reduce the risk of all-cause mortality if you are inactive for a significant part of the rest of the day.

Worse than obesity?

Obesity is a massive problem in this country; it has been declared a disease, itself, and it also contributes to other chronic diseases. But would you believe that inactivity has more of an impact than even obesity? In an observational study, using data from the EPIC trial, inactivity might be responsible for two times as many premature deaths as obesity (6). This was a study involving 330,000 men and women.

Interestingly, the researchers created an index that combined occupational activity with recreational activity. They found that the greatest reduction in premature deaths (in the range of 16 to 30 percent) was between two groups, the normal weight and moderately inactive group versus the normal weight and completely inactive group. The latter was defined as those having a desk job with no additional physical activity. To go from the completely inactive to moderately inactive, all it took, according to the study, was 20 minutes of brisk walking on a daily basis.

So what have we learned about inactivity? If you are inactive, increasing your activity to be moderately inactive by briskly walking for 20 minutes a day may reduce your risk of premature death significantly. Even if you exercise the recommended 150 minutes a week, but are inactive the rest of the day, you may still be at risk for cardiovascular disease. You can potentially further reduce your risk of cardiovascular disease by increasing your activity with small additions throughout the day.

The underlying message is that we need to consciously move throughout the day, whether at work with a walk during lunch or at home with recreational activity. Those with desk jobs need to be most attuned to opportunities to increase activity. Simply setting a timer and standing or walking every 30 to 45 minutes may increase your activity levels and possibly reduce your risk.

References:

(1) Exerc Sport Sci Rev. 2008;36(4):173-178. (2) WHO report: http://bit.ly/1z7TBAF. (3) JAMA. 2013;310(23):2562-2563. (4) Diabetologia 2012; 55:2895-2905. (5) Ann Intern Med. 2015;162:123-132, 146-147. (6) Am J Clin Nutr. online Jan. 24, 2015.

Dr. 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.   

Photo from Stony Brook Medicine
Dr. Kenneth Kaushansky

When choosing a hospital, whether for yourself or a loved one, it pays to have the peace of mind in knowing that you or your loved one will receive the highest quality of care. One way to help ensure that peace of mind is to do your homework.

We recently received news that will give the residents of Suffolk County and beyond one more reason to feel confident about choosing Stony Brook University Hospital for their health care needs. Our hospital has been named one of America’s 100 Best Hospitals™ for 2019 by Healthgrades, the first organization in the country to rate hospitals entirely on the basis of the quality of clinical outcomes.

Recipients of the America’s 100 Best Hospitals Award are recognized for overall clinical excellence based on quality outcomes for 34 conditions and procedures for 4,500 hospitals nationwide. Healthgrades reviews three years of Medicare and other inpatient data, comparing actual to predicted performance for specific and common patient conditions. 

This impressive distinction was achieved by the entire Stony Brook University Hospital team working together to achieve one goal — to deliver on a commitment to provide every patient with exceptional care. We continuously put patient safety and quality of care first, while bringing cutting-edge services and evidence-based medicine to our community. 

As one of America’s 100 Best Hospitals, Stony Brook University Hospital is in the top 2 percent of hospitals nationwide and one of only four hospitals in New York State exhibiting exemplary clinical excellence over the most recent three-year evaluation.

Stony Brook was also named one of America’s 100 Best Hospitals for cardiac care, coronary intervention and stroke care. I’m proud to report that our hospital is the only one in the entire U.S. Northeast region, and one of only two hospitals in the nation, to achieve America’s 100 Best Hospitals in all four of these categories.

With so many choices, it helps to understand that the quality of care you receive varies from hospital to hospital. Whether you are planning an elective surgery or you are admitted to our hospital unexpectedly, it’s important to know that at Stony Brook University Hospital, you’ll be at one of the nation’s best.

Dr. Kenneth Kaushansky is senior vice president, Health Sciences, and dean, Renaissance School of Medicine at Stony Brook University.

Stock photo

By Nancy Marr

Concern about the school to prison pipeline has mounted in recent years. At the opening of the first federal hearing on the subject, earlier this year, Sen. Dick Durbin (D-IL) said, “For many young people, our schools are increasingly a gateway to the criminal justice system. This phenomenon is a consequence of a culture of zero tolerance that is widespread in our schools and is depriving many children of their fundamental right to an education.” 

Matthew Cregot, an attorney with the NAACP Legal Defense Fund, explained, “With suspension a top predictor of dropout, we must confront this practice if we are ever to end the ‘dropout crisis,’ or the so-called achievement gap.”

A zero-tolerance policy requires school officials to hand down specific, consistent and harsh punishment — usually suspension or expulsion — when students break certain rules. The punishment applies regardless of the circumstances, the reasons for the behavior (like self-defense) or the student’s history of discipline problems.

These policies developed in the 1990s in response to school shootings and general fears about crime. The school to prison pipeline starts (or is best avoided) in the classroom. When combined with zero-tolerance policies, a teacher’s decision to refer students for punishment can mean they are pushed out of the classroom, and much more likely to be headed toward the criminal justice system.

On May 10, Suffolk County Sheriff Errol D. Toulon Jr. (D) and Assemblywoman Kimberly Jean-Pierre (D-Wheatley Heights) from Babylon brought together experts in juvenile justice, child development, human services, law and trauma to develop A Holistic Approach to Deconstructing the Prison Pipeline.

Testimony at the hearing identified domestic abuse, substance abuse, mental health issues, lack of education and gangs as factors that lead young people into crime, and called for the creation of “safe spaces” for “at-risk” children to receive counseling, recreational activities, job training and education.

Intervention to help a child must recognize that he may be calling out for help, angry at himself and his environment; instead, what he gets is punishment. Significantly, three previously incarcerated women testified that prison had rescued them. It changed their environment by providing for their basic needs, making them follow rules, requiring them to go to school.

Jerri Katzerman, deputy legal director of the Southern Poverty Law Center, said that the increase in police in school buildings, called school resource officers, has contributed to the increase in in-school arrests. The vast majority of these arrests are for nonviolent offenses, often for being disruptive.

A recent U.S. Department of Education study found that more than 70 percent of students arrested in school-related incidents or referred to law enforcement are black or Hispanic. Children with special needs are also arrested at a higher rate than others. Instead of pushing children out, Katzerman said, teachers need a lot more support and training for effective discipline, and schools need to use best practices of behavior modification to keep these kids in school where they belong. 

In restorative justice circles, which bring together the student who has committed the crime with the victims and any others who are affected, it is possible to repair the harm, restore relationships and help the student become accountable for his actions. 

Parent groups have successfully worked with school districts to change zero-tolerance policies and adopt schoolwide positive behavior support systems that create a more welcoming environment for children and their parents, encouraging parents to advocate effectively for their children in suspension cases. These are societal issues that will not be solved solely within schools. We need to take action to create a society that meets the needs of all children.

“Deconstructing the prison pipeline is about mobilizing all facets of the community to prevent juvenile delinquency and crime,” said Toulon. “It’s about implementing practical prevention and intervention solutions that will improve people’s lives and make our communities safer.”

You can support programs in your school or community that work for all children, but especially those who need help to overcome the trauma of family problems or mental illness.

Nancy Marr is first vice president of the League of Women Voters of Suffolk County, a nonprofit, nonpartisan organization that encourages the informed and active participation of citizens in government and influences public policy through education and advocacy. For more information, visit www.lwv-suffolkcounty.org or call 631-862-6860.

Jet

MEET JET!

This week’s shelter pet is a beautiful 9-month-old terrier mix named Jet. Surrendered to a high kill shelter in Texas due to his owner’s personal problems, he is now safe at Kent Animal Shelter.

Jet is a lovely dog and would do well in any home situation. He weighs 25 pounds and comes neutered, vaccinated and microchipped.

Black dogs very often get overlooked in shelters.  Won’t you come and meet this little guy and give him a chance? You may just fall in love! 

Kent Animal Shelter is located at 2259 River Road in Calverton. The adoption center is open seven days a week from 10 a.m. to 4 p.m. For more information on Jet and other adoptable pets at Kent, call 631-727-5731 or visit www.kentanimalshelter.com.

Annabelle’s Key Lime Cheesecake

By Barbara Beltrami

People who live in hot climates know about limes. They use them lavishly in savory and sweet dishes as well as drinks and know just how refreshing their taste can be, particularly if they’re key limes, which have an extra intense flavor and tartness. I think a lime dessert on a balmy evening under the stars or as a pick-me-up with just a glass of iced tea or coffee on a steamy afternoon is the supreme finale and palate pleaser when something sweet is in order. Here are three winners to take your taste buds to some really cool places.

Tea Lime Cookies

YIELD: Makes about 2 dozen cookies

INGREDIENTS:

2 teaspoons freshly squeezed lime juice

1/3 cup milk

1 stick unsalted butter, softened

¾ cup granulated sugar

1 egg

2 teaspoons freshly grated lime zest

1¾ cups flour

1 teaspoon baking powder

¼ teaspoon baking soda

2 tablespoons freshly squeezed lime juice

¼ cup sifted confectioners’ sugar

DIRECTIONS:

Preheat oven to 350 F. In a small bowl combine the two teaspoons lime juice and milk; let sit about 5 minutes. In a large bowl use electric mixer to cream together the butter and sugar until light and fluffy; beat in egg with lime zest; then stir in lime juice-milk mixture. In a separate bowl, sift together the flour, baking powder and baking soda; blend into butter mixture; drop by rounded teaspoonfuls onto ungreased baking sheet. Bake 10 minutes, until edges are pale brown. Let cool slightly on baking sheet before transferring to wire rack to cool completely. In a small bowl, thoroughly combine remaining 2 tablespoons lime juice and confectioners’ sugar. Brush onto cooled cookies. Serve with iced tea or iced coffee.

Annabelle’s Key Lime Cheesecake

Annabelle’s Key Lime Cheesecake

YIELD: Makes 6 to 8 servings

INGREDIENTS:

1½ cups graham cracker crumbs

2 tablespoons sugar

½ stick unsalted butter, melted

2½ eight-ounce bricks cream cheese, softened

¾ cup sugar

3 eggs

1 cup sour cream

3 tablespoons flour

¾ cup Key lime juice

Dash vanilla extract

DIRECTIONS:

Preheat oven to 375 F. In a medium bowl combine graham cracker crumbs, two tablespoons sugar and melted butter. Press onto bottom and partly up sides of a greased 10-inch spring form pan. Bake 5 to 10 minutes; cool on wire rack.

In a large bowl using a mixer on medium-high speed beat cream cheese and three-quarters cup of sugar until smooth. Beat in eggs, one at a time; then beat in remaining ingredients until mixture is smooth; pour into cooled crust. Bake in 375 F oven for 15 minutes; reduce heat to 250 F and bake another 45 to 55 minutes, until mixture is just set.

Remove from oven, cool on wire rack, cover and refrigerate 6 to 8 hours. Remove from pan, top with whipped cream if desired, and serve chilled with coffee, tea or honeydew liqueur.

Alice’s Key Lime Pie

YIELD: Makes 6 to 8 servings

INGREDIENTS:

1½ cups finely ground graham cracker crumbs

1/3 cup granulated sugar

6 tablespoons melted unsalted butter

4 egg yolks

1 tablespoon freshly grated lime zest

One 14-ounce cans sweetened condensed milk

2/3 cup Key lime juice

DIRECTIONS:

Preheat oven to 350 F. In a medium bowl, thoroughly combine the graham cracker crumbs, sugar and melted butter. Press mixture onto bottom and sides of 8- or 9-inch pie plate. Bake about 10 minutes; cool in plate on wire rack. While crust is cooling, using wire whisk attachment to mixer, beat egg yolks with lime zest until very fluffy, about 5 minutes. Gradually add sweetened condensed milk and continue to beat until thickened, about 3 to 5 minutes longer. With mixer speed on low, add lime juice and beat just until blended, no longer. Pour into crust and bake about 10 minutes, until filling is barely set (a knife inserted in center should come out clean). Cool to room temperature, refrigerate, then freeze for half an hour before serving. Serve with sweetened whipped cream.

John Broven Photo by Diane Wattecamps

By John Broven

Part two of three

I’ve been waiting patiently to write this second part of my personal Brexit overview (see part 1, “Brexit: To leave or not to leave, that is the big question,” TBR News Media’s papers and websites, March 14). There has been an interested response from TBR readers, although as expected not everybody agreed with my Europhile stance or interpretation of events. An apt New York Times description was “fractured Britain.”

Even now, there is no resolution to the terms for the United Kingdom of Great Britain and Northern Ireland to leave the European Union as determined by a national referendum June 23, 2016, almost three years ago — the vote was 51.89 to 48.11 percent. The March 29 deadline went by, so did one on April 12. Now the departure date has been extended begrudgingly by the EU until Oct. 31. That’s Halloween, as many wags have pointed out. Still the drama continues.

Prime Minister Theresa May resigns

On May 24, Prime Minister Theresa May (Conservative, known as Tories) announced her forthcoming departure in tears for failing to deliver Brexit. Never a team player, she was rapidly losing support among her Brexit-leaning party. The withdrawal agreement negotiated with the EU was criticized from all sides even as May tried to soften her parliamentary bill by including environmental measures, workers rights and even the prospect of a second referendum — anathema to Brexiteers in her own party. With no majority in sight for her deal, she will formally resign on June 7, immediately after the state visit by President Donald Trump (R).

She is now the second prime minister to be felled by Brexit in the footsteps of David Cameron (Conservative), who was responsible for calling the 2016 referendum. Indeed, the Tory Party’s neurosis with Europe had previously ensnared former prime ministers, Margaret Thatcher and John Major.

Tory leadership battle

Now, the Brexit process has been put on hold while the ruling Conservative Party elects a new leader, expected by the end of July. That leaves four short months to finalize leave arrangements. Understandably, the EU is running out of patience and has indicated it will not renegotiate the deal on the table, including the controversial Irish backstop.

The number of Tory prime minister candidates currently stands at 11, still well short of the tally of U.S. Democratic presidential candidates. At the time of writing the bookies favorite is the self-serving former mayor of London, Boris Johnson, the New York City-born member of parliament of British parents who dealt a fatal blow to Cameron’s 2016 Vote Remain campaign by treacherously joining the Vote Leave team. The covertly ambitious Michael Gove and hardliner Dominic Raab are also in the running. Just as the U.S. Democratic candidates are in a quandary over presidential impeachment proceedings, so the U.K. Tory leadership candidates are scrambling for Brexit answers.

Our president has caused local controversy by favoring Johnson. If the former mayor is elected as prime minister by the Conservative Party and his pronouncements are carried out, he could lead the country into the worst of all possibilities on Oct. 31 — a hard no deal. It is chilling to think that such a chaotic scenario could happen to the fifth largest economy in the world, with an impact far beyond the borders of Great Britain and Northern Ireland.

As Will Hutton described it in London’s The Guardian, the Brexiteers view is of a blissful but flawed image of “sunlit uplands of immigrant-free, global free trade.” Sir Elton John, also in The Guardian, was more blunt: “I’m ashamed of my country for what it has done. It’s torn people apart … I am sick to death of politicians, especially British politicians. I am sick to death of Brexit. I am a European. I am not a stupid, colonial, imperialist English idiot.”

EU elections shock

The British government had hoped to avoid taking part in the recent EU elections, but as the country was still formally one of the 28 member states the people went to the polls on May 23. In keeping with the unpredictable Brexit mess, what a shocking result it turned out to be. Former UKIP leader and an elected member of the European Parliament since 1999, Nigel Farage, who has been described by his Euro colleagues as a “one-man wrecking ball,” had formed the new Brexit Party only six weeks previously and topped the polls with a 30.8 percent share of the vote. The two leading parties in British politics for almost 100 years, Labour (third place) and Conservatives (fifth), managed a meager 23 percent of the vote between them, beaten by second-place Liberal Democrats with their remain message and fourth-place Green Party with an urgent climate-change agenda.

Tellingly, the Tories suffered their worst election result since formation in 1834 and registered only 8.8 percent of the vote, with no seats won in London. May’s party had also taken a shellacking in the earlier county council elections. That’s the current governing party, don’t forget. As The Washington Post noted, coalition governments and a genuine multiparty system may be the future of British politics.

In effect, British voters were giving a severe kicking to the government and lead opposition party under arch-socialist Jeremy Corbyn for their inept handling of Brexit. Intriguingly, Scotland and Northern Ireland still balloted majority votes to remain candidates. The MEPs term will end if and when Brexit occurs. Taking all the parties into account, the respective total leave and remain votes were very close, which is where we came in — a divided nation with a divided parliament and parties internally divided.

The cross-Europe vote showed a fragmentation of parties, with the establishment center-left and center-right bloc losing power. The populist parties in Britain, France and Italy showed gains but surprisingly little elsewhere, notably in Holland. There was a general message that the EU needs to address growth, security, immigration (again) and climate change (the U.S. please note). Still, with a turnout in excess of 50 percent, there are indications the Europeans still see their union as the future. In the wake of the Brexit debacle, it seems the other Euro populist movements are determined to fight for their cause from inside the EU, not on the outside with little influence.

Incidentally, I was impressed by the BBC World News TV election coverage Sunday, May 26, and its first-class presenter Ros Atkins. I learned a lot about the EU, its procedures, the debating arguments and how countries from Germany to Latvia voted. If only Brexit voters had been educated likewise.

Where the UK stands

Embarrassingly, Britain’s pragmatic standing in the world seems to be falling by the day. I’ve lost count of the number of barbed Monty Python jokes I’ve seen in print. As my good friend John Ridley, of Hildenborough, Kent, told me, “I can’t recall any other democratic country committing an act of such extreme self-harm ever before.”

The Brexit fiasco shows on a macro level that elections do matter and do have consequences — in this instance, for an entire nation and its future. And the dangers of putting such a critical issue to an ill-informed public by way of a loosely worded referendum have been fully exposed.

If there is a lesson for us all, it is a message that TBR News Media carries at every election: Your vote counts, please vote — and do understand what you’re voting for. That applies from presidential elections to the local fire departments, libraries and schools (the turnout for the recent Three Village Central School District budget vote was abysmal).

With Brexit still unresolved, I am readying myself for a part 3 Your Turn article but further patience may be required on the part of myself and TBR readers. Will there be a second referendum, general election, another EU extension or a hard no deal?

John Broven, a member of the TBR News Media editorial team, is an English-born resident of East Setauket, who immigrated to the United States in 1995. He has written three award-winning (American) music history books. An updated edition of his second book, “South to Louisiana: The Music of the Cajun Bayous,” has just
been published.

By Daniel Dunaief

Daniel Dunaief

We pack our cars, suitcases and purses. We bring cameras, camcorders, extra batteries, chargers and cards filled with positive messages and gifts.

At this time of year, we bear witness to the conclusion of one educational course — primary, middle or high school, college or even graduate school — as we and the graduate prepare for the next step.

In between bites from the buffet, we pause for proud pictures with the graduate and we share our admiration for what he or she has accomplished even as we anticipate the next adventure.

Most of these ceremonies involve walking, sitting, standing and cheering, eating and driving. The action takes a backseat to the words and sentiment that mark the occasion. The graduation speakers offer personal anecdotes and words of wisdom, even as they recognize that short speeches, particularly for those eager to fill an empty stomach or discharge a full bladder, are a welcome part of the day.

While we’re milling around, we have ample opportunities to impart our own wisdom, to share encouraging words and to provide the kind of tailwind that accelerates the next phase of life.

So, what do we say? Did we pack our belongings, but neglect to choose from the wealth of words that can fill a sail with air, that can help us feel capable of defying gravity, that can enable us to see through this moment to a magnificent future?

How often do we watch an interview with someone who has accomplished the unimaginable, who doesn’t know what to say or who is it at a loss for words when someone shoves a microphone in that person’s direction?

We have time to consider the right words, to be supportive, and to make our trip to another state or another school meaningful, even if the graduate is too close to the focal point of his or her life to know how to react to the torrent of feelings and thoughts.

We can rely on a Hallmark card, a Thesaurus or a set of clichés to share our thoughts, or we can take a moment to find the right words, in between all our packing, our search for the right gift and our purchasing plane tickets.

Someday, a daughter graduate may be sitting on a plane heading for a meeting in Salt Lake City and may wonder how she got there and whether she can succeed in the next phase. Maybe she’ll recall the moment you took her aside, placed your hand on her shoulder, smiled in her eyes and suggested she paved her own path with perspiration — if she appreciates alliteration.

She may recall how you enveloped her hand in yours when you reminded her that everything, even a moment of weakness, provides opportunities for the next success. Perfection, she’ll recall as she remembers how you accidentally spit on her cheek when you started to speak, isn’t about the perfect achievement but about the perfect effort.

She will recall the moment you told her how much she inspired you with her awareness of the needs of others and with her grace under pressure.

If your graduate is anything like the ones in my family, for whom skepticism and cynicism hover nearby, he or she may roll their eyes and search for a phone to text a friend to ask if the recipient of the message can believe what you just said.

Someday, the graduate or that friend may borrow a word, phrase or idea from the ones you shared, providing fuel to a tank that seemed empty and converting the next impossible task into a reality.

By Leah S. Dunaief

Leah Dunaief

A recent article in The New York Times asked, “What is your oldest or most cherished grudge?” Everyone holds grudges, I guess, and they can range from some perceived slight or cutting remark to deep hurt or betrayal. While we all know that forgiveness is a lot healthier than anger, still there is something immutable about a deeply held grudge. However hard and sincerely you try to let go of it and go on with your life, it’s impossible to entirely discard the pain. Some people even admit to tending their grudges like a garden.

“Holding onto a grudge really is an ineffective strategy for dealing with a life situation that you haven’t been able to master,” said Dr. Frederic Luskin, founder of the Stanford Forgiveness Project, as reported in separate Times articles by Tim Herrera and Katherine Schulten. The psychological study suggested that “skills-based forgiveness training may prove effective in reducing anger as a coping style, reducing perceived stress and physical health symptoms, and thereby may help reduce” the stress we put on our immune and cardiovascular systems. Carrying anger into old age can result in higher levels of inflammation and chronic illness.

So how do we discard grudges? How do we forgive?

Luskin urges that we recognize three things. First that forgiveness is for you, not the offender. Second that it’s best to do it now. And finally that forgiveness is about freeing yourself.

Then to continue the process, change the story about the source of the grudge. Rather than being a victim, think of yourself as heroic. Then think of the good things in your life so as to balance the harm. And remember that life doesn’t always turn out the way we want. Luskin emphasizes that forgiveness is a learnable skill. It just takes a little practice, he advises.

Now all of the above sounds good but I have another track to suggest. To sooth a grudge, there is nothing quite as satisfying as revenge. And the best revenge? A life well lived. It’s an old adage but true.

So what makes for a life well lived? I guess there are as many answers as there are people, but I can tell you mine. Make your home a happy and comfortable place by creating a room or a corner just for yourself. All you need is a special chair with a fluffy pillow or a bedside table with your latest reading choices or music source, and of course a picture you love on the wall. Take an aromatic bath. Welcome friendship and love in your life. If all else fails, get a dog.

When the weather is glorious, take a guilt-free walk, even for five minutes. Say hello to strangers in the post office or the supermarket aisle and watch a smile appear on their faces. Make yourself something you really like to eat, and if you shouldn’t be eating it, just eat a little. Do some kind of work that is worthy of you, then take pride in the way you carry it out. Clean out just one desk drawer and feel like you have your life under control. Remember to laugh at life’s little incongruities.

Go see a good movie. Or a play. Or attend a concert. These can all be found locally. Plan a trip, even if it’s only for a Saturday afternoon to the East End. Then go on it and see how many new things there are to see. Buy a shirt or an ice cream cone. Celebrate every possible occasion and even celebrate just for the heck of it. Take a nap, if only for 20 minutes.

And for Pete’s sake, read a newspaper, preferably a hometown paper because that tends to have more good news!

Hypothyroidism is a condition in which the thyroid gland is not able to produce enough thyroid hormone. Stock photo
Treatment doesn’t always result in weight loss
Dr. David Dunaief

By David Dunaief, M.D.

Many refer to hypothyroidism as a potential cause for weight gain and low energy. But do we really know what it is and why it is important?

The thyroid is a butterfly-shaped organ responsible for maintaining our metabolism. It sits at the base of the neck, just below the laryngeal prominence, or Adam’s apple. The prefix “hypo,” derived from Greek, means “under” (1). Therefore, hypothyroidism indicates an underactive thyroid and results in slowing of the metabolism.

Blood tests determine if a person has hypothyroidism. Items that are tested include thyroid stimulating hormone (TSH), which is usually increased, thyroxine (free T4) and triiodothyronine (free T3 or T3 uptake). Both of these last two may be suppressed (2).

There are two types of primary hypothyroidism: subclinical and overt. In the overt (more obvious) type, classic symptoms include weight gain, fatigue, thinning hair, cold intolerance, dry skin and depression, as well as the changes in all three thyroid hormones on blood tests mentioned above. In the subclinical, there may be less obvious or vague symptoms and only changes in the TSH. The subclinical can progress to the overt stage rapidly in some cases (3). Subclinical is substantially more common than overt; its prevalence may be as high as 10 percent of the U.S. population (4).

Potential causes or risk factors for hypothyroidism are medications, including lithium; autoimmune diseases, whether personal or in the family history; pregnancy, though it tends to be transient; and treatments for hyperthyroidism (overactive thyroid), including surgery and radiation.

The most common type of hypothyroidism is Hashimoto’s thyroiditis, where antibodies attack thyroid gland tissues (5). Several blood tests are useful to determine if a patient has Hashimoto’s: thyroid peroxidase (TPO) antibodies and antithyroglobulin antibodies.

Myths versus realities

I would like to separate the myths from the realities with hypothyroidism. Does treating hypothyroidism help with weight loss? Not necessarily. Is soy potentially bad for the thyroid? Yes. Does coffee affect thyroid medication? Maybe. Let’s look at the evidence.

Medications

Levothyroxine and Armour Thyroid are two main medications for hypothyroidism. The difference is that Armour Thyroid converts T4 into T3, while levothyroxine does not. Therefore, one medication may be more appropriate than the other, depending on the circumstance. T3 can also be given with levothyroxine, which is similar to using Armour Thyroid.

What about supplements?

A study tested 10 different thyroid support supplements; the results were downright disappointing, if not a bit scary (6). Of the supplements tested, 90 percent contained actual medication, some to levels higher than what are found in prescription medications. These supplements could cause toxic effects on the thyroid, called thyrotoxicosis. Supplements are not FDA-regulated; therefore, they are not held to the same standards as medications. There is a narrow therapeutic window when it comes to the appropriate medication dosage for treating hypothyroidism, and it is sensitive. Therefore, if you are going to consider using supplements, check with your doctor and tread very lightly.

Soy impact

In a randomized controlled trial, the treatment group that received higher amounts of soy supplementation had a threefold greater risk of conversion from subclinical hypothyroidism to overt hypothyroidism than those who received considerably less supplementation (7). According to this small, yet well-designed, study, soy has a negative impact on the thyroid. Therefore, those with hypothyroidism may want to minimize or avoid soy.

The reason that soy may have this negative impact was illustrated in a study involving rat thyrocytes (thyroid cells) (8). Researchers found that soy isoflavones, especially genistein, which are usually beneficial, may contribute to autoimmune thyroid disease, such as Hashimoto’s thyroiditis. They also found that soy may inhibit the absorption of iodide in the thyroid.

Weight loss

Wouldn’t it be nice if the silver lining of hypothyroidism is that, with medication to treat the disease, we were guaranteed to lose weight? In a retrospective study, results showed that only about half of those treated with medication for hypothyroidism lost weight (9). This was a small study, and we need a large randomized controlled trial to test it further.

WARNING: The FDA has a black box warning on thyroid medications — they should never be used as weight loss drugs (10). They could put a patient in a hyperthyroid state or worse, having potentially catastrophic results.

Coffee

Taking levothyroxine and coffee together may decrease the absorption of levothyroxine significantly, according to one study (11). It did not seem to matter whether they were taken together or an hour apart. This was a very small study involving only eight patients. Still, I recommend avoiding coffee for several hours after taking the medication.

There are two take-home points, if you have hypothyroid issues: Try to avoid soy products, and don’t think supplements that claim to be thyroid support and good for you are harmless because they are over the counter and “natural.” In my clinical experience, an anti-inflammatory, vegetable-rich diet helps improve quality of life issues, especially fatigue and weight gain, for those with Hashimoto’s thyroiditis.

References:

(1) dictionary.com. (2) nlm.nih.gov. (3) Endocr Pract. 2005;11:115-119. (4) Arch Intern Med. 2000;160:526-534. (5) mayoclinic.org. (6) Thyroid. 2013;23:1233-1237. (7) J Clin Endocrinol Metab. 2011 May;96:1442-1449. (8) Exp Biol Med (Maywood). 2013;238:623-630. (9) American Thyroid Association. 2013;Abstract 185. (10) FDA.gov. (11) Thyroid. 2008;18:293-301.

Dr. 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.     

٭We invite you to check out our weekly Medical Compass MD Health Videos on Times Beacon Record News Media’s website, www.tbrnewsmedia.com.٭

Many of Madagascar’s iconic lemur species such as this black-and-white ruffed lemur are critically endangered. Photo by Daniel Burgas

By Daniel Dunaief

As a part of an ambitious reforestation plan announced in March, Madagascar’s newly elected president Andry Rajoelina explained that he wanted to change the way his nation off the southwest coast of the African continent was known, from the Red Island to the Green Island.

An international collection of scientists, including lemur expert and award-winning scientist Patricia Wright of Stony Brook University, recently weighed in on other ways Rajoelina can help conservation goals for the country through a five-step solution they outlined in the journal Nature Sustainability.

“We are all very concerned” about the fate of biodiversity in Madagascar, said Wright. “We know that only with a collaborative effort can we push things in the right direction.”

Madagascar, which has numerous species endemic to the island nation, including many of the lemurs Wright studies, is known as the island of red clay in part because deforestation has exposed much of the clay underlying the country. This clay has eroded into rivers, which have washed into the ocean.

“If you flew over the whole island, it would be very sad” because of all the exposed red clay from deforestation, Wright said.

She remains optimistic about Rajoelina’s goals and the potential for achieving them. The president “talked about going on the offensive and reforestation is one of his platforms,” she said. “It’s most important to reforest with endemic species,” as opposed to eucalyptus and pine.

Unlike in other countries, where politicians sometimes view conservation and economic development as forces pulling in opposite directions, Malagasy leaders acknowledge and recognize the benefit of preserving unique habitats that are home to the rare and threatened species of Madagascar.

“If you destroy all the forests, you destroy all the water and they will no longer be able to farm,” Wright said. “The natural wildlife and habitats are closely connected to their well-being. One of the biggest industries is ecotourism, which supports many industries on the ground. It’s not like there’s a line between people and wildlife.”

Indeed, the scientists acknowledge the importance of financial growth for the country that dovetails with their conservation goals.

“Conservation needs to contribute to, and not detract from, national efforts targeting economic development,” Julia Jones of Bangor University, in Wales, who led the study, said in a press release. “It must not make situations worse for the rural poor who are so often marginalized in decision making.”

The people of Madagascar have many of the same needs as those in other countries, as they seek jobs, health care, and good schooling, Wright said. “These families are closer to not having enough food to eat and they are much poorer if the natural resources are all destroyed.”

Concerned about the fate of biodiversity in Madagascar, Jones contacted Wright, who suggested the team enlist the help of Jonah Ratsimbazafy from the University of Antananarivo in Madagascar.

“It was just a matter of bringing together some of the key players in conservation for 20 years,” explained Wright.

The group generated a list of five priorities.

First on the list is tackling environmental crime. The scientists suggest using new technologies, including remote sensing and rapid DNA barcoding, to allow forest rangers and others to identify protected species. To improve this effort, however, the Ministry of Justice also needs to enhance the way it reacts to environmental crimes.

The researchers suggest prosecuting and fining those who traffic in rosewood or the critically endangered species for the pet trade. They see progress in this arena in the northeastern part of the island nation, where prosecutors have effectively charged some people who have sold rosewood.

Second, the group recommends investing in protected areas. The researchers urge greater investment in policy, legal and economic conditions that encourage additional investment in nature, which could include improving infrastructure to develop tourism around protected areas, payment for ecosystem services and debt for nature swaps.

Critically endangered species such as these ploughshare tortoises may be extinct in the wild within the next few years if illegal collection isn’t stopped. Photo by Chris Scarffe

Third, the scientists urge that major infrastructure developments limit the impact on biodiversity. The current environmental impact assessment law is over 20 years old and needs an update to require the use of environmental assessment. This component also includes a greater commitment to enforcement.

Fourth, the scientists suggest strengthening tenure rights for local people over natural resources. Most farmers can’t get certification for their land, which reduces the incentive for them to invest in settled agriculture and potentially exacerbates forest clearance. A review of tenure laws could help local landowners and biodiversity.

Finally, researchers recognize a growing crisis in fuel wood. They urge an investment in reforestation efforts, which could provide environmental and economic benefits.

While these steps are important for Rajoelina and the government in Madagascar, Wright suggests several ways Long Islanders can help. She urges school teachers to cover Madagascar in their classes. Teachers in the area who are interested in gathering information about the island nation can write to Wright at Patricia.Wright@stonybrook.edu.

She also urges people to become involved through social media, which they can use to have fundraisers through organizations like PIVOT, an organization committed to improving health in developing nations like Madagascar and strongly encourages people to visit Madagascar, where they can enjoy the benefits of ecotourism.

Visitors to Madagascar would have the incredible opportunity to witness the varied biodiversity for themselves.“We have charismatic lemurs,” Wright said, although many of them are critically endangered. Even if they can’t travel that far, people can support students who wish to study abroad.

“I don’t think health and wildlife are separated,” Wright said. “The health of the people depends on us preserving natural resources.”

She is looking forward to the Annual Association for Tropical Biology and Conservation meeting in Antananarivo, Madagascar, from July 30 through August 3. “Hopefully, we will be going forward with the next step during or shortly after that meeting.”

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