Health

Photo courtesy of St. Catherine of Sienna

“Life is like a disco, no matter how the music changes, you just keep on dancing.” The charmed quote is taken from the 2011 movie, Jumping the Broom, and captured the essence of St. Catherine of Siena Hospital’s 8th Annual Pink Ribbon Salute, held on Oct. 2. Each year, the breast cancer survivor event adopts a creative theme to add a layer of fun to the celebration.

This year, the event took on a disco theme — and more than 100 breast cancer survivors showed up in their best Saturday Night Fever attire ready to dance the night away as they triumph, despite the changes cancer may have brought upon their lives. 

“It was wonderful to see familiar and new faces in our growing family of courageous women celebrating their fearless determination to overcome,” said St. Catherine’s Administrative Director of Reconstructive Microsurgery Dr. Diana Yoon-Schwartz.

The event was moderated by St. Catherine’s breast health navigator Meiling Alsen, and a special welcome was given by chief nursing officer Mary Jane Finnegan. 

“When I look at all of you, I know I am surrounded by strong, courageous women, along with your family members and friends, who have survived or are in the process of surviving a fight that no one should ever have to fight — you truly are my inspiration,” said Finnegan. 

The welcome was followed by the latest updates in breast care by St. Catherine’s Medical Director of Breast Health Services Dr. Jana Deitch, who also took the opportunity to address survivors directly. “Tonight is a wonderful night about celebrating women who fight the tough fight every day — you are not only surviving, but thriving and giving back to other women who may need some encouragement on the journey to healing,” said Deitch.

The disco mood was further set with live renditions of the era’s top hits, played by Just Cause Band. The band, originated by attorneys, has grown into a diversified group, born from the love of music and a desire to help the community by supporting charity events at no cost. Thanks to the philanthropic and harmonizing skills of Just Cause Band, survivors and supporters danced and sang all night, and when the rendition of Gloria Gaynor’s “I Will Survive” was played, the room erupted in unified triumph. 

“It is a moment I will always remember — it was electrifying and inspiring,” said Deitch.

The Pink Ribbon has become a tradition that survivors and staff look forward to annually. “Our survivors and staff dance the night away in celebration — it is an evening we all cherish, filled with laughter and hope, share with family and friends,” said St. Catherine’s Medical Director of Breast Imaging Dr. Anne Green. 

“I’m proud to be a part of an exceptional group of compassionate breast health specialists who service patients from one location in their own community — we are a community that provides the true continuum of care for our patients — so, we will keep on dancing right beside them!”

The Pink Ribbon Salute is supported by St. Catherine of Siena’s senior leadership, and the event was co-sponsored with the support of Suffolk Anesthesia Associates, Genomic Health Inc. Myriad Genetics, New York Cancer Specialists, New Street Plastic Surgery and Square Care.

Exercise, especially endurance-based, can reduce your risk of forming gallstones. Stock photo
Weight and inactivity are among the greatest risk factors

By David Dunaief, M.D.

Dr. David Dunaief

Gallstones affect up to 20 million Americans between the ages of 20 and 74, with a more than two times increased occurrence in women than in men, according to the NHANES III survey (1). There are two types of gallstones, 80 percent of which are cholesterol stones and 20 percent of which are pigment stones.

Common symptoms

Gallstones may be asymptomatic; however, when gallstones block either the cystic or common bile ducts, symptoms occur. Symptoms include dull or crampy abdominal pain that is exacerbated by meals and lasts one to five hours. Jaundice, which includes yellowing of skin and eyes, is another symptom. Others include nausea and vomiting, rapid heart rate, hypotension (low blood pressure) and fever (2).

Tests used for diagnosis

Blood tests include complete blood count, where there may be a rise in white blood cells; liver enzymes; and the pancreatic enzymes lipase and amylase. Diagnostic tests that have more accuracy are the endoscopic ultrasonography (EUS) and endoscopic retrograde cholangiopancreatography (ERCP); however, these are invasive. Less accurate but noninvasive tests include abdominal X-ray, ultrasound and CAT scan (CT). The tests used also depend on where the stone may be located. Hepatobiliary (HIDA) scans are accurate if the stone is located in the cystic duct. And magnetic resonance retrograde cholangiopancreatography (MRCP) is used if the stone is thought to be located in the common bile duct (2).

What are the risk factors?

There are a multitude of risk factors. Some of these are modifiable, others are not. The modifiable ones include obesity, measured by body mass index (BMI); rapid weight loss; fat consumption; hormone replacement therapy (HRT); oral contraceptives; decreased physical activity; Crohn’s disease; and certain drugs. One nonmodifiable risk factor is age; the older we get, the higher the risk, with age 40 being the demarcation line (3). Other risk factors are gender, with females being more predisposed; pregnancy; and family history (4).

Let’s look at the evidence.

Obesity risks

Obesity may play an important role. The reason obesity is implicated is potentially due to bile becoming supersaturated (5). Bile is a substance produced in the liver and stored in the gallbladder. Bile aids in the digestion or breakdown of fats in the small intestines. Crystals may form, creating cholesterol gallstones from the bile.

Body mass index

A body mass index of greater than 30 kg/m² is considered obese. In a meta-analysis of two prospective, forward-looking observational trials, Copenhagen General Population Study and the Copenhagen City Heart Study, those in the highest quintile of BMI were almost three times as likely to experience symptomatic gallstones compared to those who were in the lowest quintile (6). The highest quintile was those who had a mean BMI of 32.5 kg/m² and thus were obese, whereas those in the lowest quintile had a mean BMI of 20.9 kg/m². This is a comparison of obese to ideal BMI. Not surprisingly, since women in general have a higher risk of gallstones, they also have a higher risk when their BMI is in the obese range compared to men, a 3.36-fold increase and 1.51-fold increase, respectively.

Also, the research showed that for every 1 kg/m² increase in BMI, there was a 7 percent increase in the risk of gallstones. Those who had genetic variants that increased their likelihood of an elevated BMI had an even greater increase in gallstone risk —17 percent — per 1 kg/m². In the study population of approximately 77,000, more than 4,000 participants became symptomatic for gallstones.

Physical activity

In the Physicians’ Health Study, a prospective observational trial, those in the lowest quintile of activity between the ages of 40 and 64 had a 72 percent increased risk of gallstone formation, and those 65 and older had a 33 percent increased risk (7). Also, men who were 65 and older and watched television more than six hours a week were at least three times as likely to have gallstones as those who watched fewer hours. There was a substantial increased risk for those under 65, as well, though to a slightly lesser degree.

Diabetes rears its ugly head

Just like with obesity, diabetes is almost always a culprit for complications. In a prospective observational study, those with diabetes were at a significant 2.55 times greater risk of developing gallstones than those without (8). Again, women had a higher propensity than men, but both had significant increases in the risk of gallstone formation, 3.85 times and 2.03 times, respectively. There were almost 700 participants in this study. The researchers believe that an alteration in glucose (sugar) metabolism may create this disease risk.

Hormone replacement therapy

If you needed another reason to be leery of hormone replacement therapy (HRT), then gallstones might be it. In a prospective observational trial, women who used HRT, compared to those who did not, had a 10 percent increased risk in cholecystectomy — removal of the gallbladder — to treat gallstones (9). Though this may not sound like a large increase, oral HRT increased the risk 16 percent, and oral estrogen-only therapy without progestogens increased the risk the most, 38 percent. Transdermal HRT did not have a significantly increased risk.

It is never too early or too late to treat obesity before it causes, in this case, gallstones. With a lack of exercise, obesity is exacerbated and, not surprisingly, so is symptomatic gallstone formation. Diabetes needs to be controlled to prevent complications. HRT, unless menopausal symptoms are unbearable, continues to show why it may not be a good choice.

References:

(1) Gastroenterology. 1999;117:632. (2) emedicine.medscape.com. (3) J Hepatol. 1993;18 Suppl 1:S43. (4) uptodate.com. (5) Best Pract Res Clin Gastroenterol. 2014 Aug;28:623-635. (6) Hepatology. 2013 Dec;58:2133-2141. (7) Ann Intern Med. 1998;128:417. (8) Hepatology. 1997;2:787. (9) CMAJ. 2013;16;185:549-550.

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.  

Birds are known as indicator species: they tell us if things are alright in the ecosystem. Photo above: A male rose-breasted grosbeak rests in a tulip tree. Photo by Luci Betti-Nash

A new study in the Sept. 20 issue of Science has found that in the United States and Canada bird populations have fallen a staggering 29 percent since 1970.

Such a dramatic drop has scientists concerned that the decline could be a sign of an ecosystem collapse. Habitat loss is considered a prime culprit. 

Huntington resident Coby Klein understands the big picture. He’s an ecology professor at Baruch College and a guide with the Huntington-Oyster Bay Audubon Society.

“If the arctic continues to become warmer and drier, it will cause larger and more frequent fires,” he said. “Fires kill birds and destroy nesting habitats and drive down populations of sandpipers, gulls, terns, waterfowl and birds of prey that migrate through or winter on Long Island.”

The best thing people can do, if you really have an interest in protecting birds and the environment, he said, is to vote.

Otherwise, the Audubon Society is committed to transforming communities back into places where birds flourish. Sterile lawns, ornamental species, pesticides and herbicides mean that on a local level, the landscape no longer supports functioning ecosystems.

Klein himself said that he lives on a postage-stamp-sized lot and the only native plant that thrives in his yard is poison ivy. But he notes that the Audubon Society is sponsoring a campaign called Creating Bird-Friendly Communities. The program is designed to educate the public on what they can do to help reverse the damage done and revive disappearing bird populations.

Growing native plants is a key component to re-establishing the ecological functions of cities and towns, according to the society and its experts. And they say the concept is easier on the back and wallet.

To flourish, birds need (a) plenty of food, (b) shelter where they can rest, (c) clean water to drink and bath in and (d) safe places to raise their young. Native plants and the insects that co-evolved around them are vital to a healthy system. The more native plants, the Audubon emphasizes, the more food and shelter. More bugs, caterpillars and seed pods on more public and private land is part of the solution.

The Audubon’s Native Plants Database, which is on its website, suggests plants according to ZIP code. The choices were hand-selected by local experts and include information about the birds and creatures it benefits. Serviceberry, for example, is recommended for Long Island’s North Shore communities. The small, shrublike tree with dense branching produces white flowers in the spring followed by red, purple or black berries. It attracts butterflies and caterpillars, as well as warblers and woodpeckers and about nine other types of birds. The database can be a good first place to explore landscape options.

The Long Island Native Plant Initiative’s website is another good resource. The local nonprofit gathers wild seeds and makes  native plants commercially available. It also grows and sells the native plant species to local nurseries to increase availability. Polly Weigand, the executive director, recommends requesting native plants from your favorite garden center to increase demand. It’s goal is to reach more businesses in the nursery industry. Once people get into the habit of  providing suitable habitats, birds become less vulnerable and are potentially more capable of adapting to climate conditions, according to the Audubon.

Native gardens, experts agree, are also relatively maintenance free and require little to no special irrigation system or fertilizers or toxic chemicals.  So, it saves time and money and is a  healthier option for people in the long run.

This fall consider practicing less drastic and costly yard cleanup. The Audubon recommends leaving the seed heads of perennials in the garden and skipping the raking. Leaf litter, they say, is free fertilizer, and a good place for birds to forage for worms and other critters. If tree limbs fall, they say, consider building a brush pile that will provide birds with shelter from the wind and predators. Branches settle and decompose over the seasons and make room for the next year’s contributions.

Plant asters and woody shrubs like bayberry and winterberry this fall.  The waxy fruit of bayberry provides an important source of energy to migrating birds. Evergreens, too, like cedars, firs and holly, provide shelter and something for birds to eat in winter. In general, milkweed, goldenrod and sunflowers are important plants for the rest of the year.

“When you plant native species in your home landscapes it’s a protective way of ensuring that invasive ornamental species seeds don’t spread and dominate the rest of Long Island’s landscape,” said Weigand.  

Overall, the objective is to lose some lawn, or create pathways through it, and create habitat layers. Tall canopy trees produce nuts and provide nest cavities for shelter. Shrubs and small trees throw fruit for bird food and herbaceous plants supply seeds and a habitat for pollinators. Decaying leaves produce the base of all habitats. It also happens to be where moth pupae live, a favorite food of baby birds.

Start small, the Audubon states, and cluster plants in groupings of five or more of the same species. Pollinators, they say, prefer to feed from masses of the same flower. And remember to include a birdbath or hollowed out rock where rainwater collects, so birds have a supply of fresh water.

In the end, you’ve created a backyard sanctuary and a sure method for healthy, sustainable living. 

Three Village Central School District becomes the first school district in New York to join a national lawsuit against e-cigarette manufacturer Juul. TBR News Media file photo

Three Village Central School District is joining the fight against vaping devices.

In a letter from Superintendent Cheryl Pedisich and Board of Education President William Connors, the district announced it became the first school district in New York to join a national lawsuit against e-cigarette manufacturer Juul.

“As educators, it is our duty to protect the health and safety of our students, and we believe this company is compromising those efforts while simultaneously disrupting the educational process by marketing to teens,” Pedisich and Connors wrote.

Officials stated in the letter that legal fees will be covered by the firms representing the parties in the suit and will not come from district taxes.

The district officials said in the letter vaping devices are easy for teenagers to hide and use. 

“This epidemic, while a national one, has had a direct and grave impact on our local school community,” school officials said. “As a district, we have needed to divert resources and deploy new ones to combat the problem of teen vaping.”

Three Village has installed devices to detect vaping, created prevention programs, adjusted health curricula to focus on the dangers of vaping, created a new student assistant counselor position to focus on prevention and treatment, and embraced new disciplinary actions and a districtwide zero-tolerance policy on vaping, according to the letter.

Nearly 40 percent of 12th grade students and 27 percent of high school students in New York State are now using e-cigarettes, according to New York State officials.

The U.S. Centers for Disease Control and Prevention states on its website that the use of e-cigarettes is unsafe for children, teens and young adults, as most e-cigarettes contain nicotine and other harmful substances. According to the agency, highly-addictive nicotine can harm adolescent brain development, which continues into the early to mid-20s.

As at Oct. 8, the CDC has reported 1,080 vaping-associated illnesses in the United States with 23 deaths. There have been 110 cases attributed to New York, according to the state’s health department. On the same day, the death of a Bronx teen was announced as the first confirmed fatality related to vape products in New York.

 

Steroids can be helpful but in moderation. Stock photo
Studies suggest shorter duration treatments can be as effective, with fewer side effects

By David Dunaief, M.D.

Dr. David Dunaief

Steroids typically make headlines related to their use as a performance-enhancing drug in sports. However, if we look beyond the flashy headlines, we see that corticosteroids, or steroids, play an important role in medicine.

Medical use

Steroids have an anti-inflammatory effect. This is critical since many acute and chronic diseases are based at least partially on inflammation. Chronic diseases that benefit include allergic, inflammatory and immunological diseases (1). These types of diseases touch on almost every area of the body, from osteoarthritis and autoimmune diseases to asthma, COPD (emphysema and chronic bronchitis) and eye disorders.

Steroids are delivered orally, topically as creams, lotions and eye drops, or via injections, intravenous solutions and inhaled formulations. The most commonly known medication is prednisone, but there are many others, including prednisolone, methylprednisolone, cortisone, hydrocortisone and dexamethasone.

Their benefits can be tremendous, improving functionality and reducing pain or improving breathing. You could say they are lifesaving in some instances, and with rescue inhalers they may just be that.

The bad

However, there is a very big caveat: They come at a price. Steroids cause weight gain, increased glucose (sugars), high blood pressure, cardiovascular events, osteoporosis, change in mood (psychoses), cataracts, glaucoma, infection, peptic ulcers, Cushing’s syndrome, and the list goes on. These are among the reasons medical professionals recommend using the least amount for the shortest time.

The upshot

The good news is that a plant-based diet may have similar beneficial effects in chronic diseases as steroids without all the downsides. Let’s look at the evidence.

The role in pneumonia

Pneumonia is among the top-10 leading causes of death in the world (2). In a meta-analysis (a group of nine studies), there was no overall effect of corticosteroids in reducing the risk of mortality in community-acquired pneumonia (3). However, when the data was broken into subsets, the findings were different. In subset data of those who had severe pneumonia, there was a statistically significant 74 percent reduction in mortality. And when duration was the main focus in subgroup analysis, those who received prolonged use of steroids reduced their risk of mortality by half. 

Unfortunately, with the benefit comes an increased risk of adverse events, and this meta-analysis was no exception. There was a greater than two-times increased risk of abnormally high glucose levels with prolonged use. Thus, when giving steroids, especially for a prolonged use, it may be wise to check glucose levels.

In a randomized controlled trial (RCT), the gold standard of studies, results reinforced the beneficial effects of steroids on pneumonia. They showed that in those with both severe pneumonia and high inflammation, there was a two-thirds reduction in treatment failures when corticosteroids were added to the regimen (4). There were 120 patients involved in the study. They received antibiotics plus either methylprednisolone or placebo for five days.

Osteoarthritis: surprising results

As we know, osteoarthritis specifically of the knee is very common, and intra-articular (in the joint) injections directly into the knee are becoming routine treatment. A study compared injectable hyaluronic acid to injectable corticosteroid (5). The results showed that over three months, the corticosteroid was superior to hyaluronic acid in terms of reducing pain, 66 percent versus 43.8 percent, respectively. 

Interestingly, over the longer term, 12 months, hyaluronic acid reduced the pain and maintained its effect significantly longer than the steroid, 33 percent versus a meager 8.2 percent, respectively. Study groups received five injections of either steroid or of hyaluronic acid directly to the knee over a five-week period. Thus, steroids may not always be the most effective choice when it comes to pain reduction. Hyaluronic acid may have caused this beneficial effect by reducing inflammation, protecting cartilage and preventing cell death, according to the authors.

COPD: Length may not matter

It is not unusual to treat COPD patients with oral steroids. But what is the proper duration? The treatment paradigm has been two weeks with 40 mg of corticosteroids daily. However, results in an RCT of 600 patients showed that five days with 40 mg of corticosteroid was equivalent to 14 days of the same dosage and frequency (6). The hope is that the shorter use of steroids will mean fewer side effects. We have come a long way; prior to 1999, eight weeks of steroids was a more commonplace approach to treating acute COPD exacerbations.

Dietary effect

One of the great things about steroids is that they reduce inflammation, and we know that the basis of greater than 80 percent of chronic disease is inflammation. A plant-based diet involving lots of vegetables and fruits and some grains may have a similar effect as steroids, but without the side effects. The effect may be to modify the immune system and reduce inflammation (7).

The bioactive substances from plants thought to be involved in this process are predominantly carotenoids and the flavonoids. Thus, those patients who respond even minimally to steroids are likely to respond to a plant-based diet in much the same beneficial way without the downsides of a significant number of side effects. Diet, unlike steroids, can be used for a long duration and a high intake, with a direct relationship to improving disease outcomes.

In conclusion, it is always better to treat with the lowest effective dose for the shortest effective period when it comes to steroids. The complications of these drugs are enumerable and must always be weighed against the benefits. Sometimes, other drugs may have more beneficial effects over the long term, such as hyaluronic acid injections for knee osteoarthritis. A plant-based diet, with anti-inflammatory properties similar to steroids, may be a useful alternative for chronic disease or may be used alongside these drugs, possibly reducing their dosage and duration.

References:

(1) uptodate.com. (2) N Engl J Med. 1995;333(24):1618-1624. (3) PLoS One. 2012;7(10):e47926. (4) JAMA. 2015;313(7):677-686. (5) Open Access Rheum 2015;7:9-18. (6) JAMA. 2013;309(21):2223-2231. (7) Int J Vitam Nutr Res. 2008 Dec;78(6):293-298.

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.   

Think twice before running out and getting a cup of coffee if you have AFib. Stock photo
The role of caffeine is still in question

By David Dunaief, M.D.

Dr. David Dunaief

Atrial fibrillation (AFib) is a common arrhythmia, an abnormal or irregular heartbeat. Though there are several options, including medications and invasive procedures, treatment mostly boils down to symptomatic treatment, rather than treating or reversing underlying causes.

What is AFib? It is an electrical malfunction that affects the atria, the two upper chambers of the heart, causing them to beat “irregularly irregular.” This means there is no set pattern that affects the rhythm and potentially causes a rapid heart rate. The result of this may be insufficient blood supply throughout the body.

Complications that may occur can be severely debilitating, such as stroke or even death. AFib’s prevalence is expected to more than double by 2030 (1). Risk factors include age (the older we get, the higher the probability), obesity, high blood pressure, premature atrial contractions and diabetes.

AFib is not always symptomatic; however, when it is, symptoms include shortness of breath, chest discomfort, light-headedness, fatigue and confusion. This arrhythmia can be diagnosed by electrocardiogram (ECG), but more likely with a 24-hour Holter monitor. The challenge in diagnosing AFib is that it can be intermittent.

There may be a better way to diagnose AFib. In a study, the Zio Patch, worn for 14 days, was more likely to show arrhythmia than a 24-hour Holter monitor (2). The Zio Patch is a waterproof adhesive patch on the chest, worn like a Band-Aid, with one ECG lead.

There are two main types of AFib, paroxysmal and persistent. Paroxysmal is acute, or sudden, and lasts for less than seven days, usually less than 24 hours. It tends to occur with greater frequency over time, but comes and goes. Persistent AFib is when it continues past seven days (3). AFib is a progressive disease, meaning it gets worse, especially without treatment.

Medications are meant to treat either the rate or rhythm or prevent strokes from occurring. Those that treat rate include beta blockers, like metoprolol, and calcium channel blockers, such as diltiazem (Cardizem). Examples of medications that treat rhythm are amiodarone and sotalol. Then there are anticoagulants that are meant to prevent stroke, such as warfarin and some newer medications, dabigatran (Pradaxa), rivaroxaban (Xarelto) and apixaban (Eliquis). The newer anticoagulants are easier to administer but may have higher bleeding risks, in some circumstances with no antidote.

There is also ablation, an invasive procedure that requires threading a catheter through an artery, usually the femoral artery located in the groin, to reach the heart. In one type of ablation, the inappropriate nodes firing in the walls of the atria are ablated, or destroyed, using radiofrequency. This procedure causes scarring of atrial tissue. When successful, patients may no longer need medication.

The role of obesity

There is good news and bad news with obesity in regards to AFib. Let’s first talk about the bad news. In studies, those who are obese are at significantly increased risk. In the Framingham Heart Study, the risk of developing AFib was 52 percent greater in men who were obese and 46 percent greater in women who were obese when compared to those of normal weight (4). Obesity is defined as a BMI >30 kg/m², and normal weight as a BMI <25 kg/m². There were over 5,000 participants in this study with a follow-up of 13 years. The Danish Diet, Cancer and Health Study reinforces these results by showing that obese men were at a greater than twofold increased risk of developing AFib, and obese women were at a twofold increased risk (5).

Now the good news: Weight loss may help reduce the frequency of AFib episodes. That’s right; weight loss could be a simple treatment for this very dangerous arrhythmia. In a randomized controlled trial of 150 patients, those in the intervention group lost significantly more weight, 14 kg (32 pounds) versus 3.6 kg (eight pounds), and saw a significant reduction in atrial fibrillation severity score (AFSS) compared to those in the control group (6).

AFSS includes duration, severity and frequency of atrial fibrillation. All three components in the AFSS were reduced in the intervention group compared to the control group. There was a 692-minute decrease in the time spent in AFib over 12 months in the intervention arm, whereas there was a 419-minute increase in the time in AFib in the control group. These results are potentially very powerful; this is the first study to demonstrate that managing risk factors may actually help manage the disease.

Caffeine

According to a meta-analysis (a group of six population-based studies) done in China, caffeine does not increase, and may even decrease, the risk of AFib (7). The study did not reach statistical significance. The authors surmised that drinking coffee on a regular basis may be beneficial because caffeine has antifibrosis properties. Fibrosis is the occurrence of excess fibrous tissue, in this case, in the atria. Atrial fibrosis could be a preliminary contributing step to AFib. Since these were population-based studies, only an association can be made with this discovery, rather than a hard and fast link. Still, this is a surprising result.

However, in those who already have AFib, it seems that caffeine may exacerbate the frequency of symptomatic occurrences, at least anecdotally. With my patients, when we reduce or discontinue substances that have caffeine, such as coffee, tea and chocolate, the number of episodes of AFib seems to decline. I have also heard similar stories from my colleagues and their patients. So, think twice before running out and getting a cup of coffee if you have AFib. What we really need are randomized controlled studies done in patients with AFib, comparing people who consume caffeine regularly to those who have decreased or discontinued the substance.

The bottom line is this: If there were ever a reason needed for obese patients to lose weight, treating atrial fibrillation should be on the top of the list, especially since it is such a dangerous disease with severe potential complications.

References:

(1) Am J Cardiol. 2013 Oct. 15;112:1142-1147. (2) Am J Med. 2014 Jan.;127:95.e11-7. (3) Uptodate.com. (4) JAMA. 2004;292:2471-2477. (5) Am J Med. 2005;118:489-495. (6) JAMA. 2013;310:2050-2060. (7) Canadian J Cardiol online. 2014 Jan. 6.

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. 

Many businesses in the area will decorate their windows in support like the Cutting Hut in Port Jefferson Station.

Paint Port Pink, Mather Hospital’s annual breast cancer awareness campaign, returns this year with a full calendar of events. The month-long breast health outreach by Mather’s Fortunato Breast Health Center raises awareness, provides educational information and fosters solidarity in the community.

Paint Port Pink begins Tuesday, Oct. 1 with a Turn on Your Lights event for local community partners and residents, who turn on pink lights that were distributed by the hospital along with flags and information on breast health. Many community partners decorate their display windows with a pink theme and Mather recognizes the best efforts through their annual window decorating contest.

Mather Hospital employees dressed in pink during last year’s event.

New this year is Ladies Night Out at Comsewogue Public Library on Wednesday, Oct. 2, designed to celebrate women’s health by combining fun activities with wellness information. Participants can attend a mini-paint night, make their own body scrubs and get a back and neck massage by Mather-affiliated chiropractors. They can also learn about breast health from the Fortunato Breast Health Center’s Co-Medical Director Dr. Michelle Price, participate in a Reiki circle and get information on good nutrition for women from a Mather registered dietitian and sample healthy smoothies.

The Pink Your Pumpkin contest also returns this year. The contest asks participants to visit a local farm stand or craft store and find the perfect pumpkin, use their imagination to decorate it, and then submit a photo to ccourt1@northwell.edu before Oct. 20. The top three winners will be selected by employee leaders at Mather Hospital on Oct. 21, and the results will be posted on Mather’s Facebook page.

Wear Pink Day is Oct. 18 – which is World Mammography Day – when Mather employees and community residents are encouraged to dress in pink and post their photos at #paintportpink.

Paint Port Pink community partners will again offer special promotions and fundraisers for the Fortunato Breast Health Center’s Fund for Uninsured, which offers no-cost or discounted mammography screenings to those with little or no insurance. These include Kilwin’s, Panera Bread, Chick-fil-A, Amazing Olive and Ethan Allen Furniture, Setauket.

The fall semester of HealthyU, Mather’s seminar series and exhibit fair, is on Saturday, Oct. 26. The day will feature many informative seminars including Women and Heart Health, the Brittle Bones of Osteoporosis, a Checklist for Health after 60, Tax Tips for Seniors and Staying Young Forever. Register for this free event at https://www.matherhospital.org/healthyu-registration/.

For more information about Paint Port Pink, please call 631-476-2723 or visit www.matherhospital.org/pink.

Photos from Mather Hospital

Stock photo

The Ward Melville Heritage Organization will host the 5th annual Holistic Nutrition Seminar at its Educational & Cultural Center, 97P Main St., Stony Brook on Saturday, Sept. 28 from 11 a.m. to 3 p.m. Author, biochemist and certified nutritionist Yu-Shiaw Chen will speak about the Recipe for a Healthier You. $45 per person at the door includes a healthy lunch and testimonial sharing. Advance registration is required at www.linutrition.com. For more information, please call 631-751-4267 or 631-697-5572.

See flyer for more information.

5th-Annual-Holistic-Nutrition-Seminar-Sept-28-2019-flyer-1-1

Significantly decreasing red meat consumption may be one solution for combatting iron overload. Stock photo
Excess iron may contribute to diabetes, eye disease and cardiovascular disease

By David Dunaief, M.D.

Dr. David Dunaief

When we think of iron, we associate it with reducing fatigue and garnering energy. Therefore, the more we get, the better, right? For many of us, this presumption is not grounded in reality.

Iron plays an integral role in such processes as DNA synthesis and adenosine triphosphate (ATP) production, which provides energy for cells (1). Therefore, it’s important to maintain iron homeostasis, or balance.

Iron in excess amounts may contribute to a host of diseases, including diabetes, diabetic retinopathy, age-related macular degeneration (AMD), glaucoma, Parkinson’s disease and even heart disease. These diseases are perpetuated because, when we have excess iron, it may cause free radicals, which cause breakdown of DNA and tissues, ironically, the very things that iron homeostasis tends to preserve (2).

Significantly decreasing red meat consumption may be one solution for combatting iron overload. Stock photo

What helps us differentiate between getting enough iron and iron overload? It depends on the type of iron we ingest. There are two main types: heme iron and nonheme iron. Dietary heme, or blood, iron primarily comes from red meat and is easily absorbed into the gut. Dietary nonheme iron comes from other sources, such as plants and fortified foods, which are much more difficult sources to absorb. By focusing on the latter source of dietary iron, you may maintain homeostasis, since the gut tends to absorb 1 to 2 mg of iron but also excretes 1 to 2 mg of iron through urine, feces and perspiration.

Not only does it matter what type of iron we consume but also the population that ingests the iron. Age and gender are critical factors. Let me explain. Women of reproductive age, patients who are anemic and children may require more iron. However, iron overload is more likely to occur in men and postmenopausal women because they cannot easily rid the body of excess iron.

Let’s investigate some of the research that shows the effects of iron overload on different chronic diseases.

Impact on diabetes

In a meta-analysis (a group of 16 studies), results showed that both dietary heme iron and elevated iron storage (ferritin) may increase the risk of type 2 diabetes (3). When these ferritin levels were high, the risk of diabetes increased 66 to 129 percent. With heme iron, the group with the highest levels had a 39 percent increased risk of developing diabetes. There were over 45,000 patients in this analysis. You can easily measure ferritin with a simple blood test. These levels are modifiable through blood donation and avoidance of heme iron, thus reducing the risk of iron overload.

Diabetic retinopathy

Diabetic retinopathy is a complication of diabetes that occurs when glucose, or sugar, levels are not tightly controlled. Iron excess and its free radicals can have detrimental effects on the retina, or the back of the eye (4). This is potentially caused by oxidative stress resulting in retinal tissue damage (5).

So how does iron relate to uncontrolled glucose levels? In vitro studies (preliminary lab studies) suggest that high glucose levels may perpetuate the breakdown of heme particles and subsequently raise the level of iron in the eye (6). In fact, those with diabetic retinopathy tend to have iron levels that are 150 percent greater than those without the disease (7). Diets that are plant-based and nutrient-dense are some of the most effective ways to control glucose levels and avoid diabetic retinopathy.

Age-related macular degeneration

Continuing with the theme of retinal damage, excessive dietary iron intake may increase the risk of AMD according to the Melbourne Collaborative Cohort Study (8). AMD is the number one cause of blindness for people 65 and older. People who consumed the most iron from red meat increased their risk of early AMD by 47 percent. However, due to the low incidence of advanced AMD among study participants, the results for this stage were indeterminate.

I have been frequently asked if unprocessed red meat is better than processed meat. This study showed that both types of red meat were associated with an increased risk. This was a large study with over 5,000 participants ranging in age from 58 to 69.

Cardiovascular disease

Though we have made considerable headway in reducing the risk of cardiovascular disease and even deaths from these diseases, there are a number of modifiable risks that need to be addressed. One of these is iron overload.

In the Japan Collaborative Cohort, results showed that men who had the highest amount of dietary iron were at a 43 percent increased risk of stroke death, compared to those who ate the least amounts (9). And overall increased risk of cardiovascular disease death, which includes both heart disease and stroke, was increased by 27 percent in men who consumed the most dietary iron. Over 23,000 Japanese men between the ages of 40 to 79 were involved in this study.

In conclusion, we should focus on avoiding heme iron, especially for men and postmenopausal women. Too much iron creates a plethora of free radicals that damage the body. Therefore, the best way to circumvent the increased risk of chronic diseases with iron overload is prevention. Significantly decreasing red meat consumption and donating blood on a quarterly basis, assuming that one is not anemic, may be the most effective strategies for not falling into the trap of iron overload.

References:

(1) Proc  Natl  Acad  Sci USA. 1997;94:10919-10924. (2) Clin Haematol. 1985;14(1):129. (3) PLoS One. 2012;7(7):e41641. (4) Methods Enzymol. 1990;186:1-85. (5) Rev Endocr Metab Disord. 2008;9(4):315-327. (6) Biophys Chem. 2003;105:743-755. (7) Indian J Ophthalmol. 2004;52:145-148. (8) Am J Epidemiol. 2009;169(7):867-876. (9) J Epidemiol. 2012;22(6):484-493. Epub 2012 Sept 15.

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.