Health

The streets of Stony Brook were filled with more than 300 runners and an estimated 460 walkers participating in the Walk for Beauty and Hercules on the Harbor 10K Run Oct. 22. Cancer survivors along with family members and friends collect donations to support their walk or run, which takes them through the scenic and historic Stony Brook. All proceeds go directly to a targeted research fund at Stony Brook Medicine for Breast Cancer Research and The WMHO Unique Boutique for wigs.

Foods high in Vitamin D include egg yolks, beef, shiitake mushrooms, cheese, milk and cold-water fatty fish like salmon, above.
In most geographic locations, sun exposure will not correct vitamin D deficiencies

By David Dunaief, M.D.

Dr. David Dunaief

Vitamin D is one the most widely publicized and important supplements. We get vitamin D from the sun, food and supplements. With our days rapidly shortening here in the Northeast, I thought it would be worthwhile to explore what we know about vitamin D supplementation.

Vitamin D has been thought of as an elixir for life, but is it really? There is no question that, if you have low levels of vitamin D, replacing it is important. Previous studies have shown that it may be effective in a wide swath of chronic diseases, both in prevention and as part of the treatment paradigm. However, many questions remain. As more data come along, their meaning for vitamin D becomes murkier. For instance, is the sun the best source of vitamin D?

At the 70th annual American Academy of Dermatology meeting, Dr. Richard Gallo, who was involved with the Institute of Medicine recommendations, spoke about how, in most geographic locations, sun exposure will not correct vitamin D deficiencies. Interestingly, he emphasized getting more vitamin D from nutrition. Dietary sources include cold-water fatty fish, such as salmon, sardines and tuna.

We know its importance for bone health, but as of yet, we only have encouraging — but not yet definitive — data for other diseases. These include cardiovascular and autoimmune diseases and cancer.

There is no consensus on the ideal blood level for vitamin D. The Institute of Medicine recommends more than 20 ng/dl, and The Endocrine Society recommends at least 30 ng/dl. More experts and data lean toward the latter number.

Skin cancer

Vitamin D did not decrease nonmelanoma skin cancers (NMSCs), such as squamous cell and basal cell carcinoma. It may actually increase them, according to one study done at a single center by an HMO (1). The results may be confounded, or blurred, by UV radiation from the sun, so vitamin D is not necessarily the culprit. Most of the surfaces where skin cancer was found were sun exposed, but not all of them.

The good news is that, for postmenopausal women who have already had an NMSC bout, vitamin D plus calcium appears to reduce its recurrence, according to the Women’s Health Initiative study (2). In this high-risk population, the combination of supplements reduced risk by 57 percent. However, unlike the previous study, vitamin D did not increase the incidence of NMSC in the general population. NMSC occurs more frequently than breast, prostate, lung and colorectal cancers combined (3).

Cardiovascular mixed results

Several observational studies have shown benefits of vitamin D supplements with cardiovascular disease. For example, the Framingham Offspring Study showed that those patients with deficient levels were at increased risk of cardiovascular disease (4).

However, a small randomized controlled trial (RCT), the gold standard of studies, calls the cardioprotective effects of vitamin D into question (5). This study of postmenopausal women, using biomarkers such as endothelial function, inflammation or vascular stiffness, showed no difference between vitamin D treatment and placebo. The authors concluded there is no reason to give vitamin D for prevention of cardiovascular disease.

The vitamin D dose given to the treatment group was 2,500 IUs. Thus, one couldn’t argue that this dose was too low. Some of the weaknesses of the study were a very short duration of four months, its size — 114 participants — and the fact that cardiovascular events or deaths were not used as study end points. However, these results do make you think.

Weight benefit

There is good news, but not great news, on the weight front. It appears that vitamin D plays a role in reducing the amount of weight gain in women 65 years and older whose blood levels are more than 30 ng/dl, compared to those below this level, in the Study of Osteoporotic Fractures (6).

This association held true at baseline and after 4.5 years of observation. If the women dropped below 30 ng/dl in this time period, they were more likely to gain more weight, and they gained less if they kept levels above the target. There were 4,659 participants in the study. Unfortunately, vitamin D did not show statistical significance with weight loss.

Mortality decreased

In a meta-analysis of a group of eight studies, vitamin D with calcium reduced the mortality rate in the elderly, whereas vitamin D alone did not (7). The difference between the groups was statistically important, but clinically small: 9 percent reduction with vitamin D plus calcium and 7 percent with vitamin D alone.

One of the weaknesses of this analysis was that vitamin D in two of the studies was given in large amounts of 300,000 to 500,000 IUs once a year, rather than taken daily. This has different effects.

USPSTF recommendations

The U.S. Preventive Services Task Force recommends against giving “healthy” postmenopausal women the combination of vitamin D 400 IUs plus calcium 1,000 mg to prevent fractures (8). It does not seem to reduce fractures and increases the risk of kidney stones. There is also not enough data to recommend for or against vitamin D with or without calcium for cancer prevention.

Need for clinical trials

We need clinical trials to determine the effectiveness of vitamin D in many chronic diseases, since it may have beneficial effects in preventing or helping to treat them (9). Right now, there is a lack of large randomized clinical trials. Most are observational, which provides associations, but not links. The VITAL study is a large RCT looking at the effects of vitamin D and omega-3s on cardiovascular disease and cancer. It is a five-year trial, and the results should be available in 2018.

When to supplement?

It is important to supplement to optimal levels, especially since most of us living in the Northeast have insufficient to deficient levels. While vitamin D may not be a cure-all, it may play an integral role with many disorders.

References: (1) Arch Dermatol. 2011;147(12):1379-1384. (2) J Clin Oncol. 2011 Aug 1;29(22):3078-3084. (3) CA Cancer J Clin. 2009;59(4):225-249. (4) Circulation. 2008 Jan 29;117(4):503-511. (5) PLoS One. 2012;7(5):e36617. (6) J Women’s Health (Larchmt). 2012 Jun 25. (7) J Clin Endocrinol Metabol. online May 17, 2012. (8) AHRQ Publication No. 12-05163-EF-2. (9) Endocr Rev. 2012 Jun;33(3):456-492.

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

From left, Gary Gerard, lead interventional/cardiac catheterization technologist, Stony Brook Southampton Hospital; Dr. Travis Bench, director, Cardiac Catheterization Lab, Stony Brook Southampton Hospital; Helen VanDenessen, nurse manager, Imaging, Stony Brook Southampton Hospital; and Dr. Dhaval Patel, cardiologist, Stony Brook Medicine. Photo from SBU

By Javed Butler, MD

Dr. Javed Butler

Stony Brook Medicine has opened the new Cardiac Catheterization (Cath) Laboratory at Stony Brook Southampton Hospital to improve access to lifesaving heart care for residents of the East End of Long Island.

The lab provides emergency and elective treatments delivered by Stony Brook University Heart Institute specialists, for easier, faster access to the highest standards of cardiac care. The standard of care for a person experiencing a heart attack is that the blocked artery should be opened within 90 minutes of contact with medical care. That procedure can only be done in a cardiac catheterization lab by highly trained personnel.

For the rapidly increasing population of the East End, the nearest cath lab was previously located at Stony Brook University Hospital, up to 70 miles and a 60- to 90-minute drive. Even transportation by ambulance or helicopter could result in a life-threatening delay.

The new cath lab, led by interventional cardiologist Dr. Travis Bench, is currently the only facility in the East End capable of providing clinically complex care to critically ill heart patients. Bench and his partner, Dr. Dhaval Patel, have East End cardiology practices in Southampton and Center Moriches.

The lab will save lives by providing more immediate intervention for serious heart events such as myocardial infarctions (heart attacks). A delay in restoring blood flow through an artery increases the likelihood for significant damage to the heart. By allowing physicians to open a blocked artery in Southampton, without having to first transport a patient to Stony Brook, damage to the heart can be minimized and total heart failure may be prevented.

At the Southampton cath lab, doctors will be able to perform percutaneous coronary intervention (PCI), a nonsurgical procedure in which a physician inserts catheters through the skin to reach affected structures. The PCI treatments at Stony Brook Southampton Hospital include emergency and elective procedures.

The Southampton lab is staffed every day, around the clock, by Stony Brook Heart Institute’s interventional cardiologists with the most up-to-date knowledge and skills to diagnose and treat patients with heart disease.

For patients who need emergency catheterization, Stony Brook’s “Code H” protocol has produced an average “door-to-perfusion” time of 56 minutes, almost 45 minutes below the New York State regulated treatment guidelines. That is the level of care we strive for at Stony Brook Southampton Hospital. The systems and processes are in place and we look forward to taking care of our patients out east with that same dedication to quality and excellence.

To view a video and learn more about the Cath Lab at Stony Brook Southampton Hospital, visit www.heart.stonybrookmedicine.edu.

Dr. Javed Butler is the co-director of the Heart Institute and chief of the Division of Cardiology at Stony Brook Medicine.

Smithtown United Civic Association published the above master plan aimed at revitalizing Main Street and the downtown area on its Facebook page Oct. 6. Photo from Smithtown United Civic Association

A small group of Smithtown citizens have come together to draft and present a plan they hope may lead to big changes for Main Street.

The Smithtown United Civic Association unveiled a detailed conceptual plan for downtown revitalization Oct. 6 on its Facebook page. The group is asking residents to review the proposal and provide feedback via social media before they present it to town officials.

Timothy Small, president of Smithtown United, said the organization’s goal is to give local residents a voice in the future of their town. It was formed when Smithtown residents came together earlier this year after two events: New York Gov. Andrew Cuomo (D) allocated $20 million for sewers in Smithtown and the proposed sale of Smithtown school district administration headquarters on New York Avenue to the town for a sewer treatment plant to support a condominium development. Small said the two events set in motion real opportunity for revitalization of the town.

“If you look at the downtown areas of Smithtown, Kings Park and St. James, they are tired looking,” he said. “There’s a lot of vacant shops and properties. We live in a wonderful town. The schools are wonderful, we love our homes, but it’s our downtown business districts that are deeply suffering.”

Small, a retired engineer who held an executive position at a utility company, said for approximately six months the group assessed the community needs and drew inspiration from surrounding towns including Huntington, Patchogue, Sayville, Bay Shore, Farmingdale and Babylon for changes they’d like to see in Smithtown.

Smithtown United’s plan for the western downtown area focuses on several key points including consolidation of the town offices into the New York Avenue school building and retaining the sports field behind it for public use.

“It’s the last green space that remains in all of downtown,” Small said. “I would consider that an anchor for the western edge of redevelopment. It would be tragic to see that property lost to dense development.”

The civic supports the town’s acquisition of the property in exchange for selling off its other buildings scattered across the business district, but discussions of the deal have been tabled by the Smithtown school officials. The plan also proposes several existing downtown storefronts be made into two-story, mixed-use buildings with retail on the first floor and apartments above. These housing options, according to Small, would be attractive to young adults and senior citizens. Behind the existing New York Avenue school district property, the plan calls for construction of a new sports and community center.

“We need a place for our kids to go in the evening,” Small said. “There needs to be a community space for our residents and young adults.”

The conceptual design also calls for several changes to Smithtown’s existing roadways, including a rotary at the intersection of Main Street and New York Avenue and rerouting Edgewater Avenue to run parallel to Main Street. This would cause Edgewater Avenue to empty onto Maple Avenue, and there would be a new set of village townhouses built on the southwest corner of the new intersection.

To further increase available housing, the proposed plan suggests the construction of three-story, transit-oriented housing near the Long Island Rail Road train station and municipal parking lots.

Initial feedback on the plan from residents on the civic’s Facebook page has been a mix of positive and negative, along with offers to help refine it. Supporters have praised the organization for taking action, while critics expressed traffic concerns.

“Main Street is already undersized for what it is used for,” said John McCormick, 29, of Smithtown. “[The] parking does not look to be sufficient for customers of the first-floor shops and people renting out upstairs apartments.”

McCormick, a young homeowner, feared adding townhouses and apartments would change the character of the local community and the plan’s possible impact on the school district.

Smithtown resident Michael Tarquinio, 20, said the plan was a step in the right direction but needed to be more innovative.

“They need to stop thinking with a Robert Moses mind-set,” Tarquinio said, who is studying environmental science at the University of Maine. “I’m all for it, but you can’t wipe out your heritage and start fresh. You need to know where you came from to know where you are going.”

He said he believes successful downtown revitalization will require the civic to work with town, county and state officials to improve roadways and mass transportation options to reduce traffic.

Small said he agreed the proposed overhaul of both the business and residential space in downtown Smithtown required cooperation at several levels of government. It would only be possible if sewers can be brought to the downtown area.

“Anyone who is going to invest money into redevelopment won’t unless there is adequate sanitary sewer conditions,” Small said. “It’s essential.”

The civic group has tentative plans to present its proposal to Smithtown officials at the Oct. 26 town board meeting at 7 p.m. at town hall.

Melinda Murray, on left, and Karen Acompora, on right, who are the founders of Copiague-based Heart Screen New York, gave Shoreham-Wading River Girl Scout Jordan McClintock, at center, a $400,000 grant to help with her Gold Award project. Photo by Kevin Redding

A Shoreham-Wading River senior showed a lot of heart this past weekend by making sure her fellow students and community members got theirs checked out.

Jordan McClintock, a 17-year-old Girl Scout, saw the culmination of a two-year Gold Award project Saturday, Oct. 14, as Albert G. Prodell Middle School’s gymnasium became a mini medical center fully staffed with cardiologists, physicians and nurse practitioners from hospitals across the state, bringing with them life-saving equipment. The medical professionals provided more than 400 registrants — between the ages 12 and 25 — with free, all-day heart screenings in an effort to raise awareness about sudden cardiac arrest, the leading cause of death in young athletes.

A volunteer shows a girl how to use an AED machine. Photo by Kevin Redding

With help from a $400,000 grant by Copiague-based Heart Screen New York, McClintock’s event allowed students from Shoreham-Wading River and beyond to get thorough cardiovascular screenings, which included an electrocardiogram test, a blood pressure reading and final consultation with medical professionals. Pediatric cardiologists were available in case further testing was needed and students were given hands-only CPR and automatic external defibrillator training after their exams.

As heart screenings are not generally covered by health insurance, the event also made it possible for parents to evaluate a crucial component of their children’s health without spending up to $1,000 per exam.

“This is amazing,” said Maureen MacDowell, whose son, a cross country runner at the school, was screened Saturday. “It’s a huge deal that the girl who organized this did so. It’s definitely worth having.”

Marlene Baumeister, the mother of a football player, said other school districts should use the event as a model for their own heart screenings.

Tony Zajac, a Shoreham-Wading River parent and coach, called the program excellent.

“It’s very educational for these kids and more in-depth than I thought,” Zajac said. “It gives them feedback on their own heart health while teaching them how to potentially save somebody else’s life.”

Sudden cardiac arrests claim the lives of more than 2,000 people under 25 in the country every year, according to the American Academy of Pediatrics, and yet they are not included in most routine physical exams or pre-participation sports physicals. One out of 100 students that attend a heart screening will discover an underlying heart condition.

“If I can save one life with early detection, my work for the past two years will have been all worth it.”

—Jordan McClintock

“If I can save one life with early detection, my work for the past two years will have been all worth it,” said McClintock, an aspiring pediatrician. “I’m really hoping it initiates some conversations among my peers and their families.”

The Girl Scout developed her project as a freshman after she got her own heart screening done at St. Francis Hospital in Roslyn, which was offered in partnership with Heart Screen New York, based on her family’s history of cardiac problems.

It was through the procedure, which she referred to as “painless” and “relieving,” that McClintock began her years-long correspondence with Karen Acompora, the co-founder of Heart Screen New York.

Acompora lost her 14-year-old son to a sudden cardiac arrest during a high school lacrosse game in 2000 after a ball struck his chest between heartbeats. She and Melinda Murray, a Queens-based mother whose son collapsed on a basketball court and died from an undetected heart condition, formed Heart Screen New York together as a way to detect heart trouble in local youths and prevent as many deaths as possible.

Heart Screen New York hosts only two screenings per year due to the expenses and resources needed for each one.

“I thought it was an amazing program and would be great if I could bring it to Shoreham,” McClintock said. “Out here we’ve never really had anything like this that’s free and promotes cardiovascular health in student-athletes and the community in general. I was very inspired by Karen’s story.”

McClintock’s perseverance paid off, literally, early last year when Heart Screen New York representatives informed her Shoreham-Wading River would be the site of their October 2017 screening.

A young boy is shown how to perform CPR. Photo by Kevin Redding

“I think the screening is certainly opening a lot of eyes in the Shoreham community and Jordan’s done such a nice job of advertising and promoting the event,” Acompora said. A founder of another group called the Louis J. Acompora Memorial Foundation, in memory of her son, the Northport mother hopes heart screenings will eventually become a mandatory part of physicals. In fact, she and Murray have been pushing legislation for years to make electrocardiograms part of student-athlete’s preparticipation screening process.

“There’s a lack of knowledge on the part of individuals who feel it’s too costly to do heart screenings, but how do you put a price tag on life?” said Murray, whose 17-year-old son Dominic died in 2009, exactly three years after his father died from a massive heart attack. “We’re really proud of Jordan. It’s having a great impact at the school and is really spreading the awareness of the importance of heart screenings.”

Among the volunteers at the event was Shoreham senior and baseball player Jack Crowley, who, two years ago, at 15 years old, was declared medically dead after a line drive hit him in the chest. Crowley’s heart stopped and he was unable to breathe. He was brought back to life from the shock of an automatic external defibrillator — which Heart Screen New York had pushed to make available in as many locations as possible.

“They’re the reason I’m here,” Crowley said. “Get a heart screening. It’s so much better than learning the hard way that you have an issue.”

Senior volleyball player Lindsay Deegan said of the screening: “This is something I never would’ve thought of doing this before, so it’s cool to know what’s going on.”

McClintock is expected to receive her Gold Award during a ceremony in Spring 2018.

“Girl Scouts pledge to help people at all times, and Jordan’s stellar work truly exemplifies that promise,” said Yvonne Grant, President and CEO for Girl Scouts of Suffolk County. “Jordan’s Gold Award project is an inspiring and extraordinary way to bring awareness.”

Students take samples from Nissequogue River to analyze. Photo by Sara-Megan Walsh

By Sara-Megan Walsh

Hundreds of students from Smithtown to Northport got wet and dirty as they looked at what lurks beneath the surface of the Nissequogue River.

More than 400 students from 11 schools participated in “A Day in the Life” of the Nissequogue River Oct. 6, performing hands-on citizens scientific research and exploring the waterway’s health and ecosystem. The event was coordinated by Brookhaven National Laboratory, Central Pine Barrens Commission, Suffolk County Water Authority and New York State Department of Environmental Conservation.

Northport High School students analyze soil taken from the bottom of Nissequogue River. Photo by Sara-Megan Walsh

“’A Day in the Life’ helps students develop an appreciation for and knowledge of Long Island’s ecosystems and collect useful scientific data,” program coordinator Melissa Parrott said. “It connects students to their natural world to become stewards of water quality and Long Island’s diverse ecosystems.”

More than 50 students from Northport High School chemically analyzed the water conditions, marked tidal flow, and tracked aquatic species found near the headwaters of the Nissequogue in Caleb Smith State Park Preserve in Smithtown. Teens were excited to find and record various species of tadpoles and fish found using seine net, a fishing net that hangs vertically and is weighted to drag along the riverbed.

“It’s an outdoor educational setting that puts forth a tangible opportunity for students to experience science firsthand,” David Storch, chairman of science and technology education at Northport High School, said. “Here they learn how to sample, how to classify, how to organize, and how to develop experimental procedures in an open, inquiry-based environment. It’s the best education we can hope for.”

Kimberly Collins, co-director of the science research program at Northport High School, taught students how to use Oreo cookies and honey to bait ants for Cold Spring Harbor Laboratory’s Barcode Long Island. The project invites students to capture invertebrates, learn how to extract the insects’ DNA then have it sequenced to document and map diversity of different species.

Children from Harbor Country Day School examine a water sample. Photo by Sara-Megan Walsh

Further down river, Harbor Country Day School students explored the riverbed at Landing Avenue Park in Smithtown. Science teacher Kevin Hughes said the day was one of discovery for his fourth- to eighth-grade students.

“It’s all about letting them see and experience the Nissequogue River,” Hughes said. “At first, they’ll be a little hesitant to get their hands dirty, but by the end you’ll see they are completely engrossed and rolling around in it.”

The middle schoolers worked with Eric Young, program director at Sweetbriar Nature Center in Smithtown, to analyze water samples. All the data collected will be used in the classroom to teach students about topics such as salinity and water pollution. Then, it will be sent to BNL as part of a citizens’ research project, measuring the river’s health and water ecosystems.

Smithtown East seniors Aaron Min and Shrey Thaker have participated in this annual scientific study of the Nissequogue River at Short Beach in Smithtown for last three years. Carrying cameras around their necks, they photographed and documented their classmates findings.

“We see a lot of changes from year to year, from different types of animals and critters we get to see, or wildlife and plants,” Thaker said. “It’s really interesting to see how it changes over time and see what stays consistent over time as well. It’s also exciting to see our peers really get into it.”

Maria Zeitlin, a science research and college chemistry teacher at Smithtown High School East, divided students into four groups to test water oxygenation levels, document aquatic life forms, measure air temperature and wind speed, and compile an extensive physical description of wildlife and plants in the area.

Smithtown High School East students take a water and soil sample at Short Beach. Photo by Sara-Megan Walsh

The collected data will be brought back to the classroom and compared against previous years.

In this way, Zeitlin said the hands-on study of Nissequogue River serves as a lesson in live data collection. Students must learn to repeat procedures multiple times and use various scientific instruments to support their findings.

“Troubleshooting data collection is vital as a scientist that they can take into any area,” she said. “Data has to be reliable. So when someone says there’s climate change, someone can’t turn around and say it’s not true.”

The Smithtown East teacher highlighted that while scientific research can be conducted anywhere, there’s a second life lesson she hopes that her students and all others will take away  from their studies of the Nissequogue River.

“This site is their backyard; they live here,” Zeitlin said. “Instead of just coming to the beach, from this point forward they will never see the beach the same again. It’s not just a recreational site, but its teeming with life and science.”

Lower triglycerides may reduce cardiovascular risk

By David Dunaief, M.D.

Dr. David Dunaief

The lipid, or cholesterol, profile is one of the most common batteries of blood tests. Why? Abnormal cholesterol levels may have an integral role in exacerbating a number of chronic diseases. These diseases are some of the most common, including atherosclerosis (hardening of the arteries), cardiovascular disease (heart disease and stroke) and vascular dementia. It’s even thought to be a component of age-related macular degeneration, the number one cause of vision loss in those who are at least age 60 in industrialized countries (1).

Let’s delve into the components that make up the cholesterol profile. The lipid panel is made up of several components. These include total cholesterol, HDL or “good cholesterol,” LDL or “bad cholesterol” and triglycerides. Many people focus more on total cholesterol, HDL, and LDL and less on triglycerides. We worry about whether the levels are high enough for HDL and are low enough for total cholesterol and LDL. Is this the proper focus? With total cholesterol and LDL, this seems to be appropriate.

However, with HDL it is becoming more complicated; it is less about how high the levels are and more about the functionality of HDL. There are drugs that increase HDL levels, such as niacin and the fibrates, without significantly reducing cardiovascular events. This was demonstrated in the AIM-HIGH trial (2). In this trial, niacin added to a statin drug increased HDL levels and decreased triglyceride levels without a change in the primary end point of cardiovascular outcomes. Thus, they were deemed less than satisfactory and the trial was abruptly ended. However, triglycerides get the short end of the stick. Just look at the lack of coverage in the mainstream media. In this article, we will explore the different components of the lipid panel and the supposed roles they play in our health. Let’s look at the research.

HDL — the good cholesterol that may not be so good

Eating one-and-a-half cups of oatmeal each day can lower your cholesterol by 5 to 8 percent.

For years, when patients were told their total cholesterol and LDL are high, they asked if their HDL levels compensated for this. Of course, we in the medical community are partially to blame for fueling this thinking. More and more studies point to the importance of HDL functionality rather than the level.

In a study investigating a specific gene variant, or mutation, those who had very high levels of HDL, a mean of 106 mg/dL, and two copies of a P376L mutation, had an increased risk of heart disease (3). In a population of 300 participants with this very high level of HDL, only one had this mutation.

When the investigators broadened the number to 1,282 participants, the results were the same. Results were consistent when they looked at a meta-analysis of 300,000 participants with high HDL.

Carriers of the gene mutation, meaning they had one copy instead of two, were at a 79 percent increased risk of heart disease. Those who had this gene mutation were mostly Ashkenazi Jews of European descent. The good news is that this gene mutation is rare. However, it does show that in certain circumstances, HDL is not always good.

Lest you become too relaxed about this study, since the occurrence was uncommon, another study’s results showed that there is a U-shaped curve when it comes to HDL levels (4). In other words, those on the lowest and the highest ends of HDL levels had higher risk of death from both cardiovascular and noncardiovascular death. There were associations among HDL and other factors, like vegetable and fruit consumption, high blood pressure, diabetes, age and sex. Thus, HDL may not by itself be an indicator of heart disease death risk as suggested by the investigators in the trial. This was a large population-based study with over 600,000 participants.

In a third study, results showed that functionality is more important than HDL level (5). What is called the cholesterol-efflux capacity may be central to HDL functionality. This technique calibrates the reverse transport of cholesterol. Cholesterol is removed from a type of white blood cell in the wall of the artery, put back into the bloodstream and removed by the liver. The importance of the functionality is that a higher cholesterol-efflux capacity results in a lower risk of cardiovascular disease. In other words, you may not be able to rely on HDL levels to determine cardioprotective effects.

Triglycerides should get their due

Triglycerides need their 15 minutes of fame, just like the rest of the cholesterol profile. Triglycerides may be an independent risk factor for cardiovascular disease. In a study, results showed that triglycerides are an independent risk factor for all-cause mortality in those with heart disease (6). But even more interesting is that those with high normal levels, those between 100 and 150 mg/dL, have a significantly increased risk of cardiovascular death. In other words, those who are still within normal limits, but at the upper end, should consider reducing their levels.

The results also showed a dose-dependent curve; the higher the levels of triglycerides, the higher the risk of death from cardiovascular disease. Measurements used included borderline high of 150-199 mg/dL, moderately high of 200-499 mg/dL and very high of >500 mg/dL. This was a secondary prevention trial, meaning the patients already had heart disease. Unfortunately, a disproportionate number of patients were men, 81 percent. However, this study had a strong duration of 22 years with data based on 15,000 patients. The weakness of this trial was its inability to control for confounders such as sickness, treatments and cause of death. Still, this signifies that triglycerides have an important role in our health.

Triglycerides are affected by diet. The elements in the diet that raise levels include sugars, grains — for some even whole grains — and starchy vegetables as well as saturated fats and trans fats.

What about whole eggs? Good, bad or neutral?

Today, the debates in the medical community over eggs’ merits, detriments or neutrality continue. In an observational trial from Finland, results show that one egg a day did not increase the risk of heart disease (7). Whew, now we can put that debate behind us and eat eggs, right? NOT SO FAST!

While the strength of the trial was its very impressive duration of 21 years, the weaknesses of the trial were huge. First, participants were asked for a four-day dietary history at the start of the trial and then never again. It was assumed that they were eating the same foods over this long time period. Second, there were no blood tests taken specifically for the study. In other words, there are no cholesterol levels for the trial. So we don’t know if one egg a day — and remember we’re making a gigantic assumption that they did eat one egg a day — had any negative impact on cholesterol levels. Third, this study population did not include women. There were 1,032 men involved. Having said all this, you could try an egg a day. However, I would highly recommend a physician’s supervision.

In my practice, I had several patients eat two eggs a day, and their total cholesterol levels went up by approximately 100 mg/dL in one month. But this is anecdotal data from my clinical experience.

In conclusion, don’t think you’re safe if you have a high HDL level. It is best to lower your triglycerides to below 100 mg/dL, and an effective way to do this is by reducing sugars, grains, starchy vegetables and saturated fat in your diet. However, there is subset data suggesting that the fibrate class of drugs may have benefit in those who have triglycerides of at least 500 mg/dL (6).

References: (1) www.nlm.nih.gov. (2) N Engl J Med 2011; 365:2255-2267. (3) Science 2016; 351:1166-1171. (4) AHA 2015 Scientific Sessions; Nov. 10, 2015. (5) N Engl J Med. 2014;371(25):2383-2393. (6) Circ Cardiovasc Qual Outcomes 2016;9:100-108. (7) Am J Clin Nutr. 2016;103(3):895-901.

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.

Health professionals from John T. Mather Memorial Hospital will be on hand to provide free blood pressure screenings at the event. File photo by Heidi Sutton

By Ernestine Franco

We all strive to lead healthy lives. We strive to eat healthy foods, even if sometimes we overindulge. We strive to be active, even if sometimes we spend too much time in front of the TV or computer. We strive to do what our doctors tell us to do, even if sometimes we don’t like what we hear. To reach these goals, we can use all the help that’s out there. To provide some of this help the Sound Beach Civic Association will bring together health professionals at a free Health and Wellness Expo on Saturday, Oct. 21, from 10 a.m. to 2 p.m., at the Sound Beach Firehouse, 152 Sound Beach Blvd. The event is co-sponsored by the Times Beacon Record News Media.

The civic invites everyone to come and learn how to make good health decisions from a variety of health professionals. Mather Hospital and its physician services group, Harbor View Medical Services, will provide glucose screening, blood pressure screening, body mass index as well as distribute kits for colon cancer screening.

Ergonomic posture exams will be provided by The Chiropractic Joint, hearing screenings by Ear Works Audiology, body wrap demonstration and fat fighter demonstration by IT Works Health and Wellness and carbon monoxide testing for smokers by Suffolk County Health Department.

Rite Aid will provide flu shots. To get a flu shot, you’ll need to bring any insurance information (including Medicare Parts B & D), a list of any medical conditions, as well as your primary care physician’s name, address and phone number.

Suffolk County Police, 7th Precinct, will be there with a Shed the Meds box so you can safely dispose of unused/unwanted prescriptions and over-the-counter drugs. The Sound Beach Fire Department will be on hand to showcase its Emergency Medical Services (EMS) equipment and explain best practices for calling 911 for a medical emergency. Ameriprise will bring some table goodies and provide information on your financial health. Echo Pharmacy will have information on compounding, pet prescriptions, medical equipment and more. Senior Callers is a personalized calling service that offers regular check-in to your loved ones.

Suffolk Center for Speech specializes in the treatment and correction of a number of language disorders. The mission of Wellness and Chiropractic Solutions is to help people get well without drugs and surgery. Young Living Essential Oils will provide material on how to kick toxins out of your system as well as some samples and raffles.

The civic has brought together health professionals providing information for all stages of life, with two specifically geared for our young people: the North Shore Youth Council (NSYC) and the LI Chapter of NYC + PANDAS/PANS Awareness Group and NY PANS Awareness Group.

Are you looking for reasons to try yoga? At 11 a.m. and 1 p.m. join Barbara Delledonne of the Santi Yoga Community for a yoga demonstration. Delledonne has been practicing yoga for 25 years and believes there is a yoga for everyone. “If you can breathe, you can practice,” she said. “It’s had a tremendous impact on my life and it’s something I want to share with everyone.”

At noon, Joanne Lauro, nutrition director and co-founder of the Community Growth Center and owner and founder of Healthy Living Network, will present a short talk, “Alkalize and Live.” Lauro is a holistic health coach and functional fitness instructor. Join Lauro and learn how food can have a negative and positive impact on your body, mind and spirit.

Our eating habits directly determine our health, but often, because of our busy schedules, we don’t practice healthy eating. So, complete your experience and sample some healthy snacks and pick up some water provided by Bonnie Boeger, a Coldwell Banker Residential Broker, as well as some recipes for healthy living.

“We hope this expo will help build awareness of health risks and provide information on how to make behavioral changes to enhance one’s health,” Bea Ruberto, president of the civic said. We should all strive to “eat well, live well and be well!” For more information, please call 631-744-6952.

A short walk after eating may help lower blood sugar levels
Similar risks found in prediabetes and diabetes

By David Dunaief

Dr. David Dunaief

Let’s start with a quiz:

1. Compared to sitting, which has more benefit on diabetes?

a) Standing for five minutes every half hour

b) Walking for five minutes every half hour

c) Neither had benefit, the activities were too short

d) Both were potentially equal in benefit

2. True or false? Diabetes patients are predominantly obese and overweight.

Diabetes just won’t go away. It seems that every time I write about the disease, the news is doom and gloom about how it has become a pandemic. The prevalence, or the number with the disease, and the incidence, or the growth rate of the disease, always seem to be on the rise, with little end in sight.

Depression and stress

We don’t want to make you depressed or stressed, especially since these conditions combined with diabetes can have dangerous outcomes. In fact, in an observational study, results showed that diabetes patients with stress and/or depression had greater risk of cardiovascular events and death, compared to those with diabetes alone. When diabetes patients had stress or depression, there was a 53 percent increased risk of death from cardiovascular disease (1). And in those diabetes patients who had both stress and depression, there was two times greater risk of death from heart disease than in those without these mental health issues. These results need to be confirmed with more rigorous study.

Something to brighten your day!

However, there is good news. According to the Centers for Disease Control and Prevention, the incidence, or the rate of increase in new cases, has begun to slow for the first time in 25 years (2). There was a 20 percent reduction in the rate of new cases in the six-year period ending in 2014. This should help to brighten your day. However, your optimism should be cautious; it does not mean the disease has stopped growing, it means it has potentially turned a corner in terms of the growth rate, or at least we hope. This may relate in part to the fact that we have reduced our consumption of sugary drinks like soda and orange juice. By the way, the answers to the quiz questions are (1) d and (2) True, although not all patients have a weight issue.

Get up, stand up!

It may be easier than you think to reduce the risk of developing diabetes. This goes along with the answer to the first question: Standing and walking may be equivalent in certain circumstances for diabetes prevention. In a small, randomized control trial, the gold standard of studies, results showed that when sitting, those who either stood or walked for a five-minute duration every 30 minutes, had a substantial reduction in the risk of diabetes, compared to those who sat for long uninterrupted periods (3).

There was a postprandial, or postmeal, reduction in the rise of glucose of 34 percent in those who stood and 28 percent reduction in those who walked, both compared to those who sat for long periods continuously in the first day. The effects remained significant on the second day. A controlled diet was given to the patients. In this study, the difference in results for those who stood and those who walked was not statistically significant.

The participants were overweight, postmenopausal women who had prediabetes, HbA1C between 5.7 and 6.4 percent. The HbA1C gives an average glucose or sugar reading over three months. The researchers hypothesize that this effect of standing or walking may have to do with favorably changing the muscle physiology. So, in other words, a large effect can come from a very small but conscientious effort. This is a preliminary study, but the results are impressive.

Can prediabetes and diabetes have similar complications?

Diabetes is much more significant than prediabetes, or is it? It turns out that both stages of the disease can have substantial complications. In a study of those presenting in the emergency room with acute coronary syndrome (ACS), those who have either prediabetes or diabetes have a much poorer outcome. ACS is defined as a sudden reduction in blood flow to the heart, resulting in potentially severe events, such as heart attack or unstable angina (chest pain).

In the patients with diabetes or prediabetes, there was an increased risk of death with ACS as compared to those with normal sugars. The diabetes patients experienced an increased risk of greater than 100 percent, while those who had prediabetes had an almost 50 percent increased risk of mortality over and above the general population with ACS. Thus, both diabetes and prediabetes need to be taken seriously.

Sadly, most diabetes drugs do not reduce the risk of cardiac events. And bariatric surgery, which may reduce or put diabetes in remission for five years, did not have an impact on increasing survival (4).

What do the prevention guidelines tell us?

The United States Preventive Services Task Force renders recommendations on screening for diseases. On one hand, I commend them for changing their recommendation for diabetes screening. In 2008, the USPSTF did not believe the research provided enough results to screen asymptomatic patients for abnormal sugar levels and diabetes. However, in October 2015, the committee drafted guidelines suggesting that everyone more than 45 years old should be screened, but the final guidelines settled on screening a target population of those between the ages of 40 and 70 who are overweight or obese (5). They recommend that those with abnormal glucose levels pursue intensive lifestyle modification as a first step.

This is a great step forward, as most diabetes patients are overweight or obese; however, 15 to 20 percent of diabetes patients are within the normal range for body mass index (6). So this screening still misses a significant number of people.

Potassium: It’s not just for breakfast anymore

When we think of potassium, the first things that comes to mind is bananas, which do contain a significant amount of potassium, as do other plant-based foods. Those with rich amounts of potassium include dark green, leafy vegetables, almonds, avocado, beans and raisins. We know potassium is critical for blood pressure control, but why is this important to diabetes?

In an observational study, results showed that the greater the excretion of potassium through the kidneys, the lower the risk of cardiovascular disease and kidney dysfunction in those with diabetes (7). There were 623 Japanese participants with normal kidney function at the start of the trial. The duration was substantial, with a mean of 11 years of follow-up. Those who had the highest quartile of urinary potassium excretion were 67 percent less likely to experience a cardiovascular event or kidney event than those in the lowest quartile. The researchers suggested that higher urinary excretion of potassium is associated with higher intake of foods rich in potassium.

Where does this leave us for the prevention of diabetes and its complications? You guessed it: lifestyle modifications, the tried and true! Lifestyle should be the cornerstone, including diet, stress reduction and exercise, or at least mild to moderate physical activity.

References: (1) Diabetes Care, online Nov. 17, 2015. (2) cdc.gov. (3) Diabetes Care. online Dec. 1, 2015. (4) JAMA Surg. online Sept. 16, 2015. (5) Ann Intern Med. 2015;163(11):861-868. (6) JAMA. 2012;308(6):581-590. (7) Clin J Am Soc Nephrol. online Nov. 12, 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.

PRETTY IN PINK: Shops along East Main Street and, right, the sign at Mather Hospital during last year’s Paint Port Pink event. Photo from Mather Hospital
Month-long events planned in celebration of Paint Port Pink
Astoria Bank will once again present Paint Port Pink to benefit the Fortunato Breast Health Center at Mather Hospital. Above, employees of the Port Jefferson Station branch at last year’s event.

Throughout the month of October, Paint Port Pink, John T. Mather Memorial Hospital’s annual breast cancer community outreach, will once again light up Port Jefferson to raise awareness about the disease, share information and education and foster solidarity in the community.

Presented by Astoria Bank, the outreach encourages women to get their annual mammograms and learn more about breast health. The American Cancer Society reports that the chance of a woman having invasive breast cancer sometime during her life is about 1 in 8. While the vast majority of breast abnormalities are benign, they can cause great anxiety for a woman and her family. Since there is still no sure way to prevent breast cancer, increased awareness, education and early detection are critical components of breast health care.

 

The Fortunato Breast Health Center at Mather Hospital recommends that women follow the American Cancer Society‘s guidelines for early detection of breast cancer: first mammography by age 40 and yearly mammograms after age 40; clinical breast exam at least every three years beginning at age 20 and annually after age 40; and monthly breast self-examination.

Among the new Paint Port Pink offerings this year are two Paint Night fundraisers — one at Comsewogue Public Library in Port Jefferson Station, on Friday, Oct. 13, from 6 to 8 p.m., and at Muse Paintbar in the Harbor Square Mall in Port Jefferson on Thursday, Oct. 26, from 6:30 to 9 p.m. Friends, co-workers and family members can have fun painting while supporting the Fortunato Breast Health Center’s Fund for Uninsured. Fee is $45 for each workshop and preregistration is required; $15 from every registration fee at the library and 45 percent from the Muse Bar event will benefit the Fund for Uninsured.

Local retail community partners will offer special events throughout the month to benefit the Fund for the Uninsured including:

Panera Bread in Port Jefferson Station will hold a special fundraising night on Thursday, Oct. 5, from 4 to 8 p.m. with a percentage of all purchases (must present qualifying flyer, available on www.paintportpink.org) donated.

Amazing Olive in Port Jefferson will hold a special olive oil tasting on Thursday, Oct. 12, from 7 to 9 p.m. with 10 percent of the tasting fee donated.

Bounce Blow Dry Bar in Port Jefferson on Friday, Oct. 13, from 10 a.m. to 5 p.m. will offer blow outs for $20 with 10 percent of the proceeds donated.

Pindar Vineyards Wine Store in Port Jefferson will hold a wine tasting on Saturday, Oct. 14, from 3 to 7 p.m., with 15 percent of all Rosé or Summer Blush wine purchases donated.

Fedora Lounge Boutique Hair Salon, Port Jefferson, will hold a $20 hair cut-a-thon on Saturday, Oct. 14, from noon to 4 p.m. with 100 percent of the proceeds donated.

Five Guys Burgers and Fries in Port Jefferson Station will hold a special fundraising night on Wednesday, Oct. 18, from 4 to 10 p.m. with 10 percent of all purchases donated.

East Main & Main, Port Jefferson, will offer a day of donut tasting on Saturday, Oct. 21, with 10 percent of the proceeds from pink donut sales donated.

Photo from Mather Hospital
The Frigate in Port Jefferson will donate 100 percent of the proceeds from pink cupcakes sales throughout October.

Month-long promotions include:

•Amazing Olive, of Port Jefferson and Patchogue, will donate $1 from every bottle of olive oil sold and 40 percent of special pink ribbon soap purchases.

•Chick-fil-A, Port Jefferson Station, will donate a portion of all milk shake sales.

•The Frigate, Port Jefferson, will donate 100 percent of the proceeds from pink cupcake sales.

•Salon Blond, Port Jefferson, will offer $10 pink hair extensions with 100 percent of the proceeds donated.

•East Main & Main, Port Jefferson, will donate 10 percent of the proceeds from pink donut sales.

•Fedora Lounge Boutique Hair Salon, Port Jefferson, will offer pink hair extensions for $15 or two for $20 with 100 percent of the proceeds donated.

•The Soap Box, Port Jefferson, will donate 10 percent of the proceeds from sales of rose water and jasmine, “pink sugar kiss,” peony rose petal and mistral soap sales.

•The Pie, Port Jefferson, will donate a portion of the proceeds from sales of pink lemonade.

•Tommy’s Place, Port Jefferson, will donate 20 percent of the proceeds from sales of pink cocktails.

•Brewology295, Port Jefferson, will donate 100 percent of the proceeds from sales of its pink cocktail.

In addition, the Port Jefferson Free Library, Port Jefferson, will offer a Paint Port Pink workshop on Friday, Oct. 6, from 2 to 4 p.m. where visitors can drop in and make a commemorative button for those who have been affected by breast cancer. Mather Hospital will host a HealthU seminar and health fair on Oct. 28 from 9 a.m. to 1:30 p.m. (free but registration required).

Visit Port Jeff Liquors, Wink Design Group anf Theatre Three for more Paint Port Pink promotions.

Mather Hospital has distributed pink lights and flags to more than 100 community partners and will post photos of decorated shops and businesses each day on the hospital’s Facebook page at www.facebook.com/matherhospital. On Wear Pink Day on Oct. 17, individuals who dress in pink are encouraged to take selfies and post them to Facebook with the hashtag #paintportpink.

Paint Port Pink’s sponsors include Long Island Physician Associates, LI Anesthesia Physicians, Long Island Bone and Joint, New York Cancer & Blood Specialists, Empire Bank, Local 342 Long Island Public Service Employees, STAT Health Management and Tritec Building Company.

For more information, please visit www.paintportpink.org.

All photos courtesy of Mather Hospital

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