Health

Above, a transmitter and wristband that can be obtained at the Suffolk County Sheriff’s Department. Photo courtesy of S.C. Sheriff's Dept.

When someone goes missing, it can be a terrifying experience for the person as well as family, friends and neighbors, especially when the individual has an impairment.

The Suffolk County Sheriff’s Department is reminding the public of its Project Lifesaver initiative after John Wile, a Stony Brook man with Alzheimer’s, was found dead Aug. 8 on the Research and Development Park property, also in Stony Brook, after leaving his home to jog two days earlier. The 10-year-old rapid-response program aids clients who may wander due to cognitive impairments or other afflictions, such as Alzheimer’s, dementia and autism.

Deputy Sheriff Sgt. Brian Weinfeld said those enrolled in the sheriff’s program wear a wristband with a transmitter that can be used on the wrist, ankle or as a necklace. The radio frequency transmitter and wristband come with a case, tester and battery. The battery and wristband have to be changed or charged every 30 to 60 days depending on the type.

He said caretakers are informed to call a special line with the Sheriff’s Department and 911 as soon as it’s discovered that someone with the transmitter is missing. The calls are received at the sheriff’s communication bureau and a text message is sent out to all Project Lifesaver responders, which is approximately 15 people within the department who are spread out from Montauk to Amityville. While all may not be working when an emergency occurs, Weinfeld said sometimes a responder will join the search on his or her day off.

Once the responders get a message that someone is missing they turn on their equipment and will receive a signal every one second transmitted from the person’s location device, Weinfeld said. The range of the signal depends on the terrain, and a responder’s antennae can pick up a signal approximately 3 miles on land and 5 in the air. The signal can be picked up by the antenna on a car or from a handheld antenna when searching on the ground. Using radio frequencies has its benefits.

“It’s not susceptible to satellites going down, cloudy weather or being in a basement,” he said. “That signal is going to be strong no matter what. Whereas with a GPS-type of device, you’re going to be relying on satellites and a clear path to the sky and that type of stuff.”

Weinfeld said responders start from where the person went missing and have an estimated range of how far the person could have wandered, which can be about 4 miles an hour. When a man in Brentwood went missing recently, a responder was near the Sagtikos State Parkway and the man was found within three minutes, according to the deputy sheriff sergeant. He said it’s critical when looking for someone who is lost that a caretaker calls the second he or she realizes, even before he or she searches for the person.

“Thankfully most of our searches end before we even get there,” he said. “Which is great. I tell all the clients, ‘Please, don’t hesitate to call us because we’re working, we’re on the road, we’re there. If you think your person is missing, just call us. We can start by sending someone to your area. Five minutes later we’re just pulling in and you found them, no big deal, we’ll just go back to work.’ I don’t want people to think they’re burdening us.”

Weinfeld said there are approximately 108 clients enrolled in the program, with roughly 50 percent being seniors with Alzheimer’s or dementia. The other 50 percent are children and adults with autism. He said there has been a 100 percent success rate out of the 3,000 reported searches in North America.

Those interested in the program can fill out a form with the Sheriff’s Department, and after a home visit and approval, can purchase the kit for approximately $300. Weinfeld said health insurance may cover the expense in some cases and others may be eligible to receive it for free.

According to the Alzheimer’s Association, a voluntary health organization in Alzheimer’s care, support and research, one in three seniors die with Alzheimer’s or other dementias, and it’s the sixth leading cause of death in the U.S. The association states 5.7 million Americans are currently living with the disease, and it’s projected that number will rise to about 14 million by 2050.

“The use of electronic tracking devices may be an appropriate part of a comprehensive safety plan which offers peace of mind for individuals with the disease and their caregivers,” said Douglas Davidson, executive director of the Alzheimer’s Association,  Long Island Chapter.”It should never be used as a replacement for needed supervision, and families should prepare for safety issues throughout the course of the disease.”

For more information on Project Lifesaver, visit www.suffolkcountysheriffsoffice.com/project-lifesaver. Also visit www.alz.org/longisland, for more information about Alzheimer’s and free programs and support available for patients in Suffolk and Nassau counties.

Symptoms of diverticular disease include lower abdominal pain and feeling bloated.
Fiber intake can affect results

By David Dunaief, M.D.

Dr. David Dunaief

Many patients say they have been diagnosed with diverticulitis, but this is a misnomer. Diverticulitis is actually a sequelae, or consequence, of diverticular disease. Diverticular disease is one of the most common maladies that affects us as we age. For instance, 10 percent of 40-year-olds are affected and, for those over the age of 60, more than 50 percent are affected (1).

The good news is that it is potentially preventable through modest lifestyle changes. My goal in writing this article is twofold: to explain simple ways to reduce your risk, while also debunking a myth that is pervasive — that fiber, or more specifically nuts and seeds, exacerbates the disease.

What is diverticular disease? It is a weakening of the lumen, or wall of the colon, resulting in the formation of pouches or out-pocketing referred to as diverticula. The cause of diverticula may be attributable to pressure from constipation. Its mildest form, diverticulosis may be asymptomatic. 

Symptoms of diverticular disease may include fever and abdominal pain, predominantly in the left lower quadrant in Western countries, or the right lower quadrant in Asian countries. It may need to be treated with antibiotics.

Diverticulitis affects 10 to 25 percent of those with diverticulosis. Diverticulitis is inflammation and infection, which may lead to a perforation of the bowel wall. If a rupture occurs, emergency surgery may be required.

Unfortunately, the incidence of diverticulitis is growing. Between 1998 and 2005, hospital admissions for acute diverticulitis increased 26 percent overall with a 73 percent increase in those between the ages of 18 and 44 (2).

Fiber, or more specifically nuts and seeds, does not exacerbate the disease.

How do you prevent diverticular disease and its complications? There are a number of modifiable risk factors, including fiber intake, weight and physical activity.

In terms of fiber, there was a prospective (forward-looking) study published online in the British Medical Journal that extolled the value of fiber in reducing the risk of diverticular disease (3). This was part of the EPIC trial, involving over 47,000 people living in Scotland and England. The study showed a 31 percent reduction in risk in those who were vegetarian. 

But more intriguing, participants who had the highest fiber intake saw a 41 percent reduction in diverticular disease. Those participants in the highest fiber group consumed >25.5 grams per day for women and >26.1 grams per day for men, whereas those in the lowest group consumed less than 14 grams per day. Though the difference in fiber between the two groups was small, the reduction in risk was substantial. 

Another study, which analyzed data from the Million Women Study, a large-scale, population-based prospective UK study of middle-aged women, confirmed the correlation between fiber intake and diverticular disease, and further analyzed the impact of different sources of fiber (4). The authors’ findings were that reduction in the risk of diverticular disease was greatest with high intake of cereal and fruit fiber.

Most Americans get <14 grams of fiber per day. The Institute of Medicine (IOM) recommends daily fiber intake for those <50 years old of 25 grams for women and 38.5 grams for men. Interestingly, their recommendations are lower for those who are over 50 years old.

Can you imagine what the effect is when people get at least 40 grams of fiber per day? This is what I recommend for my patients. Some foods that contain the most fiber include nuts, seeds, beans and legumes. In a study in 2009, specifically those men who consumed the most nuts and popcorn saw a protective effect from diverticulitis (5).

Obesity plays a role, as well. In the large prospective male health professionals study, body mass index plays a significant role, as did waist circumference (6). Those who were obese (BMI >30 kg/m²) had a 78 percent increased risk of diverticulitis and a greater than threefold increased risk of a diverticular bleed compared to those who had a BMI in the normal range of <21 kg/m². For those whose waist circumference was in the highest group, they had a 56 percent increase risk of diverticulitis and a 96 percent increase risk of diverticular bleed. Thus, obesity puts patients at a much higher risk of the complications of diverticulosis.

Physical activity is also important for reducing the risk of diverticular disease, although the exact mechanism is not yet understood. Regardless, the results are impressive. In a large prospective study, those with the greatest amount of exercise were 37 percent less likely to have diverticular disease compared to those with the least amount (7). Jogging and running seemed to have the most benefit. When the authors combined exercise with fiber intake, there was a dramatic 256 percent reduction in risk of this disease. 

Thus, the prevention of diverticular disease is one based mostly on lifestyle modifications through diet and exercise.

References:

(1) Journal of Clinical Gastroenterology. 2006;40:S108–S111. (2) Ann Surg. 2009;249(2):210. (3) BMJ. 2011; 343: d4131. (4) Gut. 2014 Sep; 63(9): 1450–1456. (5) AMA 2008; 300: 907-914. (6) Gastroenterology. 2009;136(1):115. (7) Gut. 1995;36(2):276.  

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.

Gary Wladyka, front, and Tony Kuczewski bike through the Rocky Point Mountain Bike Trail.

With the ever-expanded development along the North Shore of Long Island, it’s easy to underestimate just how many wooded trails and biking paths there are available for those who want to enjoy leisurely outdoor activities off congested roadways.

Trails to check out

Paved paths:

• Nissequogue River Trail 5.1 miles

Nissequogue River State Park, Kings Park

• Kings Park Hike & Bike Trail 1.5 miles

Nissequogue River State Park through Old Dock Road, Kings Park

• The Greenway Trail 3.4 miles

Setauket through Port Jefferson Station

Off-road paths:

• Edgewood Oak Brush Plains
Preserve 5.5 miles

Commack Road, Deer Park

Beginner through intermediate

• Calverton Pine Barrens State Forest Loop 7.6 miles

Calverton Pine Barrens State Forest

Beginner through intermediate

• Caumsett Mountain Bike Trail
5.5 miles

Caumsett State Park, Lloyd Harbor

Beginner through intermediate

• Sunken Meadow Trail 3.7 miles

Sunken Meadow State Park, Kings Park

Beginner through intermediate

• Rocky Point Mountain Bike Trail
15.2 miles

Rocky Point State Pine Barrens Preserve

Beginner through expert

• Cathedral Pines Trail 5.7 Miles

Cathedral Pines County Park,
Middle Island

Intermediate

• Meadowland Park Trail 6.0 Miles

Meadowland Park, East Northport

Intermediate

• Glacier Ridge Bike Trail 10.2 Miles

Glacier Ridge Preserve, Farmingville

Beginner through Intermediate

• Overton Trail 3.9 Miles

Overton Preserve, Coram

Intermediate through Expert

• East Setauket Trail 10.5 Miles

Laurel Ridge Setauket Woods Nature
Preserve, East Setauket

Intermediate through Expert

“We have so many trails on Long Island — more than 175 miles of them,” said Michael Vitti, the president of the Concerned Long Island Mountain Bicyclists, an organization dedicated to the growth of the activity it’s named for.

County Executive Steve Bellone (D) finally signing the long-awaited bill allocating funds for the Port Jefferson Station to Wading River Rails to Trails project, which will create a 10 mile walking and biking trails along the rights-of-way parallel to the North Shore and north of Route 25A, this might be an opportune time for people to finally put foot to pedal.

Neal Passoff, president of Campus Bicycle in Stony Brook said a prospective biker looking to pick up the hobby should start off riding on paved paths such as the Setauket to Port Jefferson Station Greenway Trail, rather than bumpy terrain.

“There’s still some challenging hills on [the Greenway Trail] but it’s great for people or families starting out that don’t want to worry about traffic,” Passoff said.

Of course, tackling a trail is a tall task without the right kind of bike. While some bikes are able to handle both roads and off-road, bike shop owners said it’s best to buy a bike specific to the style of riding a rider intends on doing. The difference, from the speeds to the shocks to the general design, will dictate how well the bike will perform on the different surfaces.

“People should think of what they plan on doing, not necessarily what they’re doing today, but what they plan on using the bike for,” Passoff said.

Bike shop owners stressed the need for a bike that feels good and fits to a rider’s body rather than forcing a fit. “Get a bike that fits, forget about specific bargains, have one that’s fitted to you,” said Richard Partenfelder, owner of The Cycle Company in Smithtown. 

After people get experienced and look to take their bikes off-road they should certainly look for beginner loops in local parks. “Every park has different terrain, and the more difficult trails are located north of the Long Island Expressway, and any trails that are south of the expressway are easier.” Vitti said. “The expressway runs along the glacial moraine, and that makes the north side more hilly.” 

Gary Wladyka, the owner of Rocky Point Cycle, said the hardest parts of most trails are how sharp the turns are and the steepness of the trail’s incline.

“For the most part the more difficult trails have more hills that are, to an inexperienced cyclist, something they end up walking up instead of riding up it,” Wladyka said.

He suggested starting on the easy parts of the Rocky Point Mountain Bike and Sunken Meadow trails because they have low inclines without any exceptionally sharp turns. 

“Try to keep to the beginner loops because they are relatively flat,” Wladyka said. “They don’t switchback turns, instead they have wider, ‘flowier’ turns.”

In terms of expert trails, both Wladyka and Passoff agreed that some of the hardest to tackle are the East Setauket Trail in Laurel Ridge Nature Preserve and the Overton Trail in the Overton Preserve located in Coram. Those trails have steep hills and sharp switchback turns that can really do a number on a novice biker if they’re not paying attention, they said.

If going into the woods, Vitti suggested people should wear high socks and spray their shoes with permethrin, a tick repellent for clothing.

Some trails are mountain bike only, and some are multiuse trails. Vitti said that while riding on these multiuse paths riders should learn proper etiquette for riding around hikers or other bikers, such as announcing your approach and pulling over to the side so others can pass if they are going in the opposite direction.

For more information about trails and riding etiquette, visit CLIMB’s website at www.climbonline.org.

A nutrient-dense, plant-based diet appears to prevent and help manage diseases that can affect vision including cataracts. Stock photo
Diet can have a significant impact on cataract risk

By David Dunaief, M.D.

Dr. David Dunaief

Cataracts affect a substantial portion of the U.S. population. In fact, 24.4 million people in the U.S. over the age of 40 are currently afflicted, and this number is expected to increase approximately 58 percent by the year 2030 — only 12 years from now — according to estimates by the National Eye Institute (1).

Cataracts are defined as an opacity or cloudiness of the lens in the eye, which decreases vision over time, as it progresses. It’s very common for both eyes to be affected. We often think of cataracts as a symptom of age, but we can take an active role in preventing them.

There are enumerable modifiable risk factors including diet; smoking; sunlight exposure; chronic diseases, such as diabetes and metabolic syndrome; steroid use; and physical inactivity. I am going to discuss the dietary factor.

Prevention

In a prospective (forward-looking) study, diet was shown to have substantial effect on the risk reduction for cataracts (2). This study was the United Kingdom group, with 27,670 participants, of the European Prospective Investigation into Cancer and Nutrition (EPIC) trial. Participants completed food frequency questionnaires between 1993 and 1999. Then, they were checked for cataracts between 2008 and 2009.

There was an inverse relationship between the amount of meat consumed and cataract risk. In other words, those who ate a great amount of meat were at higher risk of cataracts. “Meat” included red meat, fowl and pork. These results followed what is termed a dose-response curve. 

Compared to high meat eaters, every other group demonstrated a significant risk reduction as you progressed along a spectrum that included low meat eaters (15 percent reduction), fish eaters (21 percent reduction), vegetarians (30 percent reduction) and finally vegans (40 percent reduction). 

There really was not that much difference between high meat eaters, those having at least 3.5 ounces, and low meat eaters, those having less than 1.7 ounces a day, yet there was a substantial decline in cataracts. Thus, you don’t have to become a vegan to see an effect.

In my clinical experience, I’ve also had several patients experience reversal of their cataracts after they transitioned to a nutrient-dense, plant-based diet. I didn’t think this was possible, but anecdotally, this is a very positive outcome and was confirmed by their ophthalmologists (eye doctors).

Mechanism of action

Oxidative stress is one of the major contributors to the development of cataracts. In a review article that looked at 70 different trials for the development of cataract and /or maculopathies, such as age-related macular degeneration, the authors concluded antioxidants, which are micronutrients found in foods, play an integral part in prevention (3). 

The authors go on to say that a diet rich in fruits and vegetables, as well as lifestyle modification with cessation of smoking and treatment of obesity at an early age, help to reduce the risk of cataracts. Thus, you are never too young or too old to take steps to prevent cataracts.

How do you treat cataracts?

The only effective way to treat cataracts is with surgery; the most typical type is phacoemulsification. Ophthalmologists remove the opaque lens and replace it with a synthetic intraocular lens. This is done as an outpatient procedure and usually takes approximately 30 minutes. Fortunately, there is a very high success rate for this surgery. So why is it important to avoid cataracts if surgery is able to remedy the situation?

Potential consequences of surgery

There are always potential risks with invasive procedures, such as infection, even though the chances of complications are low. However, more importantly, there is a greater than fivefold risk of developing late-stage age-related macular degeneration (AMD) after cataract surgery (4). This is wet AMD, which can cause significant vision loss. These results come from a meta-analysis (group of studies) looking at more than 6,000 patients. 

It has been hypothesized that the surgery may induce inflammatory changes and the development of leaky blood vessels in the retina of the eye. However, because this meta-analysis was based on observational studies, it is not clear whether undiagnosed AMD may have existed prior to the cataract surgery, since they have similar underlying causes related to oxida tive stress.

Therefore, if you can reduce the risk of cataracts through diet and other lifestyle modifications, plus avoid the potential consequences of cataract surgery, all while reducing the risk of chronic diseases, why not choose the win-win scenario?

References:

1. nei.nih.gov. 2. Am J Clin Nutr. 2011 May; 93(5): 1128-1135. 3. Exp Eye Res. 2007; 84: 229-245. 4. Ophthalmology. 2003; 110(10): 1960. 

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.

By Anthony Petriello

St. Charles Hospital’s renowned rehabilitation department has a new second-in-command. Laura Beck, a current employee at the hospital and a Miller Place resident, was recently promoted to Vice President of Rehabilitation.

Beck will be responsible for overseeing both inpatient and outpatient rehabilitation for St. Charles as well as recently implemented programs geared toward sports medicine; treating lymphedema, a condition that leads to fluid build-up and swelling; and vestibular rehabilitation, an exercise-based program aimed at alleviating balance and gait issues.

St. Charles Hospital’s new Vice President of Rehabilitation Laura Beck. Photo from St. Charles Hospital

Beck has been working at St. Charles in various positions for 26 years, and she received her Bachelor’s Degree in Physical Therapy from Quinnipiac College, which is now Quinnipiac University. Her first position as a physical therapist was at St. Charles, and she returned to college and received her Master’s degree in Healthcare Administration and Policy from Stony Brook University.

“I am very excited for the opportunity,” she said. “St. Charles has an extremely long history, over 110 years, of excellence in rehabilitation that I am very proud to be a part of, and I am very excited for the chance to further our program, continue to grow, and continue the tradition of rehab we have had here for so many years.”

Beck has had served in many roles in her tenure at St. Charles. She started out as a staff physical therapist in 1991 and was promoted to a senior level physical therapist in 1994. Two years later Beck was promoted once again to supervising physical therapist, overseeing other therapists while still seeing patients herself. Beck started her focus on outpatient rehabilitation in 2000, when she was promoted to center manager of the Port Jefferson outpatient office.

Acknowledging her knowledge and acumen in rehabilitation, the hospital promoted her to director of Outpatient Rehabilitation, Pediatric Rehabilitation Services, and Offsite Contracts in 2003. In that position, which she held until just recently, she oversaw the daily activities of all nine of St. Charles’ outpatient rehabilitation locations across Long Island, which treat more than 10,000 patients every year, according to the hospital’s website.

Jim O’Connor, the executive vice president and chief administrative officer of St. Charles Hospital, was optimistic about Beck’s ability to fill the position and further the progress the rehabilitation department has made.

“There is a lot of opportunity to grow services … I don’t know that change is the word, I just think we have to continue to grow, stay current, and stay topical with evidence based practice.”

— Laura Beck

“Laura brings a wealth of experience to her new role for which her responsibilities include leading and directing all administrative functions of both the Inpatient and Outpatient Rehabilitation Departments,” O’Connor said. “Additionally, she will provide leadership oversight in the development of short- and long-range goals for programmatic development and financial planning as well as recommend new or revised policies and operational procedures in all administrative areas.”

Beck said she is prepared to seek new opportunities for the rehabilitation department and work to update and improve the services that are already being provided at the hospital and at outpatient locations. When asked if she would make any changes to the rehabilitation department as a whole, Beck remained pragmatic.

“There is a lot of opportunity to grow services,” she said. “We are the only inpatient rehabilitation hospital in Suffolk County, so I think we have a lot of opportunities to grow and improve the technology that is available to our patients. I don’t know that change is the word, I just think we have to continue to grow, stay current, and stay topical with evidence based practice.”

Concerned residents fill a room at the Hilton Garden Inn Stony Brook to hear about the discovery of a cancer cluster on Long Island. Photo by Anthony Frasca

By Anthony Frasca

Brad Hutton, the deputy commissioner of the New York State Office of Public Health, delivered sobering news to a standing-room-only crowd at the Hilton Garden Inn Stony Brook July 17.

At a public hearing, Hutton told concerned residents that the New York State Cancer Registry had identified three local communities with significantly elevated cancer rates for four common cancers. The affected communities include Centereach, Farmingville and Selden.

“Two of my son’s friends have cancer. One has acute lymphoblastic leukemia and one has a sarcoma.”

— Cindy Faicco

The four cancer types that were discovered to be well above the state average include lung, bladder, thyroid and leukemia. The cancer registry statistics disclosed that the rates of these cancers above the state averages were: thyroid, 43 percent; bladder, 50 percent; lung, 56 percent; and leukemia, 64 percent.

Concerned Centereach residents Cindy and Dennis Faicco had questions about how the state would handle such a discovery.

“I want to know how much they are going to reveal,” Dennis Faicco said. “I’m curious if this is just the tip of the iceberg.”

“Two of my son’s friends have cancer,” Cindy Faicco said. “One has acute lymphoblastic leukemia and one has a sarcoma.” She also said that there were other children in the area who had developed cancers.

The cancer registry has had gold-level certification since 1998, according to Hutton. New York State laws mandate cancer reporting, and this contributes to the accumulation of data; and with statistical analysis, it allows the state to identify areas of concern throughout the state.

Currently there are four areas throughout New York State that are being investigated for cancer clusters. Staten Island is being investigated because it has the highest incidence of cancer rates of the five New York City boroughs. East Buffalo and western Cheektowaga in Erie County are being studied for a high incidence of six forms of cancer, and Warren County has the highest incidence rate for all forms of cancer.

In addition to educating the audience about various causes and types of cancer, Hutton outlined a detailed plan for the upcoming state investigation.

“Simply living in a highlighted area does not mean a person is more likely to get cancer,” Hutton said, referencing a map of the three Long Island communities.

“Simply living in a highlighted area does not mean a person is more likely to get cancer.”

— Brad Hutton

The timetable for the upcoming investigation included identifying study areas, releasing cancer mapping, getting input from community members and finalizing study questions. Hutton outlined a one-year timetable to complete the investigations and recommendations, and results will be shared with the community at another public hearing by the end of 2018.

A number of residents shared personal stories of cancer and expressed concern about numerous potential sources of contamination, especially drinking water. Hutton assured the audience that the Office of Public Health would be responsive to the community’s input and would explore the issue in depth. He said that the community input would be helpful in focusing the state investigation.

Contaminated drinking water, radiation from towers, nitrates, emerging chemicals and pesticides, radium, high-tension wires and industrialization of the entire island were all highlighted issues identified by audience members in a question and answer session.

“We can’t be drinking radium,” one resident said. “That’s an emergency as far as I’m concerned.”

Ken from Centereach was concerned about high-tension utility wires and petroleum pipes feeding holding tanks. He said he had been diagnosed with a rare intestinal cancer and that his 32-year-old daughter developed a rare sarcoma.

“Here we sit with a zebra and a unicorn-type cancer,” he said. “Do you look at those in your studies?”

Joseph from Babylon told of developing a rare bladder cancer and implicated overchlorination of the water supply in addition to overindustrialization.

“As far as I’m concerned this island is done,” he said. “I can’t wait to move off this island. There is something very horribly wrong here. You can stop everything you’re doing right now, and this island will be done for a hundred years.”

The Faiccos were curious why there was little mention of childhood cancers, yet they were hopeful.

“He didn’t have any answers but we’re going to come back and hope he has some in December,” Cindy Faicco said.

The effects of high sodium are insidious

By David Dunaief, M.D.

Dr. David Dunaief

By now, most of us have been hit over the head with the fact that too much salt in our diets is unhealthy. Still, we respond with “I don’t use salt,” “I use very little,” or “I don’t have high blood pressure, so I don’t have to worry.” Unfortunately, these are myths. All of us should be concerned about salt or, more specifically, our sodium intake.

Excessive sodium in the diet does increase the risk of high blood pressure (hypertension); the consequences are stroke or heart disease. Approximately 90 percent of Americans consume too much sodium (1).

Now comes the interesting part. Sodium has a nefarious effect on the kidneys. In the Nurses Health Study, approximately 3,200 women were evaluated in terms of kidney function, looking at the estimated glomerular filtration rate (GFR) as related to sodium intake (2). Over 14 years, those with a sodium intake of 2,300 mg had a much greater chance of an at least 30 percent reduction in kidney function, compared to those who consumed 1,700 mg per day.

Why is this study important? Kidneys are one of our main systems for removing toxins and waste. The kidneys are where many initial high blood pressure medications work, including ACE inhibitors, such as lisinopril; ARBs, such as Diovan or Cozaar; and diuretics (water pills). If the kidney loses function, it may be harder to treat high blood pressure. Worse, it could lead to chronic kidney disease and dialysis. Once someone has reached dialysis, most blood pressure medications are not very effective.

Ironically, the current recommended maximum sodium intake is 2,300 mg per day, or one teaspoon, the same level that led to negative effects in the study. However, Americans’ mean intake is twice that level.

Excessive sodium in one’s diet can increase the risk of high blood pressure, which can lead to a stroke or heart disease. Stock photo

If we reduced our consumption by even a modest 20 percent, we could reduce the incidence of heart disease dramatically. Current recommendations from the American Heart Association indicate an upper limit of 2,300 mg per day, with an “ideal” limit of no more than 1,500 mg per day (3).

If the salt shaker is not the problem, what is? Most of our sodium comes from processed foods, packaged foods and restaurants. There is nothing wrong with eating out on occasion, but you can’t control how much salt goes into your food. My wife is a great barometer of restaurant salt use. If food from the night before was salty, she complains of not being able to get her rings off.

Do you want to lose 5 to 10 pounds quickly? Decreasing your salt intake will allow you to achieve this goal. Excess sodium causes the body to retain fluids. 

One approach is to choose products that have 200 mg or fewer per serving indicated on the label. Foods labeled “low sodium” have fewer than 140 mg of sodium, but foods labeled “reduced sodium” have 25 percent less than the full-sodium version, which doesn’t necessarily mean much. Soy sauce has 1,000 mg of sodium per tablespoon, but low-sodium soy sauce still has about 600 mg per tablespoon. Salad dressings and other condiments, where serving sizes are small, add up very quickly. Mustard has 120 mg per teaspoon. Most of us use far more than one teaspoon of mustard. Caveat emptor: Make sure to read labels on all packaged foods very carefully.

Is sea salt better than table salt? High amounts of salt are harmful, and the type is not as important. The only difference between them is slight taste and texture variation. I recommend not buying either. In addition to the health issues, salt tends to dampen your taste buds, masking the flavors of food.

If you are working to decrease your sodium intake, become an avid label reader. Sodium hides in all kinds of foods that don’t necessarily taste salty, such as breads, soups, cheeses and salad dressings. I also recommend getting all sauces on the side, so you can control how much — if any — you choose to use.

As you reduce your sodium intake, you might be surprised at how quickly your taste buds adjust. In just a few weeks, foods you previously thought didn’t taste salty will seem overwhelmingly salty, and you will notice new flavors in unsalted foods.

If you have a salt shaker and don’t know what to do with all the excess salt, don’t despair. There are several uses for salt that are actually beneficial. According to the Mayo Clinic, gargling with ¼ to ½ teaspoon of salt in eight ounces of warm water significantly reduces symptoms of a sore throat from infectious disease, such as mononucleosis, strep throat and the common cold. Having had mono, I can attest that this works.

Remember, if you want to season your food at a meal, you are much better off asking for the pepper than the salt.

References:

(1) cdc.gov. (2) Clin J Am Soc Nephrol. 2010;5:836-843. (3) heart.org.

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.

A diet high in fiber may help decrease the risk of heart disease, obesity and diabetes and has been linked to a lower incidence of some types of cancer. Stock photo

By David Dunaief, M.D.

Dr. David Dunaief

Many people worry about getting enough protein, when they really should be concerned about getting enough fiber. Most of us — except perhaps professional athletes or long-distance runners — get enough protein in our diets. Protein has not prevented or helped treat diseases in the way that studies illustrate with fiber. 

As I mentioned in my previous article, Americans are woefully deficient in fiber, getting between eight and 15 grams per day, when they should be ingesting more than 40 grams daily. 

In order to increase our daily intake, several myths need to be dispelled. First, fiber does more than improve bowel movements. Also, fiber doesn’t have to be unpleasant. 

The attitude has long been that to get enough fiber, one needs to eat a cardboard box. With certain sugary cereals, you may be better off eating the box, but on the whole, this is not true. Though fiber comes in supplement form, most of your daily intake should be from diet. It is actually relatively painless to get enough fiber; you just have to become aware of which foods are fiber rich.

Fiber has very powerful effects on our overall health. A very large prospective cohort study showed that fiber may increase longevity by decreasing mortality from cardiovascular disease, respiratory diseases and other infectious diseases (1). Over a nine-year period, those who ate the most fiber, in the highest quintile group, were 22 percent less likely to die than those in lowest group. Patients who consumed the most fiber also saw a significant decrease in mortality from cardiovascular disease, respiratory diseases and infectious diseases. The authors of the study believe that it may be the anti-inflammatory and anti-oxidant effects of whole grains that are responsible for the positive results. 

Along the same lines of the respiratory findings, we see benefit with prevention of chronic obstructive pulmonary disease (COPD) with fiber in a relatively large epidemiologic analysis of the Atherosclerosis Risk in Communities study (2). The specific source of fiber was important. Fruit had the most significant effect on preventing COPD, with a 28 percent reduction in risk. Cereal fiber also had a substantial effect but not as great.

Does the type of fiber make a difference? One of the complexities is that there are a number of different classifications of fiber, from soluble to viscous to fermentable. Within each of the types, there are subtypes of fiber. Not all fiber sources are equal. Some are more effective in preventing or treating certain diseases. Take, for instance, a February 2004 irritable bowel syndrome (IBS) study (3). 

It was a meta-analysis (a review of multiple studies) study using 17 randomized controlled trials with results showing that soluble psyllium improved symptoms in patients significantly more than insoluble bran.

Fiber also has powerful effects on breast cancer treatment. In a study published in the American Journal of Clinical Nutrition, soluble fiber had a significant impact on breast cancer risk reduction in estrogen negative women (4). Most beneficial studies for breast cancer have shown results in estrogen receptor positive women. This is one of the few studies that has illustrated significant results in estrogen receptor negative women. 

The list of chronic diseases and disorders that fiber prevents and/or treats also includes cardiovascular disease, Type 2 diabetes, colorectal cancer, diverticulosis and weight gain. This is hardly an exhaustive list. I am trying to impress upon you the importance of increasing fiber in your diet.

Foods that are high in fiber are part of a plant-rich diet. They are whole grains, fruits, vegetables, beans, legumes, nuts and seeds. Overall, beans, as a group, have the highest amount of fiber. Animal products don’t have fiber. Even more interesting is that fiber is one of the only foods that has no calories, yet helps you feel full. These days, it’s easy to increase your fiber by choosing bean-based pastas. Personally, I prefer those based on lentils. Read the labels, though; you want those that are solely made from lentils without rice added.

If you have a chronic disease, the best fiber sources are most likely disease dependent. However, if you are trying to prevent chronic diseases in general, I would recommend getting fiber from a wide array of sources. Make sure to eat meals that contain substantial amounts of fiber, which has several advantages, such as avoiding processed foods, reducing the risk of chronic disease, satiety and increased energy levels. Certainly, while protein is important, each time you sit down at a meal, rather than asking how much protein is in it, you now know to ask how much fiber is in it. 

References:

(1) Arch Intern Med. 2011;171(12):1061-1068. (2) Amer J Epidemiology 2008;167(5):570-578. (3) Aliment Pharmacology and Therapeutics 2004;19(3):245-251. (4) Amer J Clinical Nutrition 2009;90(3):664–671. 

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.

Preventing diabetes, cancer and stroke

By David Dunaief, M.D.

Dr. David Dunaief

What better way than a season centered around eating al fresco to kick-start you on the path to preventing chronic diseases? In the past, I have written about the dangers of processed meats in terms of causing chronic diseases, such as cancer, diabetes, heart disease and stroke. These are foods commonly found at barbecues and picnic meals. Therefore, I think it is only fair to talk about healthier alternatives and the evidence-based medicine that supports their benefits.

The Mediterranean-style diet is the key to success. It is composed of thousands of beneficial nutrients that interact with each other in a synergistic way. This particular diet, as I have mentioned in previous articles, includes fish, green leafy vegetables, fruit, nuts and seeds, beans and legumes, whole grains and small amounts of olive oil. We all want to be healthier, but doesn’t healthy mean tasteless? Not necessarily.

At a memorable family barbecue, we had a bevy of choices that were absolutely succulent. These included a three-bean salad, mandarin orange salad with raspberry vinaigrette, ratatouille with eggplant and zucchini, salmon filets baked with mustard and slivered almonds, roasted corn on the cob, roasted vegetable and scallop shish kebobs and a large bowl of melons and berries. I am drooling at the memory of this buffet. Let’s look at the scientific evidence.

Cancer studies

Fruits and vegetables may help prevent pancreatic cancer. This is very important, since by the time there are symptoms, the cancer has spread to other organs and the patient usually has less than 2.7 years to live (1). Five-year survival is only 5 percent (2). In a case control (epidemiological observational) study, cooked vegetables showed a 43 percent reduction and noncitrus fruits showed an even more impressive 59 percent reduction in risk of pancreatic cancer (3). Interestingly, cooked vegetables, not just raw ones, had a substantial effect. 

Garlic plays an important role in reducing the risk of colon cancer. In the IOWA Women’s Health Study, a large prospective (forward-looking) trial involving 41,837 women, there was a 32 percent reduction in risk of colon cancer for the highest intake of garlic compared to the lowest. Vegetables also showed a statistically significant reduction in the disease as well (4). Many of my patients find that fresh garlic provides a wonderful flavor when cooking vegetables.

Diabetes studies — treatment and prevention

Fish plays an important role in reducing the risk of diabetes. In a large prospective study that followed Japanese men for five years, those in the highest quartile of intake of fish and seafood had a substanttial decrease in risk of Type 2 diabetes (5). Smaller fish, such as mackerel and sardines, had a slightly greater effect than large fish and seafood in potentially preventing the disease. Therefore, there is nothing wrong with shrimp on the “barbie” to help protect you from developing diabetes. 

Nuts are beneficial in the treatment of diabetes. In a randomized clinical trial (the gold standard of studies), mixed nuts led to a substantial reduction of hemoglobin A1c, a very important biomarker for sugar levels for the past three months (6). As an added benefit, there was also a significant reduction in LDL, bad cholesterol, which reduced the risk of cardiovascular disease. The nuts used in the study were raw almonds, pistachios, pecans, peanuts, cashews, hazelnuts, walnuts and macadamias. How easy is it to grab a small handful of unsalted raw nuts, about 2 ounces, on a daily basis to help treat diabetes?

Stroke 

Olive oil appears to have a substantial effect in preventing strokes. The Three City study showed that olive oil may have a protective effect against stroke. There was a 41 percent reduction in stroke events in those who used olive oil (7). Study participants, who were followed for a mean of 5.2 years, did not have a history of stroke at the start of the trial. Though these are promising results, I would caution use no more than one tablespoon of olive oil per day, since there are 120 calories in a tablespoon. 

It is not difficult to substitute the valuable Mediterranean-style diet for processed meats or at least add them to the selection. This plant-based diet offers a tremendous number of protective elements in the prevention of many chronic diseases. So this Independence Day and beyond, plan to have on hand some mouth-watering healthy choices.

» A staple of the Mediterranean pantry, beans are a healthy, versatile and super affordable ingredient. Rich in antioxidants, fiber, B vitamins and iron, they are a hearty great alternative to high-fat proteins. Serve guests the following three-bean salad as a side dish at your next summer barbecue or picnic. 

Three-Bean Salad

YIELD: Makes 10 servings

INGREDIENTS:

1 15-ounce can of black beans

1 15-ounce can of red kidney beans

1 15-oounce can of cannellini beans

1 yellow bell pepper, chopped

½ red onion, finely chopped

¼ cup olive oil

2 tablespoons red wine vinegar or to taste

1 clove garlic, minced

1 small bunch cilantro, basil or parsley, chopped

¼ cup dill pickle, diced

¼ cup celery, chopped

Salt and pepper to taste

DIRECTIONS: 

Wash and drain the beans. Transfer to large bowl. Add remaining ingredients, toss well and refrigerate for a few hours before serving.

References:

(1) Nature. 2010;467:1114-1117. (2) Epidemiol Prev Anno 2007;31(Suppl 1). (3) Cancer Causes Control. 2010;21:493-500. (4) Am J Epidemiol. 1994 Jan 1;139(1):1-15. (5) Am J Clin Nutr. 2011 Sep;94(3):884-891. (6) Diabetes Care. 2011 Aug;34(8):1706-1711. (7) Neurology. 2011 Aug 2;77(5):418-425. 

Dr. Dunaief is a speaker, author and local lifestyle medicine physician focusing on the integration of medicine, nutrition, fitness and stress management. 

Lack of exercise is the dominant risk factor for heart attacks. Stock photo
Over the age of 30, inactivity creates the greatest risk

By David Dunaief, M.D.

Dr. David Dunaief

In last week’s article, I wrote about unusual symptoms that may indicate a myocardial infarction (heart attack) and the importance of knowing these atypical major symptoms beyond chest pain. This is not an easy task. I thought a good follow-up to that article would be one that focused on preventable risk factors.

The good news, as I mentioned previously, is that we have made great strides in reducing mortality from heart attacks. When we compare cardiovascular disease — heart disease and stroke — mortality rates from 1975 to the present, there is a substantial decline of approximately one-quarter. However, if we look at these rates since 1990, the rate of decline has slowed (1).

Plus, one in 10 visits to the emergency room are related to potential heart attack symptoms. Luckily, only 10 to 20 percent of these patients actually are having a heart attack (2). We need to reduce our risk factors to improve this scenario.

Some risk factors are obvious. Others are not. The obvious ones include age (men at least 45 years old and women at least 55 years old), family history, high cholesterol, high blood pressure, obesity, sedentary lifestyle, diabetes and smoking. Less obvious risk factors include gout, atrial fibrillation and osteoarthritis. Lifestyle modifications, including a high-fiber diet and exercise, also may help allay the risks.

Let’s look at the evidence.

Obesity

On a board exam in medicine, if smoking is one of the choices with disease risk, you can’t go wrong by choosing it. Well, it appears that the same axiom holds true for obesity. But how substantial a risk factor is obesity? 

In the Copenhagen General Population Study, results showed an increased heart attack risk in obese (BMI >30 kg/m²) individuals with or without metabolic syndrome (high blood pressure, high cholesterol and high sugar) and in those who were overweight (BMI >25 kg/m²) (3). The risk of heart attack increased in direct proportion to weight. Specifically, there was a 26 percent increase in heart attack risk for those who were overweight and an 88 percent increase in risk for those who were obese without metabolic syndrome. This study had a follow-up of 3.6 years.

It is true that those with metabolic syndrome and obesity together had the highest risk. But, it is quite surprising that obesity, by itself, can increase heart attack risk when a person is “metabolically healthy.” Since this was an observational trial, we can only make an association, but if it is true, then there may not be such a thing as a “metabolically healthy” obese patient. Therefore, if you are obese, it is really important to lose weight.

Sedentary lifestyle

If obesity were not enough of a wake-up call, let’s look at another aspect of lifestyle: the impact of being sedentary. An observational study found that activity levels had a surprisingly high impact on heart disease risk (4). Of four key factors — weight, blood pressure, smoking and physical inactivity — age was the determinant as to which one had the most negative effect on women’s heart disease risk. Those under the age of 30 saw smoking as most negatively impactful. For those over the age of 30, lack of exercise became the most dominant risk factor for heart disease, including heart attacks.

For women over the age of 70, the study found that increasing physical activity may have a greater positive impact than addressing high blood pressure, losing weight, or even quitting smoking. However, since high blood pressure was self-reported and not necessarily measured in a doctor’s office, it may have been underestimated as a risk factor for heart disease. Nonetheless, the researchers indicated that women should make sure they exercise on a regular basis to most significantly reduce heart disease risk.

Gout

When we think of gout, we relate it to kidney stones. But gout increases the risk of heart attacks by 82 percent, according to an observational study (6). Gout tends to affect patients more when they are older, but the risk of heart attack with gout is greater in those who are younger, ages 45 to 69, than in those over 70. What can we do to reduce these risk factors?

There have been studies showing that fiber decreases the risk of heart attacks. However, does fiber still matter when someone has a heart attack? In a recent analysis using data from the Nurses’ Health Study and the Health Professional Follow-up Study, results showed that higher fiber plays an important role in reducing the risk of death after a heart attack (7).  

Those who consumed the most fiber, compared to the least, had a 25 percent reduction in post-heart attack mortality. Even more impressive is the fact that those who increased their fiber after the cardiovascular event had a 31 percent reduction in mortality risk. In this analysis, it seemed that more of the benefit came from fiber found in cereal. The most intriguing part of the study was the dose response. For every 10-g increase in fiber consumption, there was a 15 percent reduction in the risk of post-heart attack mortality. Since we get too little fiber anyway, this should be an easy fix.

Lifestyle modifications are so important. In the Nurses’ Health Study, which followed 120,000 women for 20 years, those who routinely exercised, ate a quality diet, did not smoke and were a healthy weight demonstrated a whopping 84 percent reduction in the risk of cardiovascular events such as heart attacks (8).

Osteoarthritis

The prevailing thought with osteoarthritis is that it is best to suffer with hip or knee pain as long as possible before having surgery. But when do we cross the line and potentially need joint replacement? Well, in a study, those with osteoarthritis of the hip or knee joints that caused difficulty walking on a flat surface were at substantially greater risk of cardiovascular events, including heart attack. (5) Those who had surgery for the affected joint saw a substantially reduced heart attack risk. It is important to address the causes of osteoarthritis to improve mobility, whether with surgery or other treatments.

What have we learned? We can substantially reduce the risk of heart attacks and even potentially the risk of death after sustaining a heart attack with lifestyle modifications that include weight loss, physical activity and diet — with, in this case, a focus on fiber. While there are a number of diseases that contribute to heart attack risk, most of them are modifiable. With disabling osteoarthritis, addressing the causes of difficulty with mobility may also help reduce heart attack risk.

References:

(1) Heart. 1998;81(4):380. (2) JAMA Intern Med. 2014;174(2):241-249. (3) JAMA Intern Med. 2014;174(1):15-22. (4) Br J Sports Med. 2014, May 8. (5) Presented Research: World Congress on OA, 2014. (6) Rheumatology (Oxford). 2013 Dec;52(12):2251-2259. (7) BMJ. 2014;348:g2659.  (8) N Engl J Med. 2000;343(1):16.

Dr. Dunaief is a speaker, author and local lifestyle medicine physician focusing on the integration of medicine, nutrition, fitness and stress management. 

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