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Director of the Heart Rhythm Center at Stony Brook Heart Institute Dr. Eric Rashba is holding the new Watchman FLX device, which provides protection from strokes for people with atrial fibrillation. Photo from Stony Brook Medicine

The butterflies that color backyards are welcome companions for spring and summer. The ones that flutter towards the upper part of people’s chests can be discomforting and disconcerting.

In an effort to spread the word about the most common form of heart arrhythmia amid American Heart Month, the Stony Brook Heart Institute recently held a public discussion of Atrial fibrillation, or A-fib.

Caused by a host of factors, including diabetes, chronic high blood pressure, and advanced age, among others, A-fib can increase the risk of significant long-term health problems, including strokes.

In atrial fibrillation, the heart struggles with mechanical squeezing in the top chamber, or the atrium. Blood doesn’t leave the top part of the heart completely and it can pool and cause clots that break off and cause strokes.

Dr. Eric Rashba, who led the call and is the director of the Heart Rhythm Center at Stony Brook Heart Institute, said in an interview that A-fib is becoming increasingly prevalent.

A-fib “continues to go up rapidly as the population ages,” Rashba said. It occurs in about 10% of the population over 65. “As the population ages, we’ll see more of it.”

The Centers for Disease Control and Prevention estimates that 12.1 million people in the United States will have A-fib over the next decade.

As with many health-related issues, doctors advised residents to try to catch any signs of A-fib early, which improves the likely success of remedies like drugs and surgery.

“We prefer to intervene as early as possible in the course of A-fib,” Dr. Ibraham Almasry, cardiac electrophysiologist at the Stony Brook Heart Institute, said during a call with three other doctors. “The triggers tend to be more discreet and localized and we can target them more effectively.”

Different patients have different levels of awareness of A-fib as it’s occurring.

“Every single patient is different,” said Dr. Roger Ran, cardiac electrophysiologist at the Stony Brook Heart Institute. Some people feel an extra beat and could be “incredibly symptomatic,” while others have fatigue, shortness of breath, chest discomfort, and dizziness.

Still other patients “don’t know they are in it and could be in A-fib all the time.”

Doctors on the call described several monitoring options to test for A-fib.

Dr. Abhijeet Singh, who is also a cardiac electrophysiologist at the Stony Brook Heart Institute, described how the technology to evaluate arrhythmias has improved over the last 20 years.

“People used to wear big devices around their necks,” Singh said on the call, which included about 150 people. “Now, the technology has advanced” and patients can wear comfortable patches for up to 14 days, which record every single heartbeat and allow people to signal when they have symptoms.

Patients can also use an extended holter monitor, which allows doctors to track their heartbeat for up to 30 days, while some patients receive implantable recorders, which doctors insert under the skin during a five-minute procedure. The battery life for those is 4.5 years.

Additionally, some phones have apps that record heartbeats that patients can send by email, Singh said. “We have come a long way in a few years.”

Dr. Roger Fan, a cardiac electrophysiologist at the Stony Brook Heart Institute, added that all these technologies mean that “we are virtually guaranteed to get to the bottom” of any symptoms.

Drugs vs. surgery

Doctors offer patients with confirmed cases of A-fib two primary treatment options: drugs or surgery.

The surgical procedure is called an ablation and involves entering the body through veins in the groin and freezing or burning small areas that are interfering with the heart’s normal rhythm. The procedure breaks up the electrical signals in irregular heartbeats.

Performed under general anesthetic, the procedure generally takes two to three hours. Patients can return home the same day as the operation, Rashba said.

As with any surgery, an ablation has some risks, such as stroke or heart attack, which Rashba said are “very rare” and occur in fewer than one percent of the cases. Additionally, patients may have groin complications, although that, too, has declined as doctors have used ultrasound to visualize the blood vessels.

In extremely rare occasions, some patients also have damage to the esophagus behind the heart, said Rashba, who is also a professor of medicine.

For patients experiencing symptoms like A-fib, doctors recommended a trip to the emergency room, at least the first time.

“If it’s not going away, one, you can reassure yourself, two, you can get treatment, and three, you can get a diagnosis quickly,” said Almasry.

The Stony Brook doctors said choosing the best treatment option depends on the patient.

“Everybody has different manifestations of their A-fib,” said Fan.

Among other questions, doctors consider how dangerous the A-fib is for the patients, how severe the symptoms are, and how much they affect the quality of life.

Doctors urged residents to make the kind of healthy lifestyle choices that keep other systems functioning effectively. Almasry cited a direct correlation between obesity and A-fib.

Reducing body weight by 10%, while keeping the weight off, can reduce the likelihood of A-fib recurrence, he said.

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Some medication side-effects include increased fall risk

By David Dunaief, M.D.

Dr. David Dunaief

This has been a particularly challenging winter here in the Northeast. Instead of snow, we’ve had a fair amount of ice and variable temperatures that caused snowy surfaces to ice over.

Many older adults are concerned about falling, thus they stayed inside and sedentary. While this addressed the immediate challenge of icy sidewalks, it may have increased their risk of falling in the future.

What drives this concern about falls? Even without icy steps and walkways, falls can be serious for older patients, where the consequences can be devastating. They can include brain injuries, hip fractures, a decrease in functional ability and a decline in physical and social activities (1). Ultimately, a fall can lead to loss of independence (2).

There are many factors. A personal history of falling in the recent past is the most prevalent. However, there are other significant factors, such as age and medication use. Some medications, like antihypertensive medications, which are used to treat high blood pressure, and psychotropic medications, which are used to treat anxiety, depression and insomnia, are of particular concern. Chronic diseases can also contribute.

Circumstances that predispose us to falls also involve weakness in upper and lower body strength, decreased vision, hearing disorders and psychological issues, such as anxiety and depression (3).

Setting yourself up for success

Of the utmost importance is exercise. But what do we mean by “exercise”? We mean exercises involving balance, strength, movement, flexibility and endurance, all of which play significant roles in fall prevention (4). The good news is that many of these can be done inside with no equipment or with items found around the home.

Footwear also needs to be addressed. Nonslip shoes are crucial indoors, and footwear that prevents sliding on ice in winter, such as slip-on ice cleats that fit over your shoes, is a must. In the home, inexpensive changes, like securing area rugs and removing other tripping hazards, can also make a big difference.

Does medication increase risk?

There are a number of medications that may heighten fall risk. As I mentioned, psychotropic drugs top the list. But what other drugs might have an impact?

High blood pressure medications have been investigated. A well-designed study showed an increase in fall risk in those who were taking high blood pressure medication (5). Those on moderate doses of blood pressure medication had the greatest risk of serious injuries from falls, a 40 percent increase.

Blood pressure medications have significant benefits in reducing the risks of cardiovascular disease and events. Thus, we need to weigh the risk-benefit ratio in older patients before stopping a medication. We also should consider whether lifestyle modifications, which play a significant role in treating this disease, can be substituted for medication (6).

The value of exercise

A meta-analysis showed that exercise significantly reduced the risk of a fall (7). It led to a 37 percent reduction in falls that resulted in injury and a 30 percent reduction in falls requiring medical attention. Even more impressive was a 61 percent reduction in fracture risk.

Remember, the lower the fracture risk, the more likely you are to remain physically independent. The author summarized that exercise not only helps to prevent falls but also fall injuries.

Unfortunately, those who have fallen before, even without injury, often develop a fear that causes them to limit their activities. This leads to a dangerous cycle of reduced balance and increased gait disorders, ultimately resulting in an increased risk of falling (8).

What types of exercise help?

Any consistent exercise program that improves balance, flexibility, and muscle tone and includes core strengthening should help you improve your balance. Among those that have been studied, tai chi, yoga and aquatic exercise have all been shown to have benefits in preventing falls and injuries from falls.

A randomized controlled trial showed that those who did an aquatic exercise program had a significant improvement in the risk of falls (9). The aim of the aquatic exercise was to improve balance, strength and mobility. Results showed a reduction in the overall number of falls and a 44 percent decline in the number of exercising patients who fell during the six-month trial, with no change in the control group.

If you don’t have a pool available, tai chi, which requires no equipment, was also shown to reduce both fall risk and fear of falling in older adults (10).

Another pilot study used modified chair yoga classes with a small assisted living population (11). Participants were those over 65 who had experienced a recent fall and had a resulting fear of falling. While the intention was to assess exercise safety, researchers found that participants had less reliance on assistive devices and three of the 16 participants were able to eliminate their use of mobility assistance devices.

Thus, our best line of defense against fall risk is prevention with exercise and reducing slipping opportunities. Should you stop medications? Not necessarily. But for those 65 and older, or for those who have arthritis and are at least 45 years old, it may mean reviewing your medication list with your doctor. Before you consider changing your blood pressure medications, review your risk-to-benefit ratio with your physician.

References: 

(1) MMWR. 2014; 63(17):379-383. (2) J Gerontol A Biol Sci Med Sci. 1998;53(2):M112. (3) JAMA. 1995;273(17):1348. (4) Cochrane Database Syst Rev. 2012;9:CD007146. (5) JAMA Intern Med. 2014 Apr;174(4):588-595. (6) JAMA Intern Med. 2014;174(4):577-587. (7) BMJ. 2013;347:f6234. (8) Age Ageing. 1997 May;26(3):189-193. (9) Menopause. 2013;20(10):1012-1019. (10) Mater Sociomed. 2018 Mar; 30(1): 38–42. (11) Int J Yoga. 2012 Jul-Dec; 5(2): 146–150.

Dr. David 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. 

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White-tailed deer are prevalent on Long Island. METRO photo

By Matthew Kearns, DVM

Dr. Matthew Kearns

I recently saw an article that researchers in Canada were concerned with transmission of COVID-19 from deer (white-tailed deer) to a human, as well as deer. I thought that we only had to worry about white-tailed deer as a reservoir for Lyme disease. Now COVID? Ugghhh!!! 

The Canadian scientists that performed this study did not have definitive proof that the individual that tested positive was infected directly from a deer. However, this individual had the same strain of COVID as the deer in the area and the individual did spend a considerable amount of time around deer.

The good news is a human has a much higher chance of catching COVID from another human than from a deer. Also, the symptoms this individual had were not more severe than a human to human infection. Canadian health officials do caution hunters to take additional precautions such as washing hands thoroughly, wearing goggles, and wearing a well-fitted mask when handling the respiratory tissues of a deer.  

Previously, the only documented cases of animals passing the virus to humans were in mink. Six countries — Denmark, the Netherlands, Spain, Sweden, Italy and the United States — have reported cases of farmed mink infected with the coronavirus to the World Health Organization. Danish authorities also documented over 200 humans that contracted the virus from mink. Unfortunately, many of these minks were required to be culled to prevent further spread. 

The main concern with any animal reservoir is the ability of the COVID, or any coronavirus for that matter, to mutate so easily. 

The good news? Of the 31 species of animals that have been documented infected with COVID, current data shows that dogs and cats are terrible reservoirs of the virus. Although there are documented cases of both dogs and cats testing positive for COVID-19, there is no evidence that a human has been infected directly from a dog or cat. The CDC advises all pet owners to avoid contact with their pets when isolating with an infection (if possible). If a pet is exposed, symptoms are usually very mild or none at all.  

Dr. Kearns practices veterinary medicine from his Port Jefferson office and is pictured with his son Matthew and his dog Jasmine.

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Allied Pediatrics celebrated their grand opening on Feb. 16. Photo from Allied Pediatrics

Allied Physicians Group, an independent provider of high-quality comprehensive family health care services for both children and adults, recently held their grand opening and ribbon cutting ceremony for its new office, Allied Pediatrics of Rocky Point, at 346 Route 25A, Rocky Point, on Feb. 16. The new office is the 24th Allied location on Long Island, bringing the total number of pediatric offices in the New York Metropolitan Area to 36, and is also Allied’s first office that has been constructed from the ground up.  

The 5,500 sq. ft., state-of-the-art pediatric office has eight employees, with three pediatricians Dr. Nubia Vargas-Chen, Dr. Eric Levene and Dr. Daniel Freidman. With an urgent need for Pediatricians in the area, these physicians will provide the highest quality of care to all patients in the Rocky Point and surrounding communities.  

The event was attended by Councilwoman Jane Bonner on behalf of the Town of Brookhaven.

Councilwoman Jane Bonner presents Dr. Kerry Fierstein, CEO of Allied Physicians Group, with a Certificate of Congratulations from the Town of Brookhaven on Feb. 16.

“I am very happy to welcome Allied Physicians Group’s to the Rocky Point community. This is an important new business in our community and I wish Dr. Fierstein and her staff the best of luck. We have a growing number of families with young children in the area who will be well served. This new office will be convenient for families living here in Rocky Point and the surrounding area,” said Councilwoman Bonner. 

The Rocky Point office has health safety protocols in place to protect patients from the spread of COVID-19 and other illnesses. Design elements include separate sick and well areas and a state-of-the-art HVAC system with UV lighting to improve air quality. Services for patients and families includes wellness care, vaccinations, sick care, a new parent helpline, breastfeeding support, telehealth services, nutrition assistance, asthma control education (ACE) and community education (webinars, CPR classes). 

“Our experienced pediatricians and clinicians are committed to providing high quality care and exceptional service to families and children of the Rocky Point community,” said Dr. Kerry Fierstein, CEO of Allied Physicians Group. “With a growing number of children in the community, this new office is convenient for families in Rocky Point and the surrounding areas.” 

Pictured in top photo are, from left, Lauren Diguisieppe, Angela Holdorf, Ariele Alon, Angela M. Noncarrow, District Office Director for Senator Palumbo, Pat Athanasakes, Nicole Mann, Dr. Gregson Pigott, Commissioner of the Suffolk County Department of Health Services, Dr. Nubia Vargas-Chen, lead physician at Allied Pediatrics of Rocky Point, Town of Brookhaven Councilwoman Jane Bonner, Dr. Kerry Fierstein, CEO of Allied Physicians Group, Andrew Phillips, Kevin Edwards, SVP of Business Development, Patricia Martin-Quinn, Allen Wirtenson, David Baskin, Jennifer Colamartino, Sylvia DaCunha, Heather Edwards, Executive Director of Allied Foundation, Tina Colangelo, Mary Ellen LaSala, Cathryn Mackie, Margaret Galatioto, Jack Rosebery, Josh Klinger, Brianne Chidichimo, Director of Marketing for Allied Physicians Group.

For more information, call 631-315-7747 or visit www.alliedphysiciansgroup.com.

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Studies suggest the microbiome may influence weight loss or gain

By David Dunaief, M.D.

Dr. David Dunaief

Each of us carries trillions of microorganisms in our bodies. These make up each individual’s microbiome. It includes bacteria, viruses and single-cell eukaryotes. Our relationship to these organisms is complex, and much of it is still only loosely understood. What we do know, however, is that these microbes have key roles in our healthy functioning.

While the microbiome is found throughout our bodies, including the skin, the eyes and the gut, we’re going to focus on the gut, where the majority of the microbiome resides.

Why do we care? The short answer is it may have a role in diseases — preventing and promoting them. These include obesity, diabetes, irritable bowel syndrome, autoimmune diseases, such as rheumatoid arthritis and Crohn’s, and infectious diseases, such as colitis.

Human Microbiome Project

Like the Human Genome Project, which mapped our genes, the Human Microbiome Project, funded by the National Institutes of Health from 2007 to 2016, sought to map and sequence the composition and diversity of these gut organisms and to spur future research. There have been some enlightening preliminary studies already.

What affects the microbiome? Drugs, such as antibiotics, can wipe out the diversity in the microbes, at least in the short term. Also, lifestyle modifications, such as diet, can have an impact. Microbiome diversity also may be significantly different in distinct geographic locations throughout the world.

Microbiome’s role in obesity

Obesity can be incredibly frustrating; most obese patients continually struggle to lose weight. Obese and overweight patients now outnumber malnourished individuals worldwide (1).

I know this will not come as a surprise, but we are a nation with a weight problem; about 70% of Americans are overweight or obese (2) (3). For the longest time, the paradigm for weight loss had been to cut calories. However, extreme low-caloric diets did not seem to have a long-term impact. It turns out that our guts, dominated by bacteria, may play important roles in obesity and weight loss, determining whether we gain or lose weight.

The results from a study involving human twins and mice are fascinating (4). In each pair of human twins, one was obese and the other was lean. Gut bacteria from obese twins was transplanted into thin mice. The result: the thin mice became obese. However, when the lean human twins’ gut bacteria were transplanted to thin mice, the mice remained thin.

By pairing sets of human twins, one obese and one thin in each set, with mice that were identical to each other and raised in a sterile setting, researchers limited the confounding effects of environment and genetics on weight.

The most intriguing part of the study compared the effects of diet and gut bacteria. When the mice who had received gut transplants from obese twins were provided gut bacteria from thin twins and given fruit- and vegetable-rich, low-fat diet tablets, they lost significant weight. But they only lost weight when on a good diet; there was no impact if the diet was not low in fat. The authors believe this suggests that an effective diet may alter the microbiome of obese patients, helping them lose weight. These are exciting, but preliminary, results. It is not clear yet which bacteria may be contributing these effects.

This definitely suggests that the diversity of gut bacteria may be a crucial piece of the weight-loss puzzle.

Possible role for gut bacteria in rheumatoid arthritis development

Rheumatoid arthritis (RA) is an autoimmune disease that can be disabling, with patients typically suffering from significant morning stiffness, joint soreness and joint breakdown. What if gut bacteria influenced RA risk? In a study, the gut bacteria in mice that were made susceptible to RA by deletion of certain genes (HLA-DR genes) were compared to those who were more resistant to developing RA (5). Researchers found that the RA-susceptible mice had a predominance of Clostridium bacteria and that those resistant to RA were dominated by bacteria such as bifidobacteria and Porphyromonadaceae species. The significance is that the bacteria in the RA-resistant mice are known for their anti-inflammatory effects.

Counteracting antibiotics’ gut effects

Many experience gastrointestinal upset while taking antibiotics. This is because antibiotics don’t differentiate between good and bad bacteria when they go to work. One way to counteract the negative effects is to take a probiotic during and after your course of antibiotics. I recommend Renew Life’s 30-50 billion units once a day, two hours after an antibiotic dose and continuing once a day for 14 days after you have finished your prescription. If you really want to ratchet up the protection, you can take one dose of probiotics two hours after every antibiotic dose.

Although nobody can say what the ideal gut bacteria should consist of, we do know a few things that can help you. Diet and other lifestyle considerations, such as eating and sleeping patterns or their disruptions, seem to be important to the composition and diversity of gut bacteria (6). Studies have already demonstrated prebiotic effects of fiber and significant short-term changes to the microbiome when eating fruits, vegetables and plant fiber. The research is continuing, but we’ve learned a lot already that may help us tackle obesity and autoimmune disorders.

References: 

(1) “The Evolution of Obesity”; Johns Hopkins University Press; 2009. (2) cdc.gov (3) nih.gov (4) Science. 2013;341:1241214. (5) PLoS One. 2012;7:e36095. (6) Nutrients. 2019 Dec;11(12):2862.

Dr. David 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. 

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The percentage of positive COVID-19 tests in Suffolk County continues to plummet, raising expectations of more mask-optional or mask-free options for businesses and public places in the weeks and months ahead.

The percentage of positive tests, which the Omicron wave caused to crest in the mid to high twenties in the first few weeks after the start of the year, continues to plunge into the low single digits.

Indeed, as of Feb. 20, the seven-day average for positive tests was down to 2.2%, which is considerably lower than the mid to high 20% tests in the first few weeks of January, according to public information from the New York State Department of Health.

“The data are very promising and supportive of the idea that masks may not be necessary in social settings,” Sean Clouston, associate professor in the Program in Public Health and the Department of Family, Population and Preventive Medicine at the Renaissance School of Medicine at Stony Brook University, explained in an email.

A spring and summer that lifted some pandemic rules would relieve the strain of a public health threat that claimed the lives of community members, shut down businesses, altered school learning environments and created a mental health strain.

Dr. Gregson Pigott, commissioner of the Suffolk County Department of Health Services, explained that the decline in positive tests was “expected” and that it was “reassuring that the predictions held.”

The Health Service Commissioner is hoping, unless new, more virulent variants develop that “we will enter into a period of respite from COVID-19.

Pigott, however, added that Suffolk County hospitals still had COVID patients. People over 65 have seen the greatest decrease in hospitalizations. The senior age group had accounted for 65 to 70% of hospitalizations last January. 

That rate has steadily declined amid a high rate of vaccinations and boosters.

The most recent surge caused by the Omicron variant has elevated the levels of hospitalizations among younger age groups, especially for those who are not vaccinated, Pigott explained.

On the positive side, hospital stays have likely generally been shorter than in the earlier days of the pandemic as the “medical profession has learned over the course of time what interventions work best,” Pigott added.

Monoclonal antibodies and antiviral medications such as remdesivir have reduced the likelihood of significant illness when people with positive tests receive these treatments soon after diagnosis, Pigott explained.

As for boosters, Pigott didn’t anticipate the broad need for additional shots in the immediate future.

“Recent studies are showing the booster shot to hold up quite well over time, so perhaps a booster will not be needed, at least not for a while,” he wrote.

Although doctors have identified a new subvariant of Omicron called BA.2 that the county is monitoring carefully, the World Health Organization has not classified it as a variant of concern.

Mental health

Even as the physical threat from COVID-19 may be receding, health care professionals suggested that the mental health toll from the pandemic may require continued monitoring and support.

Pigott cited two new CDC studies that indicated the children’s mental health crisis has gotten worse during the pandemic.

Adam Gonzalez, associate professor of Psychiatry & Behavioral Health at the Renaissance School of Medicine at Stony Brook University, explained that young adults, in particular, have been struggling with increased rates of anxiety and depression.

According to the Center for Disease Control and Prevention’s Household Pulse Survey, which is a 20-minute online survey, 39.2% of people nationally aged 18 to 29 had indicators of anxiety or depression between Jan. 26 and Feb. 7 of this year. 

The group with the lowest percentage of such indicators was 80 years and above, with 9.3% of that age experiencing these indicators.

“The elevated rates of mental health problems highlight the need for mental health screening, referral and treatment — incorporating mental health as part of one’s overall health and well-being,” Gonzalez added.

Stony Brook Medicine is screening for depression throughout its practices to identify people who need mental health care support, Gonzalez wrote.

Cognitive behavioral therapy in particular is effective in helping improve mental health, with a group format proving just as effective as individual therapy, Gonzalez explained.

Gonzalez added that even a single session can help improve mental health, putting people back on a healthier path.

Gonzalez has been partnering with Jessica Schleider, assistant professor in Clinical Psychology at Stony Brook University, to teach people “how to break down problems into manageable steps. Our overall goal is to help get people the skills they need to effectively manage their mental health.”

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Emma S. Clark Memorial Library, 120 Main St., Setauket will host a Health and Hygiene Drive from Saturday, Feb. 26 to Sunday, March 13.

Many of us take basic personal care items for granted, but they are essential for day-to-day health. The cost of these necessities can add up and may be inaccessible to some individuals. Thus, to support the community, the library will be collecting new toothbrushes, toothpaste, floss, shampoo, mouthwash, razors, shaving cream, feminine hygiene products, baby wipes, diapers, and more.

These personal care items will be distributed to various local organizations that help those in need of supplies. A box will be located in the Library lobby and all (residents or nonresidents) are welcome to donate. Call 631-941-4080 for more information.

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Lack of exercise may rewire the brain

By David Dunaief, M.D.

Dr. David Dunaief

What do we know about the brain? Startlingly little.

Certain drugs, head injuries and lifestyle choices have negative effects. Also, numerous disorders and diseases affect the brain. Among these are neurological, infectious and rheumatologic disorders. These can include dementia, Parkinson’s, strokes, meningitis, lupus and rheumatoid arthritis. Cancer, psychiatric mood disorders, diabetes and heart disease also have potential long-term effects.

Although this list is long, it’s not exhaustive. And while these diseases vary widely, they generally have three signs and symptoms in common: they cause either altered mental status, physical weakness or change in mood — or a combination of these.

Cognitive loss, or mental decline, is a common fear and potential side effect of many of these disorders and diseases. Of course, addressing the underlying disorder is critical. Fortunately, several studies also suggest that we may be able to help our brains function more efficiently and effectively with rather simple lifestyle changes: sleep, exercise and possibly omega-3s. Let’s look at the evidence.

Clearing brain clutter

How many of us believe the stereotype that those in their 20s are sharper and quicker-witted than older folks? Are they really?

In a study, German researchers found that educated older people tend to have a larger mental database of words and phrases to pull from since they have been around longer and have more experience (1). When this is factored into the equation, the difference in terms of age-related cognitive decline becomes negligible.

This study involved data mining and creating simulations. It showed that mental slowing may be at least partially related to the amount of clutter or data that we accumulate over the years. The more you know, the harder it becomes to come up with a simple answer to something. We may need a reboot just like a computer. This may be possible through sleep, exercise and omega-3s.

Sleep removes brain waste

Why should we dedicate a large chunk of our lives to sleep? Researchers have identified a couple of specific values we receive from sleep: one involves clearing the mind, and another involves productivity.

For the former, a study done in mice shows that sleep may help the brain remove waste, such as those all-too-dangerous beta-amyloid plaques (2). When we have excessive plaque buildup in the brain, it may be a sign of Alzheimer’s. When mice were sleeping, the interstitial space (the space between brain gyri, or structures) increased by as much as 60 percent.

This allowed the lymphatic system, with its cerebrospinal fluid, to clear out plaques, toxins and other waste that had developed during waking hours. With the enlargement of the interstitial space during sleep, waste removal was quicker and more thorough, because cerebrospinal fluid could reach much farther into the spaces. A similar effect was seen when the mice were anesthetized.

In another study, done in Australia, results showed that sleep deprivation may have been responsible for an almost one percent decline in gross domestic product for the country (3). The reason? People are not as productive at work when they don’t get enough sleep. They tend to be more irritable, and their concentration may be affected. While we may be able to turn on and off sleepiness on short-term basis, we can’t do this continually.

According to the Centers for Disease Control and Prevention, 4.2 percent of respondents reported having fallen asleep in the prior 30 days behind the wheel of a car during a 2009-2010 study (4). Most commonly, these respondents also reported getting usual sleep of six hours or fewer, snoring, or unintentionally falling asleep during the day. “Drowsy driving” led to 91,000 car crashes in 2017, according to estimates from the National Highway Traffic Safety Administration (5).

Make time for exercise

How can I exercise when I can’t even get enough sleep? Well, this study may inspire you.

In the study, rats that were not allowed to exercise were found to have rewired neurons in the area of their medulla, the part of the brain involved in breathing and other involuntary activities. There was more sympathetic (excitatory) stimulus that could lead to increased risk of heart disease (6). In rats allowed to exercise regularly, there was no unusual wiring, and sympathetic stimuli remained constant. This may imply that being sedentary has negative effects on both the brain and the heart.

This study suggests that a lack of exercise causes unwanted new connections. Human studies should be done to confirm this impact.

Omega-3 fatty acids may affect brain volume

In the Women’s Health Initiative Memory Study of Magnetic Resonance Imaging Study, results showed that those postmenopausal women who were in the highest quartile of omega-3 fatty acids had significantly greater brain volume and hippocampal volume than those in the lowest quartile (7). The hippocampus is involved in memory and cognitive function.

Specifically, the researchers looked at the levels of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) in red blood cell membranes. The source of the omega-3 fatty acids could have been either from fish or from supplementation.

It’s never too late to improve brain function. Although we have a lot to learn about the functioning of the brain, we know that there are relatively simple ways we can positively influence it.

References: 

(1) Top Cogn Sci. 2014 Jan.;6:5-42. (2) Science. 2013 Oct. 18;342:373-377. (3) Sleep. 2006 Mar.;29:299-305. (4) cdc.gov. (5) nhtsa.gov. (6) J Comp Neurol. 2014 Feb. 15;522:499-513. (7) Neurology. 2014;82:435-442.

Dr. David 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. 

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Diabetes Prevention Program

If you have prediabetes, you can take control and reduce your risk of developing diabetes. St. Charles Hospital, 200 Belle Terre Road, Port Jefferson will be conducting a free Diabetes Prevention series starting Tuesday, March 8 from 6 to 7:15 p.m. The program will provide a  trained lifestyle coach, CDC approved curriculum and group support during the course of the year. Pre-registration is required by calling 631-853-2928.

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A paper published this week in Immunity, a leading research journal highlighting discoveries in immunology by Cell Press, lays the groundwork to better understand and treat Crohn’s disease, a type of Inflammatory Bowel Disease (IBD). Beneficial interactions among intestinal cell types limit the harmful effects of a dysregulated gut microbiota, which is comprised of trillions of bacteria, viruses, and other microorganisms. These cell-cell interactions are essential to maintain a healthy gut and dysregulation of this cellular “crosstalk” can predispose the development of IBD.

Pawan Kumar

Led by Pawan Kumar, BVSc, PhD, of the Renaissance School of Medicine at Stony Brook University, the research identified a new role for Interleukin-17A (IL-17A), an immune cell-derived cytokine, in promoting selective epithelial cell development as well as limiting inflammation during colitis.Although drugs that target IL-17A are highly effective against psoriasis, an autoimmune condition, the same drugs result in adverse effects when used to treat the inflammatory responses of Crohn’s. While targeting IL-17A may reduce the pathogenesis of certain inflammatory responses, it is unclear why these treatments had opposing effects in Crohn’s patients. The research team has addressed this underlying question.

“We identified a new role for IL-17A in the intestinal inflammatory process by regulating a type of stem cell (Lgr5+) and progenitor cell function,” said Kumar, Senior Author and an Assistant Professor in the Department of Microbiology and Immunology. “We found that IL-17A acts on intestinal stem cells to promote secretory cell lineage commitment. In addition, impaired IL-17A signaling to secretory cells (ATOH1+) exacerbates colitis.

”The research team tested their findings in different murine models. Upon collaborating with Ken Cadwell of New York University, they confirmed their results in human organoids. They found that IL-17A stimulated secretory cell differentiation in cystic human intestinal organoids.“Our data suggest that there is a ‘cross talk’ between immune cells and stem cells that regulates secretory cell lineage commitment and the integrity of the mucosa,” summarizes Kumar.

The authors believe their findings will help further research and lay the groundwork for future clinical studies that investigate the therapeutic potential of IL-17A and/or its downstream effector proteins.This research is supported in part by the National Institute of Diabetes and Digestive and Kidney Diseases, the Crohn’s and Colitis Foundation, the SUNY Research Foundation and a National Science Foundation Graduate Research Fellowship.

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