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Build a risk-reduction arsenal with healthy food options

By David Dunaief, M.D.

Dr. David Dunaief

Happy “Movember!” In 2003, The Movember Foundation was founded in Australia to raise awareness and research money for men’s health issues (1). Its mission is to reduce the number of men dying prematurely 25 percent by 2030. From its modest beginnings with 30 participants, The Movember Foundation has expanded to 20 countries, more than six million participants, and funded over 1250 men’s health projects focused on mental health and suicide prevention, prostate cancer, and testicular canc

Movember Foundation’s prostate cancer initiatives focus on early detection, treatment options, and quality of life considerations for different treatments. Here, I’d like to add prevention options to the conversation.

The best way to avoid prostate cancer is with some simple lifestyle modifications. There are a host of things that may increase your risk and others that may decrease your likelihood of prostate cancer, regardless of family history.

What may increase the risk of prostate cancer? Contributing factors include obesity, animal fat and supplements, such as vitamin E and selenium. Equally as important, factors that may reduce risk include vegetables, especially cruciferous vegetables, and tomato sauce or cooked tomatoes.

Vitamin E and selenium – not the right choice

In the SELECT trial, a randomized clinical trial (RCT), a dose of 400 mg of vitamin E actually increased the risk of prostate cancer by 17 percent (2). Though significant, this is not a tremendous clinical effect. It does show that vitamin E should not be used for prevention of prostate cancer. Interestingly, in this study, selenium may have helped to reduce the mortality risk in the selenium plus vitamin E arm, but selenium trended toward a slight increased risk when taken alone. I would not recommend that men take selenium or vitamin E for prevention.

Manage your weight

Obesity showed conflicting results, prompting the study authors to analyze the results further. Ac-cording to a review of the literature, obesity may slightly decrease the risk of nonaggressive prostate cancer, however increase risk of aggressive disease (3). The authors attribute the lower incidence of nonaggressive prostate cancer to the possibility that it is more difficult to detect the disease in obese men, since larger prostates make biopsies less effective. What the results tell us is that those who are obese have a greater risk of dying from prostate cancer when it is diagnosed.

Lose or lower your animal fat and meat intake

There appears to be a direct effect between the amount of animal fat we consume and incidence of prostate cancer. In the Health Professionals Follow-up Study, a large observational study, those who consumed the highest amount of animal fat had a 63 percent increased risk, compared to those who consumed the least (4).

Here is the kicker: It was not just the percent increase that was important, but the fact that it was an increase in advanced or metastatic prostate cancer. Also, in this study, red meat had an even greater, approximately 2.5-fold, increased risk of advanced disease. If you continue to eat red meat, reduce your frequency as much as possible, targeting once a month or quarter.

In another large, prospective observational study, the authors concluded that red and processed meats increase the risk of advanced prostate cancer through heme iron, barbecuing/grilling and nitrate/nitrite content (5).

I hope you love cooked tomatoes!

Tomato sauce has been shown to potentially reduce the risk of prostate cancer. However, uncooked tomatoes have not shown the same beneficial effects. It is believed that lycopene, which is a type of carotenoid found in tomatoes, is central to this benefit. Tomatoes need to be cooked to release lycopene (6). 

In a prospective study involving 47,365 men who were followed for 12 years, the risk of prostate cancer was reduced by 16 percent with higher lycopene intake from a variety of sources (7). When the authors looked at tomato sauce alone, they saw a reduction in risk of 23 percent when comparing those who consumed at least two servings a week to those who consumed less than one serving a month. The reduction in severe, or metastatic, prostate cancer risk was even greater, at 35 per-cent. There was a statistically significant reduction in risk with a very modest amount of tomato sauce.

In the Health Professionals Follow-Up Study, the results were similar, with a 21 percent reduction in the risk of prostate cancer (8). Again, tomato sauce was the predominant food responsible for this effect. 

Although tomato sauce may be beneficial, many brands are loaded with salt, which creates its own bevy of health risks. I recommend to patients that they either make their own sauce or purchase prepared sauce made without salt.

Eat your (cruciferous) veggies

While results among studies vary, they all agree: consumption of vegetables, especially cruciferous vegetables, are beneficial to prostate cancer outcomes.

In a case-control study, participants who consumed at least three servings of cruciferous vegetables per week, versus those who consumed less than one per week, saw a 41 percent reduction in prostate cancer risk (9). What’s even more impressive is the effect was twice that of tomato sauce, yet the intake was similarly modest. Cruciferous vegetables include broccoli, cauliflower, bok choy, kale and arugula, to name a few.

A separate study of 1338 patients with prostate cancer in a larger cancer screening trial concluded that, while vegetable and fruit consumption did not appear to lower outright prostate cancer risk, increased consumption of cruciferous vegetables – specifically broccoli and cauliflower – did reduce the risk of aggressive prostate cancer, particularly of more serious stage 3 and 4 tumors (10). These results were seen with consumption of just one or more servings of each per week, when com-pared to less than one per month.

When it comes to preventing prostate cancer, lifestyle modification, including making dietary changes, can reduce your risk significantly.

References:

(1) www.movember.com. (2) JAMA. 2011; 306: 1549-1556. (3) Epidemiol Rev. 2007;29:88. (4) J Natl Cancer Inst. 1993;85(19):1571. (5) Am J Epidemiol. 2009;170(9):1165. (6) Exp Biol Med (Maywood). 2002; 227:914-919. (7) J Natl Cancer Inst. 2002;94(5):391. (8) Exp Biol Med (Maywood). 2002; 227:852-859; Int. J. Cancer. 2007;121: 1571–1578. (9) J Natl Cancer Inst. 2000;92(1):61. (10) J Natl Cancer Inst. 2007;99(15):1200-1209.

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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Stock photo

Local health care providers were eager to start administering doses of COVID-19 vaccines to children who are 5 to 11 years old, which they can now do after the Centers for Disease Control and Prevention approved the shots for children late Tuesday night.

“We definitely saw more cases [of COVID-19] in children after school started this year,” said Dr. Sharon Nachman, chief of the Division of Pediatric Infectious Diseases at Stony Brook Children’s Hospital. “We’d like to prevent that.”

Health care providers would also like to stop household transmission, in which a member of a home spreads the virus to everyone else with whom that person lives.

“Children usually get milder forms of COVID, but they can transmit disease to people around them,” Dr. Adrian Popp, chair of Infection Control at Huntington Hospital, explained in an email. “It is not unusual for children to bring COVID in the home and then household members to be exposed and get COVID, especially if they are unvaccinated and immunocompromised.”

In considering whether parents should get shots for their children, doctors urged parents to speak with their family pediatricians.

“They are the experts in your child’s care,” Nachman said. “They’ll have the most insight into who your kid is.”

Pfizer BioNTech said the vaccines, which were a third of the dose of an adult shot, were over 90% effective against symptomatic COVID-19.

The Food and Drug Administration issued emergency use authorization for vaccines for this age group.

“Authorization of the vaccine for younger children is an important step in keeping them healthy and providing their families with peace of mind,” Dr. Lee Savio Beers, president of the group, said in a statement. “The vaccine will make it safe for children to visit friends and family members, celebrate holiday gatherings, and to resume the normal childhood activities that they’ve missed during the pandemic.”

Doctors urged parents with children who have underlying cardiac or respiratory issues to give serious consideration to vaccinations that could prevent the spread of a virus that could be especially problematic for their children.

“Someone with underlying cardiac issues, if they were to get COVID-19, would have increased risk of poor outcomes,” Nachman said. “They should be prioritized. Waiting to get COVID is not a good idea.”

The same holds true for children with asthma, who could develop more problematic symptoms from contracting the virus, Nachman said.

While the doses for children will be lower, the immune system of younger people is more reactive than that for adults, which is why pharmaceutical companies tested a lower dose in their clinical trials.

Even with the smaller volume of the vaccine, “children will still not have waning immunity,” Nachman said. “It will be just as effective” as the higher dose for adults.

Besides having more reactive and resilient immune systems, healthy children also will likely have milder side effects from the vaccine because of the lower dosage.

To be sure, every child who is in this age range and becomes eligible for the shot shouldn’t immediately receive the vaccination.

The clinical trials didn’t include children with cancer or with other immunological difficulties.

“We did not enroll [children with those conditions] in clinical trials,” so it would be difficult to know how effective the vaccine would be for them, Nachman said.

Down the road, vaccinating a classroom of children in this age category could lead to a reduction in the current restrictions designed to protect the health of students and their educators.

“It’s too soon to say the next steps,” Nachman said, which could include learning without masks. Further information about the spread of the virus after vaccinations would inform future guidelines.

Popp added that booster needs for children in the future is also unknown.

“Data will be gathered and [officials] will see if this will become necessary,” Popp said.

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Rogovitz with his son Gene and his grandson Gavin surfing at Gilgo Beach in Babylon. Photo from Rogovitz

Charles Rogovitz hopes to get bottom dentures so he can relieve the stomach pain he gets from partially chewed food and can eat an apple again. Todd Warren needs to have a root canal to become eligible for a new kidney. 

Rogovitz and Warren are two of the veterans who will attend free Port Jefferson-based St. Charles Hospital’s “Give Vets a Smile” clinic on Nov. 3.

The event, which has become biannual this year and is fully booked, will provide dental care for 20 to 25 veterans.

Currently sponsored by a grant from Mother Cabrini Foundation, St. Charles has been providing an annual dental clinic for veterans since 2016.

“Our goal is to reach out to the [veterans] who do not have traditional insurance through employers,” and who “fall through the cracks,” Dr. Keri Logan, director in the Department of Dentistry at St. Charles, explained in an email. “That includes veterans who are not 100% disabled and perhaps make too much money for Medicaid, those that are homeless and the like.”

St. Charles hopes to “get as much done for them as possible,” which means that appointments typically include a visit with a hygienist as well as a dentist, Dr. Logan added.

Dr. Logan explained that veterans who do not have insurance or the means to go to a dentist regularly for routine cleanings and treatment have an increased incidence of cavities, infections and/or periodontal disease.

The event is in memory of Mark Cherches, who spent 57 years at St. Charles Hospital’s Dental Clinic and played a key role in bringing Give Veterans a Smile day to the hospital.

Dr. Cherches “heard of this from another facility a few years back and he was instrumental in giving us the idea,” Dr. Logan explained.

St. Charles is hosting the event at the Stephen B. Gold Dental Clinic.

Ruth Gold, wife of the late Stephen Gold, who was a pediatric dentist and for whom the clinic is named, appreciates the fact that the clinic is expanding with outreach programs to help the community.

The daughter of World War II veteran Milton Kalish, Gold is thankful for members of the armed forces who are “defending our country.”

Gold added that her husband would be “pleased” with the effort. “These are people who wouldn’t ordinarily go out to get their teeth checked, so this is very important.”

Rogovitz

Indeed, Rogovitz hasn’t been to a dentist in a quarter of a century.

A retired contractor who was a sergeant in the Marine Corps in Vietnam in 1967, 1968 and 1969, Rogovitz has lost his bottom teeth over the years, pulling them out when they come loose.

A resident of Babylon Village, Rogovitz has visited dentists, who estimated that it would cost $2,400 and about eight months to provide dentures for his lower jaw. He also needs dentures on his upper jaw.

“I’m hoping for the best,” Rogovitz said. “Worst comes to worst, I’ll get a lower denture and I’ll be able to masticate my food properly and not have stomach issues.”

Rogovitz has circled Nov. 3 on his calendar with highlighter in multiple colors.

The retired marine has been eating soft foods.

Rogovitz owes his life to his son Gene, who urged him to see a doctor for a general checkup in 2016. The doctor found early stage prostate cancer, which is in remission.

Rogovitz is convinced he developed cancer during his service in Vietnam, when he was given a bag of defoliant and was told to rip it open and scatter it in the grass. 

In addition, he lay in fields sprayed with Agent Orange.

Despite his health battles, Rogovitz, who calls himself a “young 74,” enjoys surfing with his son and his nine-year-old grandson, Gavin.

In addition to biting into an apple, which he hasn’t done in about 12 years, he hopes to chew on an ear of corn on the cob.

Warren

A veteran of the Navy who went on three deployments during Desert Storm, Warren has received dialysis three days a week for over 18 months.

Warren, whose rank was Petty Officer 2nd Class E5, would like to join the list for a kidney transplant.

“You have to be cleared by all these departments first,” said Warren, who is a resident of Bay Shore. “One of them is dental.”

Unable to do much walking in part because of his kidney and in part because of his congestive heart failure, Warren can’t join the organ recipient list until he has root canal.

“All of that is holding me up,” Warren said. “I have to get this root canal to get this kidney transplant.”

While St. Charles Hospital can’t guarantee any specific treatment, the dental clinic does offer root canal work as a part of that day’s free dental service for veterans.

Warren, who is 53, has sole custody of his nine-year-old son, Malachi. 

An athlete in high school who played basketball and soccer and ran track, Warren is limited in what he can do with his son in his current condition.

Warren had two teeth extracted at the Veterans Administration and is also hoping to fill that hole. When he drinks, he sometimes struggles to control the flow of liquid, causing him to choke on soda or water.

“I’m trying to do the best I can” with the missing teeth in the bottom of his mouth and the need for a root canal in the top, he said.

On behalf of himself and other veterans, Warren is grateful to St. Charles Hospital.

“I appreciate what they’re doing,” Warren said. “Let’s take care of the vets who were willing to put their lives on the line for this country.”

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Olivia Swanson
Arianna Maffei

The role of neuron and dopamine loss in Parkinson’s Disease (PD) has long been recognized by neuroscientists. However, how dopaminergic modulation affects brain regions involved in the control of voluntary movement remains a subject of investigation.

Researchers in the Department of Neurobiology and Behavior in the College of Arts and Sciences and the Renaissance School of Medicine at Stony Brook University, used an experimental model to demonstrate that a loss of midbrain dopaminergic centers impairs the ability of the primary motor cortex neurons to transform inputs into appropriate output. The finding, published in eNeuro, supports a new line of research regarding the origins of changes in the motor cortex and its role during PD.

Patients with PD show abnormal activity in the motor cortex, which to date remains difficult to explain. Scientists have proposed that motor cortex dysfunction in PD may come from loss of direct dopaminergic innervation of the cortex, or, alternatively, it could arise as a consequence of basal ganglia pathology.

Dopamine neurons are vital to a healthy brain, but they degenerate in Parkinson’s Disease. This coronal section of the ventral part of the brain visualizes midbrain dopamine neurons in a healthy brain. Green: dopamine neurons. Red: axons from the motor cortex. Blue: all neurons, cell bodies. Image from Olivia Swanson

“Our study shows that the changes in excitability of motor cortex neurons very likely are due to basal ganglia pathology and not loss of direct dopaminergic innervation of the motor cortex,” says Arianna Maffei, PhD, Professor of Neurobiology and Behavior. “The results we showed support the idea that changes in motor cortex activity due to loss of dopamine are very important for the pathophysiology of PD. This adds to our current knowledge and points to the motor cortex as a potential novel site for intervention.”

The research team assessed how the loss of dopamine affects the input/output function of neurons in the motor cortex. They tested three different ways to reduce dopamine signaling to ask how motor cortex dysfunction may arise: 1) Used pharmacology to block the receptors selectively in the motor cortex 2) Injected a toxin that kills dopaminergic neurons in the midbrain to induce basal ganglia pathology, and 3) Used the same toxin to eliminate dopamine neuron axons in the motor cortex to test the possibility that loss of dopaminergic input to the motor cortex may be responsible for its dysfunction.

Professor Maffei explains that the idea behind these approaches was to dissect out the circuit mechanisms underlying loss of function in the motor cortex and possibly use these data to better understand PD pathophysiology.

Overall, the research demonstrated that diminished dopamine signaling, whether acute or chronic, has profound effects on the excitability of primary motor cortex neurons.

The authors believe the results should spur additional research that focuses on the primary motor cortex as an additional site of intervention to treat motor symptoms and improve outcomes in PD patients.

 

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Photo courtesy of Stony Brook Medicine

According to new research released by Healthgrades, Stony Brook University Hospital (SBUH) has earned national recognition as one of America’s 50 Best Hospitals for Cardiac Surgery™, one of America’s 100 Best Hospitals for Coronary Intervention™ for seven consecutive years, one of America’s 100 Best Hospitals for Cardiac Care™ for eight consecutive years and one of America’s 100 Best Hospitals for Stroke Care™ for seven years in a row. Every year, Healthgrades, a leading online resource that connects consumers, physicians and health systems, evaluates hospital performance at nearly 4,500 hospitals nationwide for 31 of the most common inpatient procedures and conditions.*

“As the new leader of the Stony Brook Medicine healthcare system, I’m delighted by all that Stony Brook University Hospital has accomplished to earn this well-deserved recognition,” said Hal Paz, MD, Executive Vice President, Health Sciences, Stony Brook University. “I’m excited to be part of an organization that is so fully committed to quality patient outcomes, and enhancing the lives of our patients, their families and the community.”

“Being named as one of America’s best year after year shows our staff’s commitment to providing nationally recognized high-quality care to every patient who walks through our doors,” said Carol A. Gomes, MS, FACHE, CPHQ, Chief Executive Officer for Stony Brook University Hospital. “These exceptional patient outcomes are a direct result of Stony Brook’s dedication to maintaining the highest standards of service.”

“Consumers can feel confident in the America’s 100 Best Hospitals for Cardiac and Stroke Care for their commitment to quality care and exceptional outcomes. The recognition helps provide peace of mind when selecting a place for care,” said Brad Bowman, MD, Chief Medical Officer and Head of Data Science at Healthgrades.

This year, Stony Brook University Hospital has taken many steps to raise the bar for cardiac care on Long Island. The Stony Brook University Heart Institute opened its Cardiac Catheterization (Cath) and Electrophysiology (EP) Advanced Multifunctional Laboratory, bringing more advanced cardiac diagnosis and treatment to patients. Central to the lab’s operation is the latest-generation image-guided diagnostic and therapeutic imaging system, the Philips Azurion 7, which provides imaging capabilities at ultra-low radiation dose levels — allowing physicians to conduct more complex procedures with greater precision and adding a significant measure of safety for both the patients and medical team. The Heart Institute also added the Center for Advanced Lipid (Cholesterol) Management, the first of its kind in Suffolk County. The center uses testing tailored to each patient to get a complete understanding of inflammatory markers, lipid profile, apolipoprotein B levels and more. From there, Stony Brook experts can develop a cardiac disease prevention and cholesterol management plan.

Stony Brook Medicine continues to operate Long Island’s first and only Mobile Stroke Unit Program, designed to provide specialized, lifesaving care to people within the critical moments of a stroke before they even get to the hospital. This allows for time-sensitive stroke therapies to be administered earlier and for the transport of stroke patients directly to the most appropriate hospital for the level of care they require.

In 2021, SBUH received the American Heart Association/American Stroke Association’s Gold Plus Get With The Guidelines® – Stroke Award with Target: Stroke Elite Plus Honor Roll and Target: Type 2 Diabetes Honor Roll. The award recognizes Stony Brook Medicine’s commitment to ensuring stroke patients receive the most appropriate treatment according to nationally recognized, research-based guidelines based on the latest scientific evidence.

Stony Brook University Hospital was also recognized by Healthgrades for the following clinical achievements:

  • America’s 100 Best Hospitals Award for 3 years in a row (2019-2021)
  • Cardiac Care Excellence Award for 8 years in a row (2015-2022)
  • Coronary Intervention Excellence Award for 8 years in a row (2015-2022)
  • Cardiac Surgery Excellence Award for 2 years in a row (2021-2022)
  • Neuroscience Excellence Award for 7 years in a row (2016-2022)
  • Stroke Care Excellence Award for 7 years in a row (2016-2022)
  • Cranial Neurosurgery Excellence Award for 3 years in a row (2020-2022)

For its analysis, Healthgrades evaluated approximately 45 million Medicare inpatient records for nearly 4,500 short-term acute care hospitals nationwide to assess hospital performance in 31 common conditions and procedures and evaluated outcomes in appendectomy and bariatric surgery using all-payer data provided by 16 states. Healthgrades recognizes a hospital’s quality achievements for cohort-specific performance, specialty area performance, and overall clinical quality. Individual procedure or condition cohorts are designated as 5-star (statistically significantly better than expected), 3-star (not statistically different from expected) and 1-star (statistically significantly worse than expected).

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About Stony Brook University Hospital:

Stony Brook University Hospital (SBUH) is Long Island’s premier academic medical center. With 624 beds, SBUH serves as the region’s only tertiary care center and Regional Trauma Center, and is home to the Stony Brook University Heart Institute, Stony Brook University Cancer Center, Stony Brook Children’s Hospital and Stony Brook University Neurosciences Institute. SBUH also encompasses Suffolk County’s only Level 4 Regional Perinatal Center, state-designated AIDS Center, state-designated Comprehensive Psychiatric Emergency Program, state-designated Burn Center, the Christopher Pendergast ALS Center of Excellence and Kidney Transplant Center. It is home of the nation’s first Pediatric Multiple Sclerosis Center. To learn more, visit stonybrookmedicine.edu/sbuh.

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Start with small, but key dietary changes

By David Dunaief

Dr. David Dunaief

Heart disease is an umbrella term that includes a number of disorders. Most common is coronary artery disease, which can cause heart attacks. Others include valve issues and heart failure, which is a problem with the pumping mechanism. We will focus on coronary artery disease and the resulting heart attacks.

According to the Centers for Disease Control and Prevention, about 6.7 percent of U.S. adults over the age of 19 have coronary artery disease (CAD) (1). There are 805,000 heart attacks in the U.S. annually, and 200,000 of these occur in those who’ve already had a first heart attack.

Among the biggest contributors to heart disease risk are high blood pressure, high cholesterol, and smoking. In addition, if you have diabetes or are overweight or obese, your risk increases significantly. Lifestyle choices also contribute to your risk: poor diet, lack of physical activity and high alcohol consumption are among the most significant contributors.

We can significantly reduce the occurrence of CAD. The evidence continues to highlight lifestyle changes, including diet, as the most important factors in preventing heart disease. Changes that garner a big bang for your buck include the consumption of chocolate, legumes, nuts, fiber and omega-3 polyunsaturated fatty acids (PUFAs).

Can chocolate help?

Preliminary evidence shows that two pieces of chocolate a week may decrease the risk of a heart attack by 37 percent, compared to those who consume less (2). However, the authors warned against the idea that more is better. In fact, high fat and sugar content and calorically dense aspects may have detrimental effects when consumed at much higher levels. There is a fine line between potential benefit and harm. The benefits may be attributed to micronutrients referred to as flavonols.

I usually recommend that patients have one to two squares – about one-fifth to two-fifths of an ounce – of high-cocoa-content dark chocolate daily. Aim for chocolate labeled with 80 percent cocoa content. Alternatively, you can get the benefits without the fat and sugar by adding unsweetened, non-Dutched cocoa powder to a fruit and vegetable smoothie.

Who says prevention has to be painful?

Increase your dietary fiber

Fiber has a dose-response relationship to reducing risk. In other words, the more fiber you eat, the greater your risk reduction. In a meta-analysis of 10 studies, results showed for every 10-gram increase in fiber, there was a corresponding 14 percent reduction in the risk of a cardiovascular event and a 27 percent reduction in the risk of heart disease mortality (3). The authors analyzed data that included over 90,000 men and 200,000 women.

According to a 2021 analysis of National Health and Nutrition Examination Survey (NHANES) data from 2013 to 2018, only 5 percent of men and 9 percent of women get the recommended daily amount of fiber (4).

The average American consumes about 16 grams per day of fiber (5).

So, how much is “enough”? The Academy of Nutrition and Dietetics recommends 14 grams of fiber for each 1,000 calories consumed, or roughly 25 grams for women and 38 grams for men (6).

We can significantly reduce our risk of heart disease if we increase our consumption of fiber to reach the recommended levels. Good sources of fiber are fruits and vegetables with the edible skin or peel, beans and lentils, and whole grains.

Focus on legumes

 

Pixabay photo

In a prospective (forward-looking) cohort study, the First National Health and Nutrition Examination Survey Epidemiologic Follow-up Study, legumes reduced the risk of coronary heart disease by a significant 22 percent (7). Those who consumed four or more servings per week, compared to those who consumed less than one serving, saw this effect. The legumes used in this study included beans, peas and peanuts. There were over 9,500 men and women involved, spanning 19 years of follow-up.

I recommend that patients consume at least one to two servings of legumes a day, or 7 to 14 a week. Imagine the impact that could have, compared to the modest four servings per week used to reach statistical significance in this study.

Add healthy nuts

In a study with over 45,000 men, there were significant reductions in CAD with omega-3 polyunsaturated fatty acids (PUFAs). Both plant-based and seafood-based omega-3s showed these effects (8). Good sources of omega-3s from plant-based sources include nuts, such as walnuts, and ground flaxseed.

Your ultimate goal should be to become “heart attack proof,” a term used by Dr. Sanjay Gupta and reinforced by Dr. Dean Ornish. Ideally, this requires a plant-based diet. But even modest changes in diet will result in significant risk reductions. The more significant the lifestyle changes you make, the closer you will come to achieving this goal.

References:

(1) cdc.gov. (2) BMJ 2011; 343:d4488. (3) Arch Intern Med. 2004 Feb 23;164(4):370-376. (4) nutrition.org (5) NHANES 2009-2010 Data Brief No. 12. Sep 2014. (6) eatright.org. (7) Arch Intern Med. 2001 Nov 26;161(21):2573-2578. (8) Circulation. 2005 Jan 18;111(2):157-164.

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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Harold Paz. Photo from SBU

Stony Brook University President Maurie McInnis has announced that Harold “Hal” Paz, M.D., M.S., currently Executive Vice President and chancellor for health affairs at The Ohio State University and Chief Executive Officer of the Ohio State Wexner Medical Center, has been named Executive Vice President for Health Sciences at Stony Brook University, effective Oct. 4.

Paz will report to President McInnis and is a member of her senior leadership team. As EVP for Health Sciences, he will work in partnership with academic, hospital and clinical leadership and with community partners to ensure the continued development of a premier academic medical center and health system.   

“Hal has a vision of growth for Stony Brook Medicine that integrates our clinical, educational, research and service missions,” said President Maurie McInnis. “In a time of great transformation in the health care and social environments, his distinct experience will enhance our position as a world-class leader in research and innovation.” 

“It is my privilege to join Stony Brook University during a time of strategic growth and tremendous opportunity,” said Paz. “Together with partners across the university and community, I believe we can set new standards for excellence in care, research, education and innovation.”            

Paz succeeds Dr. Kenneth Kaushansky, who retired from his position as Senior Vice President of the Health Sciences in June 2021.

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Suffolk County Legislators Sarah Anker and Al Krupski present a proclamation to Little Flower Children and Family Services for their service to the community. Photo from Leg. Anker's office

On Sept. 30, Suffolk County Legislator Sarah Anker and Suffolk County Legislator Al Krupski presented a proclamation to Little Flower Children and Family Services of Wading River and certificates of appreciation to each of the facility’s almost 300 staff members to thank them for working on the frontlines throughout the COVID-19 pandemic to ensure the children and families in the community were able to access much needed services. 

The legislators were joined by Corinne Hammons, President and CEO of Little Flower Children and Family Services; Erik M. Ulrich, LCSW-R, ACSW, Clinical Director, Medical and Mental Health Department; Michelle Segretto, Vice President of Residential Services; Lauren Mones, MSW, Interim Chief of Staff and Administrative Director Health Care Management and Services; Taressa Harry, Director of Communications; Steven Valentine, Maintenance Supervisor; Harold Dean, Superintendent of the Little Flower Union Free School District; and Barbara Kullen, Board of Directors Member outside at the Wading River Duck Pond for the presentation. 

“The COVID-19 pandemic has brought many challenges to our service providers, forcing them to adapt and find innovative ways to continue to service those in need,” said Leg. Anker. “Legislator Krupski and I would like to thank all the amazing staff at Little Flower that worked directly on the frontlines each day to provide our children and families with much needed support, at a time that they likely needed it the most.”

“The work that Little Flower does on a day to day, year to year basis is very important,” said Leg. Krupski. “Trying to function in the face of a global pandemic must have been very challenging. Thank you to Little Flower for their hard work, decision making and commitment to their goals. They have set a great example of courage and determination.”

“I am genuinely grateful to Legislator Anker and Legislator Krupski for taking the time to acknowledge and support Little Flower’s remarkable frontline workers and for recognizing the tough and heroic work they do every day in support of those we serve,” said President and CEO of Little Flower Children and Family Services Corinne Hammons. 

“They have demonstrated great dedication and commitment to our clients by showing up every day, leaving the safety of their homes, balancing the risk of the pandemic to provide care, comfort, and security. We are thankful and proud of our essential workers. They are the backbone of our organization and the heart of our mission, never missing a beat as they transform caring into action,” added Hammons. 

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METRO photo
Annual eye exams are crucial

By David Dunaief, M.D.

Dr. David Dunaief

Diabetic retinopathy is a frequent consequence of diabetes and is the number one cause of blindness in the U.S. among those 20 to 74 years old (1). Diabetic retinopathy (DR) is an umbrella term for microvascular complications of diabetes that can lead to blurred vision and blindness.

Among the risk factors for DR are diabetes duration, glucose (sugar) that is not well-controlled, smoking, high blood pressure, kidney disease, pregnancy and high cholesterol (2). As of 2019, only about 60 percent of people with diabetes had a recommended annual screening for DR (3). Herein lies the challenge, because the earlier you catch it, the more likely you will be able to prevent or limit permanent vision loss.

Over time, DR can lead to diabetic macular edema (DME). Its signature is swelling caused by extracellular fluid accumulating in the macula (4). The macula is the region of the eye with greatest visual acuity. An oval spot in the central portion of the retina, it is sensitive to light. When fluid builds up from leaking blood vessels, there is potential for vision loss.

Those with the longest duration of diabetes have the greatest risk of DME. Unfortunately, many patients are diagnosed with DME after it has already caused vision loss. If not treated early, patients can experience permanent damage (3).

In a cross-sectional study using NHANES data, among patients with DME, only 45 percent were told by a physician that diabetes had affected their eyes (5). Approximately 46 percent of patients reported that they had not been to a diabetic nurse educator, nutritionist or dietician in more than a year — or never.

The problem is that the symptoms of vision loss don’t necessarily occur until the latter stages of the disorder, often after it’s too late to reverse damage. According to the authors, there needs to be an awareness campaign about the importance of getting your eyes examined on an annual basis if you have diabetes.

Treatment options

While DME has traditionally been treated with lasers, intravitreal (intraocular — within the eye) injections of anti-VEGF medications may be more effective. These work by inhibiting overproduction of a protein called vascular endothelial growth factor (VEGF), which contributes to DR and DME (6).

The results from a randomized controlled trial, the gold standard of studies, showed that intravitreal (delivery directly into the eye) injections with ranibizumab (Lucentis), whether given prompt laser treatments or treatments delayed for at least 24 weeks, were equally effective in treating DME (7). Other anti-VEGF drugs include aflibercept (Eylea) and bevacizumab (Avastin).

Some diabetes drugs increase risk

You would think that using medications to treat type 2 diabetes would prevent DME from occurring as well. However, in the THIN trial, a retrospective study, a class of diabetes drugs, thiazolidinediones, which includes Avandia and Actos, actually increased the occurrence of DME compared to those who did not use these oral medications (8). Those receiving these drugs had a 1.3 percent incidence of DME at year one, whereas those who did not had a 0.2 percent incidence. This incidence was persistent through the 10 years of follow-up. Note that DME is not the only side effect of these drugs. There are important FDA warnings of other significant issues.

To make matters worse, those who received both thiazolidinediones and insulin had an even greater incidence of DME. There were 103,000 diabetes patients reviewed in this trial. It was unclear whether the drugs, because they were second-line treatments, or the severity of the diabetes itself may have caused these findings.

This is in contrast to a previous ACCORD eye sub-study, a cross-sectional analysis, which did not show an association between thiazolidinediones and DME (9). This study involved review of 3,473 participants who had photographs taken of the fundus (the back of the eye).

What does this ultimately mean? Both of these studies were not without weaknesses. It was not clear how long the patients had been using the thiazolidinediones in either study or whether their sugars were controlled and to what degree. The researchers were also unable to control for all other possible confounding factors (10). Thus, there needs to be more study done to sort out these results.

Glucose control and diet

The risk of progression of diabetic retinopathy was significantly lower with intensive blood sugar controls using medications, one of the few positive highlights of the ACCORD trial (11). Medication-induced intensive blood sugar control also resulted in increased mortality and no significant change in cardiovascular events. But an inference can be made: A nutrient-dense, plant-based diet that intensively controls blood sugar is likely to decrease the risk of diabetic retinopathy and further vision complications (12, 13).

The best way to avoid diabetic retinopathy and DME is obviously to prevent diabetes. Barring that, it’s to have sugars well-controlled. If you or someone you know has diabetes, it is imperative that they get a yearly eye exam from an ophthalmologist so that diabetic retinopathy is detected as early as possible, before permanent vision loss occurs. It is especially important for those diabetes patients who are taking the oral diabetes class thiazolidinediones.

References:

(1) cdc.gov. (2) JAMA. 2010;304:649-656. (3) www.aao.org/ppp. (4) www.uptodate.com. (5) JAMA Ophthalmol. 2014;132:168-173. (6) Community Eye Health. 2014; 27(87): 44–46. (7) ASRS. Presented 2014 Aug. 11. (8) Arch Intern Med. 2012;172:1005-1011. (9) Arch Ophthalmol. 2010 March;128:312-318. (10) Arch Intern Med. 2012;172:1011-1013. (11) www.nei.nih.gov. (12) OJPM. 2012;2:364-371. (13) Am J Clin Nutr. 2009;89:1588S-1596S.

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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