Lifestyles

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.

Making a difference together

By Heidi Sutton

Visit the Port Jefferson Free Library table at the 2018 Green Fest

Seeking to promote an eco-friendly environment and a “greener” lifestyle, the Greater Port Jefferson Chamber of Commerce will sponsor its 10th annual Green Fest on Saturday,  June 16 from 1 to 5 p.m.

The free event will once again be held at the Port Jefferson Village Center at 101 East Broadway — a most fitting venue as the community hub is the result of a recycling/renovation of the historic Bayles Shipyard Building — and will feature green market vendors throughout the first floor and outside if the weather is nice.

The annual festival began a decade ago with the goal to educate, inform, entertain and enlighten people on how to make smart choices for a greener world including being energy conscious as a way to reduce our carbon footprint.

Quality Shredding will be at the event.

This year’s highlight will be a community shredding event from 1 to 3:30 p.m. by Quality Shredding of Deer Park. “We wanted to make more of an impact and add another dimension to the event,” said Barbara Ransome, director of operations at the chamber. Residents and visitors can bring up to three bags or boxes of personal papers per person to be shredded for free. The mobile truck is capable of shredding up to 10,000 pounds of personal paper.

Entertainment will include a yoga class by Satya Yoga & Pilates Studio in Mount Sinai (mats will be provided), two spiritual drumming circles with shamanic drummer Peter Maniscalco and a performance by improvisational solo street guitarist Jeff Bellanca of Classic Jam  1. 

Children will enjoy visiting the Port Jefferson Free Library’s Green Teens table to make a craft using recycled materials and the Sweetbriar Nature Center’s table to see their resident critters. And if your stomach starts rumbling during the event, visit the Sweet Melissa 1932 Farm to Table food truck, specializing in organic nutritional cuisine.

SERVPRO of Port Jefferson will return to the festival this year.

Of course, no festival is complete without a diverse group of over 20 select vendors highlighting green products and services including renewable solar energy, electric/hybrid and smart cars, electric bikes with live demonstrations along with a mini-farmers market offering candles, flowers, plants, soaps, yarn and baked goods for sale. 

With so much going on, this family-friendly event is a great way to kick off the summer. Come on down and enjoy the day learning about methods that promote sustainable ways of living that will benefit our environment and planet and make our community a healthier place to live. The first 100 attendees will receive a free canvas bag, courtesy of SERVPRO of Port Jefferson. Making a difference begins with one small step (or fest) at a time.

Co-sponsored by Times Beacon Record News Media, Maggio Environmental Services and SERVPRO of Port Jefferson, the event will be held rain or shine. For more information, call 631-473-1414 or visit www.portjeffgreenfest.com.

Photos courtesy of PJCC

A ribbon cutting kicks off last year's event. Photo by Alex Petroski

Spring has sprung and that means it’s time for the Greater Port Jefferson Chamber of Commerce’s annual Health & Wellness Fest. Celebrating its ninth year, the event returns to the Earl L. Vandermeulen High School, 350 Old Post Road, Port Jefferson on Saturday, April 28 from 9 a.m. to 1 p.m.  

Sample healthy snacks at the event.
Photo by Alex Petroski

Visitors to the free event will enjoy healthy food samples at a food court sponsored by St. Charles Hospital. Their new executive chef Thomas Mulzoff along with dietitians, nutritionists and staff will be on hand to assist hungry attendees and answer questions about healthy eating and diet. A nutritional menu will be offered with a variety of breakfast and lunch items including delicious multigrain breakfast parfaits, strawberry oat bars, tacos two ways (turkey carnitas and freekeh), white bean guacamole and chocolate hummus.So bring you appetite and enjoy great tasting food that is healthy for you!

The selection of health professionals and organizations is extensive, and information will be given out about supporting healthy lifestyles. Members of the Suffolk County Sheriff’s Office will be on hand to speak about their sponsored Yellow Dot Program, a free service designed to help first responders provide life-saving medical attention during that first “golden hour” after a crash or other emergency. A yellow dot in the driver’s-side rear window of your vehicle will alert first responders that vital medical information is stored in the glove compartment. In addition there will be representatives from alternative residential communities, health practitioners and low-cost health insurance plans and programs.   

There will be lots of free giveaways at the event.
Photo by Alex Petroski

Attendees also will have the benefit of many free giveaways and screenings that are so important for good health including blood pressure, body mass index (BMI) screening, glucose, lung cancer, colorectal cancer, otoscopy for cerumen (earwax), hearing, cholesterol, balance and fall prevention and posture.

If this was not enough, there will be many activities to engage in! If you like yoga why not join yoga master Diane McDonald, a life transition coach and yoga teacher, in a short mini-yoga class that will introduce you to the therapeutic benefits of physical, mental and spiritual practices.

How about visiting with licensed, registered and board-certified art therapists? Art therapy allows older adults to be creative and allows them to be reached in a way that promotes a unique form of mental health treatment. And let’s not forget man’s best friend. Learn about healthy food for your pets including Natural Hounds, which offers human-grade wet food, preportioned, nourishing dog treats tailored to your dog’s individual needs.   

New this year

Stop by the Port Jefferson Free Library table for some fun! Photo by Alex Petroski

What’s friendly, furry and can be in the room with grieving families? A trained service dog that specializes in grief therapy. Owned by Peter Moloney of Moloney Funeral Homes, Koda, a 2½-year-old black Lab Weimaraner mix, comes to the funeral home where people pet him and he shows affection to those who want it. He is the first grief therapy dog on Long Island. Come meet Koda at the Health & Wellness Fest.

A special tai chi demonstration will take place at 11:30 a.m., performed by the Authentic Shaolin Kung Fu School of Holtsville. See how these internal Chinese martial arts can be practiced for both their defense training and their health benefits through the forces of yin and yang. After the demonstration attendees will be asked to join in! 

Other activities will include pilates demonstrations by Port Jefferson Pilates located in Port Jefferson Village. Pilates is a physical fitness system developed in the early 20th century and has shown that regular sessions can help muscle conditioning in healthy adults, when compared to doing no exercise.

Don’t forget to stop by the Port Jefferson Free Library table for free giveaways, puzzle solving, coloring for all ages and brain games! Solve a riddle and win a puzzle, while supplies last. Island Christian Church members will have face painting and balloon time with additional children’s activities as well.

Family Fun Run

The Health & Wellness Fest has partnered with the Royal Educational Foundation of Port Jefferson, which will be celebrating its fifth annual Power of One Family Fun Run on April 28 as well. 

The event is designed to encourage physical activity and is intended to celebrate the positive influence we can have on one another within our families and community. Whether you wish to walk or run, the 2-mile course is open to all ages.

Christian Neubert, a Port Jefferson Schools music teacher, volunteer fireman and Port Jefferson Library trustee will be honored with the Power of One Award for his significant positive impact on the village and school community. The proceeds of this fundraiser will be used to enhance the quality of education in the Port Jefferson School District. 

The run begins at 8 a.m. at the Port Jefferson Village Center, at 101A East Broadway, continues through the streets of Port Jefferson Village, and ends at the high school where runners are welcome to visit the health fest. 

You may register by downloading the registration form at www.pjref.com (click on the Power of One Fun Run tab). You may also register the day of the run between 7:30 and 8 a.m. at the Village Center. Advanced registrants need to check in no later than 8:15 a.m.  

—————————————————————————————————————————–

The Greater Port Jefferson Chamber of Commerce’s 9th annual Health & Wellness Fest has something for the entire family. Mark your calendar now. When you finish attending the fest, visit the downtown business community for its first Port Jefferson Sidewalk Sale Days event from 1 to 5 p.m. Shop at over 20 different retailers throughout the heart of the village. If you are lucky you might win one of the two door prizes that will be raffled off at the fest, each having $250 worth of gift certificates to our local merchants in support of the Port Jefferson Retailers Association. 

For more information, please visit www.portjeffhealth.com.

Lower triglycerides may reduce cardiovascular risk

By David Dunaief, M.D.

Dr. David Dunaief

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

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

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

HDL — the good cholesterol that may not be so good

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

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

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

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

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

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

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

Triglycerides should get their due

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

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

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

What about whole eggs? Good, bad or neutral?

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

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

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

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

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

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

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

By Ernestine Franco

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

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

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

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

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

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

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

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

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

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

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

By Cathy DeAngelo

What with the baby boomer generation aging, more people than ever are reconsidering many factors in their lifestyle … and one of the most important is deciding where to live. We all age and deciding whether and/or where to move when it’s time to downsize is a process that requires thought and planning.

Finding the right retirement community or next step is about asking the right questions. That process starts with a careful consideration of your individual needs and desires. While this exercise can present its challenges, it can also be exciting to imagine a new phase of life that isn’t dictated by a work schedule and an alarm clock.

The best time to begin planning and discuss with your spouse and/or family members is while you’re still working. It takes time to figure out where you’ll want to be. There are many options out there. The more you learn about what’s available and what each has to offer, the easier your decision will be. You don’t want to be pressed to make a choice when you unexpectedly have a need.

For starters, the following are 10 questions to consider:

What kind of retirement lifestyle do I envision?

What is my budget?

What is my current health status?

What do I want to continue to do/what do I not want to do?

What will I not be able to do?

What kinds of activities interest me?

Where do I want to be -— near family, in my familiar community?

City, country, suburbs?

What kind of people do I want to be with?

What amenities would I like?

How much space do I need?

It’s important to be realistic with your answers. For example, if you have health issues now, it’s highly likely that you’re going to have more in 10 years. You have to be honest about the barriers to things you want to do now, and how will you manage those challenges later in life. Look around the house and ask what do I want … and what can I do without?

If you’re considering buying a retirement home, look beyond the real estate to the services that come with it or are nearby, as these services will be important down the road. For example, a 55-plus community that suits your lifestyle at age 60 or 65 may not have the services to support you after age 75 or 80. You’ll want to have access to a range of activities and an easy way to get to them, convenient shopping and health services, as well as have other support systems in place.

Popular options include lifecare retirement communities like Jefferson’s Ferry that enable residents to age in place, with independent living, assisted living and skilled nursing facilities available at one site; assisted living facilities that offer rooms and apartments; independent living senior living communities; condominiums and shared space with family members, to name a few.

Most of us need people to thrive. And not just those to assist us with things we’re no longer able to do, but to engage our interests and be our friends and companions. Having more time to do the things you like and enjoy the company of old and new friends and family is a wonderful gift. The best retirement plan takes into consideration each individual’s specific needs and preferences. Considering these factors ahead of time will make the decision that much less overwhelming. Take the step … and create that plan!

Cathy DeAngelo is the director of sales and marketing at Jefferson’s Ferry Lifecare Retirement Community in South Setauket.

Pat and Dennis Statuch of Port Jefferson hold "Turning Tides," by oil panter Jim Molloy, which they won at the Setauket Artists' Exhibition raffle.
Barbara and Les Wuerfl of Stony Brook hold their new painting "Welcome to the Party" by Irene Ruddock, which they won at the Setauket Artists' Exhibition raffle.
Barbara and Les Wuerfl of Stony Brook hold their new painting “Welcome to the Party” by Irene Ruddock, which they won at the Setauket Artists’ Exhibition raffle.

The Setauket Exhibition raffle winners are Barbara and Les Wuerfl of Stony Brook, who won the painting “Welcome to the Party” by exhibit coordinator, Irene Ruddock; and Pat and Dennis Statuch of Port Jefferson, now proud owners of “Turning Tides” by oil painter Jim Molloy. Congratulations!

A diet rich in fruits, vegetables, beans, nuts and oily fish may prevent breast cancer. Stock photo

By David Dunaief, M.D.

NFL players are wearing pink shoes and other sportswear this month, making a fashion statement to highlight Breast Cancer Awareness Month. This awareness is critical since annual invasive breast cancer incidence in the U.S. is 246,000 new cases, with approximately 40,000 patients dying from this disease each year (1). The good news is that from 1997 to 2008 there was a trend toward decreased incidence by 1.8 percent (2).

We can all agree that screening has merit. The commercials during NFL games tout that women in their 30s and early 40s have discovered breast cancer with a mammogram, usually after a lump was detected. Does this mean we should be screening earlier? Screening guidelines are based on the general population that is considered “healthy,” meaning no lumps were found, nor is there a personal or family history of breast cancer.

All guidelines hinge on the belief that mammograms are important, but at what age? Here is where divergence occurs; experts can’t agree on age and frequency. The U.S. Preventive Services Task Force recommends mammograms starting at 50 years old, after which time they should be done every other year (3). The American College of Obstetricians and Gynecologists recommends mammograms start at 40 years old and be done annually (4). Your decision should be based on a discussion with your physician.

The best way to treat breast cancer — and just as important as screening — is prevention, whether it is primary, preventing the disease from occurring, or secondary, preventing recurrence. We are always looking for ways to minimize risk. What are some potential ways of doing this? These may include lifestyle modifications, such as diet, exercise, obesity treatment and normalizing cholesterol levels. Additionally, although results are mixed, it seems that bisphosphonates do not reduce the risk of breast cancer nor its recurrence. Let’s look at the evidence.

Bisphosphonates

Bisphosphonates include Fosamax (alendronate), Zometa (zoledronic acid) and Boniva (ibandronate) used to treat osteoporosis. Do they have a role in breast cancer prevention? It depends on the population, and it depends on study quality.

In a meta-analysis involving two randomized controlled trials, results showed there was no benefit from the use of bisphosphonates in reducing breast cancer risk (5). The population used in this study involved postmenopausal women who had osteoporosis, but who did not have a personal history of breast cancer. In other words, the bisphosphonates were being used for primary prevention.

The study was prompted by previous studies that have shown antitumor effects with this class of drugs. This analysis involved over 14,000 women ranging in age from 55 to 89. The two trials were FIT and HORIZON-PFT, with durations of 3.8 and 2.8 years, respectively. The FIT study involved alendronate and the HORIZON-PFT study involved zoledronic acid, with these drugs compared to placebo. The researchers concluded that the data were not evident for the use of bisphosphonates in primary prevention of invasive breast cancer.

In a previous meta-analysis of two observational studies from the Women’s Health Initiative, results showed that bisphosphonates did indeed reduce the risk of invasive breast cancer in patients by as much as 32 percent (6). These results were statistically significant. However, there was an increase in risk of ductal carcinoma in situ (precancer cases) that was not explainable. These studies included over 150,000 patients with no breast cancer history. The patient type was similar to that used in the more current trial mentioned above. According to the authors, this suggested that bisphosphonates may have an antitumor effect. But not so fast!

The disparity in the above two bisphosphonate studies has to do with trial type. Randomized controlled trials are better designed than observational trials. Therefore, it is more likely that bisphosphonates do not work in reducing breast cancer risk in patients without a history of breast cancer or, in other words, in primary prevention.

In a third study, a meta-analysis (group of 36 post-hoc analyses — after trials were previously concluded) using bisphosphonates, results showed that zoledronic acid significantly reduced mortality risk, by as much as 17 percent, in those patients with early breast cancer (7). This benefit was seen in postmenopausal women but not in premenopausal women. The difference between this study and the previous study was the population. This was a trial for secondary prevention, where patients had a personal history of cancer.

However, in a RCT, the results showed that those with early breast cancer did not benefit overall from zoledronic acid in conjunction with standard treatments for this disease (8). The moral of the story: RCTs are needed to confirm results, and they don’t always coincide with other studies.

Exercise

We know exercise is important in diseases and breast cancer is no exception. In an observational trial, exercise reduced breast cancer risk in postmenopausal women significantly (9). These women exercised moderately; they walked four hours a week. The researchers stressed that it is never too late to exercise, since the effect was seen over four years. If they exercised previously, but not recently, for instance, five to nine years ago, no benefit was seen.

To make matters worse, only about one-third of women get the recommended level of exercise every week: 30 minutes for five days a week. Once diagnosed with breast cancer, women tend to exercise less, not more. The NFL, which does an admirable job of highlighting Breast Cancer Awareness Month, should go a step further and focus on the importance of exercise to prevent breast cancer or its recurrence, much as it has done to help motivate kids to exercise with it Play 60 campaign.

Soy intake

Contrary to popular belief, soy may be beneficial in reducing breast cancer risk. In a meta-analysis (a group of eight observational studies), those who consumed more soy saw a significant reduction in breast cancer compared to those who consumed less (10). There was a dose-response curve among three groups: high intake of >20 mg per day, moderate intake of 10 mg and low intake of <5 mg.

Those in the highest group had a 29 percent reduced risk, and those in the moderate group had a 12 percent reduced risk, when compared to those who consumed the least. Why have we not seen this in U.S. trials? The level of soy used in U.S. trials is a fraction of what is used in Asian trials. The benefit from soy is thought to come from isoflavones, plant-rich nutrients.

Western vs. Mediterranean diets

A Mediterranean diet may decrease the risk of breast cancer significantly.
A Mediterranean diet may decrease the risk of breast cancer significantly.

In an observational study, results showed that, while the Western diet increases breast cancer risk by 46 percent, the Spanish Mediterranean diet has the inverse effect, decreasing risk by 44 percent (11). The effect of the Mediterranean diet was even more powerful in triple-negative tumors, which tend to be difficult to treat. The authors concluded that diets rich in fruits, vegetables, beans, nuts and oily fish were potentially beneficial.

Hooray for Breast Cancer Awareness Month stressing the importance of mammographies and breast self-exams. However, we need to give significantly more attention to prevention of breast cancer and its recurrence. Through potentially more soy intake, as well as a Mediterranean diet and modest exercise, we may be able to accelerate the trend toward a lower breast cancer incidence.

References: (1) breastcancer.org. (2) J Natl Cancer Inst. 2011;103:714-736. (3) Ann Intern Med. 2009;151:716-726. (4) Obstet Gynecol. 2011;118:372-382. (5) JAMA Inter Med online. 2014 Aug. 11. (6) J Clin Oncol. 2010;28:3582-3590. (7) 2013 SABCS: Abstract S4-07. (8) Lancet Oncol. 2014;15:997-1006. (9) Cancer Epidemiol Biomarkers Prev online. 2014 Aug. 11. (10) Br J Cancer. 2008;98:9-14. (11) Br J Cancer. 2014;111:1454-1462.

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.

By losing just 10 pounds, you can prevent deadly illness, alleviate daily pain and improve your quality of life. Stock photo

By David Dunaief, M.D.

Some research shows that obesity may be reaching a plateau. Is this true? It depends on how the data is analyzed. According to one study, yes; it has plateaued when looking at short, two-year periods from 2003 to 2011 (1).

However, another published study shows a picture that is not as positive (2). The study’s authors believe obesity has not plateaued; when looking over a longer period of time, statistics suggest that obesity has reached a new milestone. There are now more obese patients in the United States than there are overweight patients. And no, it is not because we have fewer overweight patients. This is based on a study that reviewed data from the National Health and Nutrition Examination Survey (NHANES). These results were in adults over the age of 20. This should be an eye-opener.

Unfortunately, according to one study, the probability is not very good for someone to go from obese to “normal” weight in terms of body mass index (3). In this observational trial, results show that an obese man has a 0.5 percent chance of achieving normal weight, while a woman has a slightly better chance, 1 percent. This study used data from the UK Clinical Practice Datalink. The data were still not great for men and women trying to achieve at least a 5 percent weight loss, but better than the prior data. Patients who were more obese actually had an easier time losing 5 percent of their body weight.

What are two major problems with being obese? One, obesity is a disease in and of itself, as noted by the American Medical Association in 2013 (4). Two, obesity is associated with — and is even potentially a significant contributor to — many chronic diseases such as cardiovascular disease (heart disease and stroke), high blood pressure, high cholesterol, atrial fibrillation, diabetes, cancer, cognitive decline and dementia. When I attended the 28th Blackburn Course in Obesity Medicine in June 2015 at Harvard Medical School, a panel of experts noted that there are over 180 chronic diseases associated with obesity.

In this article, we will focus on one significant multifaceted disease, cancer. Watch out for cancer One of the more unpredictable diseases to treat is cancer.

What are the risk factors?

Beyond family history and personal history, obesity seems to be important. In fact, obesity may be a direct contributor to 4 percent of cancer in men and 7 percent of cancer in women (5). This translates into 84,000 cases per year (6). On top of these stunning statistics, there is about a 50 percent increased risk of death associated with cancer patients who are obese compared to those with normal BMIs (7).

What about with breast cancer?

The story may be surprising and disappointing. According to an analysis of the Women’s Health Initiative, those who were obese had increased risks of invasive breast cancer and of death once the diagnosis was made (8). The severity of the breast cancer and its complications were directly related to the severity of the obesity. There was a 58 percent increased risk of advanced breast cancer in those with a BMI of >35 kg/m2 versus those with normal BMI of <25 kg/m2. And this obese group also had a strong association with estrogen-receptor-positive breast cancer.

However, those who lost weight did not reduce their risk of breast cancer during the study. There were 67,000 postmenopausal women between the ages of 50 and 79 involved in this prospective (forward-looking) study. The researchers do not know why patients who lost weight did not reduce their risk profile for cancer and suggest the need for further studies. This does not imply that lifestyle changes do not have a beneficial impact on breast cancer.

What can we do?

We find that fat is not an inert or static substance, far from it. Fat contains adipokines, cell-signaling (communicating) proteins that ultimately may release inflammatory factors in those who have excessive fat. Inflammation increases the risk of tumor development and growth (9).

There is a potentially simple step that obese cancer patients may be able to take — the addition of vitamin D. In a study in older overweight women, those who lost weight and received vitamin D supplementation were more likely to reduce inflammatory factor IL-6 than those who had weight loss without supplementation (10). This was only the case if the women were vitamin D insufficient. This means blood levels were between 10 and 32 ng/mL to receive vitamin D.

Interestingly, it has been suggested that overweight patients are more likely to have low levels of vitamin D, since it gets sequestered in the fat cells and, thus, may reduce its bioavailability. Weight loss helps reduce inflammation, but the authors also surmise that it may also help release sequestered vitamin D. The duration of this randomized controlled trial, the gold standard of studies, was one year, involving 218 postmenopausal women with a mean age of 59.

All of the women were placed on lifestyle modifications involving diet and exercise. The treatment group received 2,000 IU of vitamin D3 daily. Those women who received vitamin D3 and lost 5 to 10 percent of body weight reduced their inflammation more than those in the vitamin D group who did not lose weight.

What does medicine have to offer?

There are a host of options ranging from lifestyle modifications to medications to medical devices to bariatric surgery. In 2015, the FDA approved two medical devices that are intragastric (stomach) balloons (11). The balloons are filled with 500 mL of saline after inserting them in the stomach via upper endoscopy. They need to be removed after six months, but they give the sense of being satiated more easily and help with weight loss.

One, the ReShape Dual Balloon, is intended to go hand-in-hand with diet and exercise. It is meant for obese patients with a BMI of 30-40 kg/m2 and a comorbidity, such as diabetes, who have failed to lose weight through diet and exercise. In a randomized controlled trial involving 326 obese patients, those who received the balloon insertion lost an average of 14.3 lb in six months, compared 7.2 lb for those who underwent a sham operation.

Lifestyle modifications

In an ode to lifestyle modifications, a study of type 2 diabetes patients showed that diet helped reduce weight, while exercise helped maintain weight loss for five years. In this trial, 53 percent of patients who had initially lost 23 lb (9 percent of body weight) over 12 weeks and maintained it over one year were able to continue to maintain this weight loss and preserve muscle mass through diet and exercise over five years (12). They also benefited from a reduction in cardiovascular risk factors. In the initial 12-week period, the patients’ HbA1C was reduced from 7.5 to 6.5 percent, along with a 50 percent reduction in medications.

We know that obesity is overwhelming. It’s difficult to lose weight and even harder to reach a normal weight; however, the benefits far outweigh the risks of remaining obese. Lifestyle modifications are a must that should be discussed with your doctor. In addition, there are a range of procedures available to either help jump start the process, to accelerate progress or to help maintain your desired weight.

References: (1) JAMA 2014;311:806-814. (2) JAMA Intern Med 2015;175(8):1412-1413. (3) Am J Public Health 2015;105(9):e54-59. (4) ama-assn.org. (6) cancer.gov/cancertopics/factsheet/risk/obesity. (7) N Engl J Med 2003;348:1625-1638. (8) JAMA Oncol online June 11, 2015. (9) Clin Endocrinol 2015;83(2):147-156. (10) Cancer Prev Res 2015;8(7):1-8. (11) fda.gov. (12) ADA 2015 Abstract 58-OR.

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.

Lemon Tea Bread

Lemon Tea Bread

Lemony herbs and lemon juice give this bread its flavor.

YIELD: Makes one loaf

INGREDIENTS:

3/4 cup milk

1 tablespoon finely chopped lemon balm

1 tablespoon finely chopped lemon thyme, and/or 1 tablespoon finely chopped lemon verbena

2 cups all-purpose flour

1 1/2 teaspoons baking powder

1/4 teaspoon salt

6 tablespoons butter or margarine, at room temperature

1 cup sugar

2 eggs

1 1/2 tablespoons grated lemon zest

Juice of two lemons

Confectioners’ sugar

DIRECTIONS: Preheat oven to 325 F. Butter a 9- by 5-inch 3-inch-deep pan. Heat milk gently with herbs, set aside and let cool. Mix the flour, baking powder and salt together in a bowl. In another bowl, cream butter and sugar until light and fluffy. Add the eggs, one at a time, beating well after each. Add the lemon zest. Gently fold in flour alternately with the herbed milk, until the batter is blended. Put the batter into the prepared pan. Bake for about 50 minutes or until a toothpick inserted in the center comes out dry. Remove from pan onto wire rack that is set over waxed paper. Pour lemon glaze (juice of two lemons and 2/3 cup confectioners’ sugar) over the still-hot bread. Garnish with some freshly grated zest.

Lavender Olive Oil Cake with Honeyed Ricotta

The lavender honey gives this cake a fresh, slightly floral aroma, but you can try using different types of honey in this recipe to subtly vary the flavor.

YIELD: 8 to 10 servings

INGREDIENTS:

Pillsbury Baking Spray with Flour

1 3/4 cups Pillsbury BEST All Purpose Flour

1 1/2 teaspoons baking powder

1/2 teaspoon kosher salt

1 cup sugar

1 tablespoon finely grated orange peel

1 tablespoon culinary lavender, crushed, plus additional 1 to 2 tablespoons for garnish

1/4 teaspoon freshly ground black pepper

2/3 cup plain yogurt

3 large eggs

2/3 cup Crisco Pure Olive Oil

1 teaspoon vanilla extract

3/4 cup heavy cream

3 tablespoons honey

3/4 cup ricotta cheese, at room temperature

DIRECTIONS: Heat oven to 350 F. Spray a 9- by 5-inch loaf pan generously with baking spray; set aside. Combine flour, baking powder and salt in a small bowl. Whisk together sugar, orange peel, lavender and pepper in a large mixing bowl until evenly distributed. Add yogurt, eggs and olive oil; continue whisking until smooth. Whisk in vanilla. Add flour mixture and gently whisk in until just combined. Scrape batter into prepared pan. Bake 55 minutes or until a toothpick inserted in center comes out clean. Cool in pan 5 minutes; remove from pan and cool completely. Whip cream with an electric mixer until soft peaks form. Add honey and continue to whip until stiff. Add ricotta, a dollop at a time, and beat until fluffy. Slice cake. Top slices with honeyed ricotta cheese and sprinkle with lavender.

 

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