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Sticking to a plant-rich diet that can reduce high blood pressure. Stock photo
Call to arms to reverse high blood pressure, once and for all

By David Dunaief, M.D.

Dr. David Dunaief

Hypertension (high blood pressure) and COVID-19 are intertwined. Those who have hypertension are more susceptible to COVID-19 and are more likely to get a severe form and experience complications from the virus. A study done in China captured the statistics: of 1099 patients infected, 15 percent had hypertension, and of those with severe cases, 23.7 percent had hypertension (1). Ultimately, those with hypertension are at higher risk, but we don’t at this point understand the specifics of why.

Even before the COVID-19 pandemic, a recent study showed that the number of deaths from hypertension had increased a whopping 26 percent overall from 2007 to 2017 (2). 

What about medications to blunt the association? There is a THEORY, not a study, that angiotensin converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) may be harmful by increasing ACE2 in the lungs, which is a receptor that COVID-19 binds to; however, there is also a case for these medications having benefits (3). Do not stop or change your hypertension medications without talking to your doctor. Remember, this is just a theory, and theories are very dangerous; we don’t have research to support them, by definition (4).

I view this as a call to arms to control and, even more importantly, treat and reverse hypertension. Presently, only 54 percent of hypertension patients are controlled with medication (5). 

Potential to control and reverse hypertension through diet

We have the capability to treat and reverse hypertension with lifestyle modifications, including diet, exercise, sleep and stress management. We are going to focus on diet.

A whole foods plant-based diet (WFPBD) that is dark green leafy vegetable-rich has been shown to help prevent, control and possibly reverse hypertension. I call this the LIFE diet, which stands for Low Inflammatory Foods Everyday. The most researched type of WFPBD is the DASH (dietary approach to stopping hypertension) diet, which emphasizes fruits, vegetables, grains and reductions in saturated fats and total fat. DASH was the first randomized control trial to show that a predominantly whole food plant-based approach reduces blood pressure (6).

Why does diet have an effect? There are several factors, including inflammation; electrolytes, specifically sodium and potassium; and phytochemicals (plant nutrients and fiber content).

Why is inflammation so important?

Inflammation is a culprit in most chronic diseases, including hypertension. It also plays a crucial role in the severity of COVID-19. Those who take a turn for the worse in COVID-19 have high inflammation. On the news, an ER doctor noted that while COVID-19 patients may come in stable, they need to be watched carefully; in 3-24 hours, they could show high inflammation and fluid in their lungs and need to be on a ventilator.

There are several studies that show a direct relationship between high sensitivity C-reactive protein, one of the most well-studied biomarkers for inflammation, and hypertension in both men and women (7)(8). In the Physicians Health Study, those men who had high hsCRP (>3 mg/L) and hypertension had a 40 percent increased risk of stroke compared to those without hypertension and with hsCRP <1, which is optimal. Not to leave women out, the CARDIA study found that premenopausal women with elevated hsCRP were significantly more likely to have hypertension.

How can we decrease inflammation?

Anti-inflammatory drugs, including NSAIDS like ibuprofen, may suppress the immune system and make patients more susceptible to COVID-19. They also worsen hypertension and may increase the risk for cardiovascular events, such as a heart attack. In fact, prescription NSAIDS carry an FDA black box warning about this dangerous side effect. Anti-inflammatory drugs should not be the “go-to” solution.

Fortunately, a WFPBD is associated with reduction in inflammation, specifically hsCRP. We recently published a study showing that the LIFE diet has an inverse relationship between blood levels of beta carotene, a phytonutrient, and hsCRP (9). As you increase the intake of dark green leafy vegetables, the higher the beta carotene and the lower the hsCRP. There was a 75 percent reduction in inflammation with those that increased their beta carotene over the normal level compared to those who were non-adherent. The DASH diet also emphasizes an increased intake of vegetables.

There are studies to suggest that, as we lower animal protein intake, we are able to better reduce blood pressure. In the EPIC study, those who at who reduced animal protein to none had the biggest impact on blood pressure. This study compared meat-eaters, fish-eaters, vegetarians and vegans (10). 

Electrolytes – sodium and potassium

The optimal approach for these electrolytes is to have a sodium to potassium ratio that is less than one. For most, this means consuming less sodium and more potassium (11). The American Heart Association emphasizes low sodium, less than 1500 mg of sodium per day and higher potassium intake (12). 

What I find in my practice is that blood levels that are south of 140 mmol/L are better and that the bottom of the range is ideal; the range is between 135-145 mmol/L. This way, whether you are sodium-sensitive or not, you can either help control blood pressure or rule it out as a factor. Potassium should be 4.5 (units) or higher. These electrolytes should come from vegetables, especially dark green leafy vegetables, which have a natural balance of potassium and sodium. Other good sources of potassium are beans and nuts.

Ultimately, the power is in your hands. By changing your diet to one that is more plant-based and vegetable-rich, you can reduce inflammation, strengthen your immune system, possibly reduce or even get off anti-hypertension medications, reverse the trend of dying from hypertension, and reduce your susceptibility to severe COVID-19.

References:

(1) N Engl J Med. Online Feb 28, 2020. (2) J Am Coll Cardiol. Online March 19, 2020). (3) Nephron. Online Mar 23, 2020.) (4) Nature. Feb 2020, 579:270–273. (5) Circulation. 2016;133:e38–e360. (6) N Engl J Med. 1997 Apr 17; 336(16):1117-24. (7) JAMA.2015 Sep:4(9):e002073 (8) Menopause. 2016 Jun; 23(6):662. (9) AJLM Online. Dec. 21, 2019. (10) Oybkuc Gektg Bytr, 2002 Oct; 5(5):645-54. (11) Circulation Online. Oct 11 2017. (12) heart.org.

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

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Linda Toga, Esq.

By Linda Toga, Esq.

THE FACTS: For months now I have been meaning to schedule an appointment with an estate planning attorney to discuss my wishes with respect to a will, healthcare proxy and power of attorney. I have a lot of questions and really need some guidance as to what I should do and how I can best ensure that my wishes will be honored. Since the onset of the coronavirus crisis, I have been losing sleep over the fact that I do not have an estate plan in place. 

THE QUESTION: Now that law offices are closed and social distancing is a reality, is there anything I can do to move my estate planning process along? 

THE ANSWER: While estate planning is extremely important, at this point in time it is more important that you do your part to avoid the spread of the virus. I urge you to stay at home to the extent possible and, if you do leave the house, to be sure to wipe down frequently used surfaces, wash your hands often and follow the guidelines set by the government for social distancing. 

That being said, while you are at home, you can certainly give some thought to your estate plan and gather the information that will be needed in order for your estate planning documents to be prepared. Although I am not in my office on a regular basis, I am continuing to work with both current and new clients by phone and email. 

While personal contact may not be an option at this time, a great deal can be accomplished remotely and I welcome the opportunity to discuss with you your concerns and wishes. Also, it should be noted that the legislators in Albany and the New York State Bar Association are considering changes to the law that would allow for remote execution and witnessing of estate planning documents during this crisis. 

In the meantime, you should give some thought to who you want to name as your agent or agents in your advanced directives such as your power of attorney and healthcare proxy. It is a good idea to ask the people you are thinking of naming as your agents whether they are comfortable with acting in that capacity. Some people may not want to or may not feel they are capable of taking on the responsibility of handling your affairs or making end of life decisions on your behalf. 

While it is important for any agent that you name to know what your wishes are, it is absolutely critical that the person you name as your healthcare proxy be fully aware of the circumstances, if any, under which you may want certain types of treatments and/or procedures to be withheld.

Once you’ve decided on who you want to name as your agents and have discussed with those people your wishes, you should be sure you have the information such as the agents’ phone numbers and addresses that will be needed to prepare your advanced directives. 

In terms of your will, you should give some thought to what assets you have and what assets will pass under your will. Only assets owned by you individually as opposed to assets that are owned jointly, held in trust or subject to a beneficiary designation form will pass pursuant to your will. These assets are called probate assets. 

Once you have a handle on what assets are probate assets and what assets will pass outside your will, you can think about who the beneficiaries of your estate will be and if and how you want the assets divided. You should consider what will happen if a beneficiary predeceases you and whether you want assets to be distributed upon your death or held in trust for future distribution. In addition to how your probate assets will be distributed, think about who will handle your estate. At a minimum, you need to name an executor and a successor executor.

Although making decisions about who will serve as your agents and executor, what your wishes are with respect to end of life care and how your assets will be distributed may seem overwhelming, as I mentioned before, I am available by phone and via email to discuss with you the estate planning process and your unique circumstances. 

Once we have developed a plan, I will send you drafts of your estate planning documents for review. Hopefully by then a procedure will have been worked out for the remote execution and witnessing of your estate planning documents. If not, at least you will be ready to execute your documents in the presence of witnesses as soon as the restrictions that are currently in place are lifted.

In the meantime, I hope that the coronavirus crisis does not cause you or your loved ones undue stress or inconvenience and that you stay well. I look forward to hearing from you. 

Linda M. Toga, Esq provides legal services in the areas of estate planning and administration, real estate, small business services and litigation. She is available for email and phone consultations. Call 631-444-5605 or email Ms. Toga at Linda@LMTOGALAW.com. She will respond to messages and emails as quickly as possible. 

Blaze

MEET BLAZE!

This week’s shelter pet is Blaze, a seven-year-old male pit terrier at the Smithtown Animal Shelter. Blaze came to the shelter after being dumped in a county park, locked in a cage. However, he has truly begun to learn to love and trust his humans. This energetic good boy enjoys running around in the shelter’s dog park, eating treats, and when it’s hot out, splashing around in the pool! He can be a very loyal dog once he learns to trust you. 

Blaze knows his basic commands like sit, wait, give paw, and walks nicely on a leash. Blaze needs an adult-only home familiar with big breed dogs, without other pets. His ideal family will spend time giving him the love (and treats) that he deserves, understanding that he had a tough life before the shelter.

*Due to the health risk presented by the Covid-19 pandemic, there will be limited public access to the shelter. If you are interested in meeting Blaze, please fill out an adoption application online. Once you have an approved application, you may meet with Blaze outside. The Smithtown Animal & Adoption Shelter is located at 410 Middle Country Road, Smithtown. For more information, please call 631-360-7575.

Deviled Eggs with Smoked Salmon

By Barbara Beltrami

Times being what they are, I have chosen to more or less ignore the holidays specifically and tried to concentrate on comfort foods which often are the stuff of celebrations anyway. Because most of us are self-quarantined and keeping social distance even from extended family if they are not part of our household, I am focusing instead on the unique togetherness that we’ve come to experience these past few weeks. 

The addition of a festive ham or matzo balls is nice, even if it’s just the immediate family, but it’s the idea of being together around the table, getting reacquainted with ourselves, each other, home cooking and mealtime ritual that supersedes even the most traditional and festive of dishes, that turns the cooking and partaking of even the most ordinary and mundane dishes into a special occasion. In that spirit I hope that you all will make this a time to not just eat together, but plan a menu and cook collaboratively because we can all forgo many things, but not food. 

So if we’re all in this together, we might as well do it and enjoy it together. The following are a few of my favorite recipes that I think make any dinner special.

Deviled Eggs with Smoked Salmon

Deviled Eggs with Smoked Salmon

YIELD: Makes 12 servings

INGREDIENTS:

6 large hard-boiled eggs

4 ounces Nova Scotia smoked salmon, minced

1/3 cup snipped chives

1/4 cup mayonnaise

2 tablespoons minced red onion

2 tablespoons capers, rinsed, drained and minced

2 tablespoons minced fennel

1 tablespoon freshly squeezed lemon juice

1 teaspoon finely grated lemon zest

Freshly ground black pepper to taste

1 1/2 tablespoons chopped fresh dill

DIRECTIONS: 

Halve eggs lengthwise; place on plate and gently scoop out yolks. Place yolks in a medium bowl and mash. Add salmon, chives, mayonnaise, onion, capers, fennel, lemon juice, lemon zest and pepper. With wooden spoon, vigorously beat to combine. Heap mixture in cavities of egg whites; sprinkle with dill; cover and refrigerate until ready to serve. Serve with cocktails or wine.

Zucchini Ribbons with Artichoke Hearts and Cherry Tomatoes

YIELD: Makes 4 servings

INGREDIENTS:

2 pounds yellow and green zucchini

1/4 cup extra virgin olive oil

Coarse salt and freshly ground black pepper to taste

One 14-ounce can artichoke hearts, drained and diced

1/2 pint cherry tomatoes, quartered

One handful flat leaf parsley, and minced

Freshly grated Parmesan cheese (optional)

DIRECTIONS:

Using a vegetable peeler cut the zucchini into lengthwise ribbons from all sides; when you get to the seeds, stop and either discard the core or save for another use. In a large nonstick skillet heat half the oil over medium-high heat. When it is nice and hot, add half the zucchini ribbons and some salt and pepper. Cook, gently stirring and tossing the zucchini, just until softened, 2 to 3 minutes. Remove and set aside to keep warm; repeat with second batch. Lower heat to medium; heat remaining oil; add artichoke hearts, tomatoes and parsley. Stirring frequently, cook until heated through, about 3 to 5 minutes. Place zucchini ribbons in serving bowl; scatter artichoke hearts and tomatoes on top, and cheese, if using. Serve hot or warm as a main dish or side dish with fish or poultry.

Flourless Chocolate Cake

Flourless Chocolate Cake

YIELD: Makes 6 to 8 servings

INGREDIENTS:

4 ounces bittersweet chocolate , coarsely chopped

8 ounces unsalted butter

3/4 cup sugar

3 large eggs

1/2 cup + 2 tablespoons cocoa powder

1 pod espresso powder

DIRECTIONS:

Preheat oven to 375 F. Butter an 8” round cake pan; line with a round of wax paper, then butter paper. In double boiler melt chocolate with butter over barely simmering water; stir until smooth. 

Remove top of double boiler from heat and whisk sugar into chocolate mixture; add eggs and whisk well. Sift half cup cocoa  powder and espresso powder over chocolate mixture and whisk until combined. Pour batter into cake pan and bake in middle of oven until top has formed a thin crust, about 25 minutes. 

Cool cake in pan 5 minutes, then remove from pan and invert onto serving plate. Dust generously with remaining two tablespoons cocoa powder. Serve with sorbet, fresh raspberries or vanilla ice cream.

Rocco's Pizzeria in Mount Sinai donated pizzas to Mather Hospital's Emergency Room staff on April 2.

In his March 27 daily COVID-19 address, New York Gov. Andrew Cuomo (D) said the current pandemic will test the mettle of all residents, potentially shaping their person in the long road ahead.

“This is a moment that forges character, forges people, changes people, makes them stronger, makes them weaker, but this is a moment that will change character,” he said.

As we look around our coverage area, especially at the business owners, we can’t help but hope this crisis will make our communities stronger.

It would have been easy for many owners to just shut their doors when multiple executive orders paused nonessential businesses from offering their services, while requiring restaurants to stop sit-down service for the time being. With many still recovering a few years after the last recession, some are still dealing with low reserve funds, and while federal relief is being made available for small businesses, some owners wonder if the help will be enough.

However, most are being resilient — doing everything in their power to keep offering services to their communities. They aren’t looking at their bank accounts and saying, “We can’t do this in this environment,” they are saying they will do their best.

Restaurants are adapting to the new climate providing curbside pickup and amping up their deliveries, including those who didn’t offer these options in the past. With their finger on the pulse of residents’ needs, they are also offering specials giving patrons a choice of a certain number of trays of food at a value price, so a customer can pick up a meal one night and feed their family for a couple of days.

But even more than that, there are several examples of restaurants giving back to the community by offering free or discounted meals to the elderly, homebound and health care workers. Multiple businesses in Port Jeff have started delivering meals to local hospitals, aided by the Port Jefferson Chamber of Commerce and Port Jeff Business Improvement District.

Dancing schools, martial arts and yoga studios, as well as other fitness centers, are posting instructional videos to their websites and offering classes via Zoom, Facebook Live or other platforms. Even on-site tutoring businesses have embraced online tools to stay in touch with students and help parents with the current homeschooling situation.

These innovative ideas will help increase the owners’ chances of keeping their doors open once America comes out on the other side of this pandemic. It’s allowed them to keep on some of their staff members and will hopefully allow them to hire back those they had to lay off. It will keep their business names on residents’ minds.

The current challenges facing the business community can be an opportunity for them to grow, and many owners are realizing this. Small businesses are the heart and soul of our towns on Long Island. Thank you to the owners and their staffs for doing everything in their power to keep our communities’ hearts beating and souls hopeful.

By David Dunaief, M.D.

Dr. David Dunaief

COVID-19, a strain of the coronavirus, is now a pandemic. I have been barraged with questions from patients, neighbors and friends. They are right to be asking questions, because there is not enough information being circulated about how to protect yourself and your family. 

Key elements

The key weapons we have in this fight against COVID-19 are containment and mitigation. A lot has been shared about containment by the Centers for Disease Control. Containment is reducing the incidence of new cases to a goal of zero, thus flattening the prevalence curve so this virus is no longer infecting anyone. This requires social distancing, hand washing for at least 20 seconds, surface cleaning, and avoiding touching your eyes, nose and mouth (1). If you have not already, I encourage you to review the guidelines at www.cdc.gov/coronavirus.

There is less information being provided about how we can minimize the severity of the disease if we are infected. This is mitigation. Mitigation is about preparing ourselves, so we experience an asymptomatic or a mild form. 

Who is most at risk?

According to a study focusing on Wuhan, China findings, people most at risk are those who have chronic diseases, with high blood pressure, diabetes and heart disease being the three most common (2). Also at risk are those who are “older,” that is 60 years or older, for they are more likely to have weakened immune systems and increased inflammation.

Managing your immune response

Ultimately, the goal is to have a healthy, appropriate immune system response. If the immune system “under-responds,” the virus’s symptoms will be more severe. Another term for this is immunocompromised. 

If the immune system is overstimulated, your white blood cells are more likely to attack healthy tissue and cause further damage, exacerbating the situation. This sometimes happens after a heart attack, where the immune response is overzealous, targets healthy tissue and causes dysfunction in the heart. This process is called remodeling.

The goal is to create a healthy/strengthened immune system — not to boost and not to suppress the immune system. You want the “Goldilocks” of immune responses: not too little, not too much, but just right.

What can be done?

The best methodology here is to lean on what I call the four pillars of lifestyle modification: diet, exercise, stress management, and sleep.  

Diet. By implementing a nutrient-dense, whole food plant-based (WFPB) diet or, more specifically, what I call a “Low Inflammatory Foods Everyday (LIFE) diet,” you can rapidly improve or even reverse these chronic diseases, decrease inflammation and strengthen your immune system, which will decrease your chances of dying from the virus.

The Lancet study referenced above found that inflammation and a weakened immune system were central to determining how people will do on entering the hospital.

What I’ve found with the LIFE diet in my practice is that people have white blood cells that are on the low end of the scale, between 2.5-4.5, rather than in the middle or upper range of 6.0-10.8. Typically, my patients’ white blood cells when they get sick stay within the normal range of 3.4-10.8. In fact., I had a patient who recently got a cold virus: their white blood cells were 3.4 before they got sick, and they rose to only 7.8, well within the normal range. This resulted in a targeted response with recovery in a very short time period. 

For those with healthy immune systems, if they do get the coronavirus, their response will be more likely targeted instead of a disproportionately large response that starts killing the virus but also the healthy tissue in the lungs, leading to increased inflammation and fluid build-up in the lungs. Dr Fauci has warned this could potentially happen – what is called a cytokine storm – although the chances are very small. Ultimately, the immune system in these situations contributes to the problem, instead of helping.

So, what can you do to incorporate LIFE diet habits into your daily routine?

Focus on fresh and frozen fruits, vegetables and legumes. This is very important. With vegetables, the focus should be on dark green leafy vegetables, such as spinach, bok choy, kale, broccoli and cauliflower, as well as mushrooms. More is better. You cannot have too much. For fruits, apples have shown to play an important role in lung health, and all types of berries have high anti-inflammatory effects. 

WFPB diets ultimately help with inflammation and immune strengthening and also support reduced stress and better sleep. The reason for these effects may have to do with the microbiome, the microbes living in your gut, which are an important determinant of how your immune system functions. Seventy percent of your immune cells are in your gut.

You can test for inflammation by looking at both white blood cell count and high sensitivity CRP (hsCRP). Beta carotene levels in the blood are a way to measure nutrient levels. I recently published a study that showed there is an inverse relationship between beta carotene in the blood and inflammation measured through hsCRP. This showed a 75 percent reduction in inflammation with higher beta carotene levels achieved through a plant-rich diet focusing on dark green leafy vegetables.

Interestingly, you don’t seem to achieve the same reduction in inflammation from vitamins or plant-based powders as you do by eating actual fruits and vegetables and legumes.

Stress management and exercise. Please, don’t panic. When you stress, your body releases cortisol, or internal steroids, that actually weaken the immune system and increase your risk of serious infection. Techniques to reduce your stress include exercise, yoga and meditation.

Mild to moderate exercise can be effective, such as a walk or jog outdoors or up and down the steps of your home. Just because the gyms may be closed in your area does not mean you can’t get exercise. It is spring, let’s take advantage of the weather, which will also help with mood and stress.

You can also exercise your lungs using an incentive spirometer. My personal favorite is the Triflo II version, but there are many on the market. I recommend taking 10 breaths using the incentive spirometer twice a day. This can help expand your lungs and keep the aveoli healthy and open. Aveoli exchange oxygen and carbon dioxide molecules to and from the bloodstream.

Sleep. Exercise will also help with sleep, as will the LIFE diet. Getting enough quality sleep is important to strengthening the immune system. Quality, not quantity, is most crucial. 

What if you are infected?

If you are infected, supportive care is most critical: stay hydrated; focus on foods with fluids in them to help with this, like fruits, vegetables, and low-salt vegetable-based soups; and sleep.

Importantly, stay away from NSAIDS. These are mostly over-the-counter medications such as ibuprofen, naproxen and even aspirin, but can be prescriptions such as diclofenac. These suppress the immune system, thus making it more difficult for it to fight (3)(4). The mechanism of action for this suppression of the immune system is an anti-inflammatory effect that is different and detrimental, compared to the favorable anti-inflammatory effects of a WFPB diet such as the LIFE diet.

Instead, you want to reduce fever using acetaminophen, or Tylenol. This will not have any effects on inflammation, thus not interfering with the body’s immune system. If you can’t tolerate acetaminophen for fever, some alternatives may be elderflowers, catnip (which is a gentle choice for children), yarrow, white willow bark, echinacea, and lemon balm, although there is little data on their effectiveness.

Do not hesitate to go to the hospital if you have difficulty breathing, persistent pain or pressure in your chest, new confusion or an inability to get up, or bluish lips or face. These are signs of potentially severe and life-threatening COVID-19 symptoms.

To sum it all up, chronic diseases and not managing those four lifestyle pillars are risk factors for dying from COVID-19. You can improve or reverse your chronic diseases, as well as strengthen your immune system and reduce inflammation through a plant-rich dark green leafy vegetable diet like the LIFE diet

References:

(1) cdc.gov/coronavirus. (2) Lancet. Published online March 9, 2020. (3) Lung. 2017;195(2):201-8. (4) Chest. 2011;139(2):387-94

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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By Daniel Dunaief

Daniel Dunaief

Disclaimer: The following column is intended to provide a lighthearted response to the ongoing pandemic. In no way does it diminish or ignore the suffering or the unimaginable horror for people who have lost loved ones or who are on the front lines of the crisis. I continue to be grateful for all the help, support, and work everyone is doing to keep us safe, fed, and cared for (see last week’s column). This latest column, however, is designed to offer comic relief.

I was thinking about how life has changed in small, and largely insignificant ways. Please find below some “before coronavirus” and “after coronavirus” trivial differences for those of us fortunate enough to be inconvenienced and not irreparably harmed by the virus and when we’re not focused on the anxiety of shuttered businesses and lost income.

Where should we eat?

BC: Do you want to go to the Italian restaurant with the cool music and the frescoes on the wall, or the Chinese restaurant, with the incredible dumplings and the endless supply of hot tea?

AC: Should we go back to the kitchen, the dining room or the bedroom, where there are so many leftover crumbs that we could eat those for dinner without going to the refrigerator?

What should we wear?

BC: We could take the newly pressed suit that’s back from the dry cleaner, the slightly wrinkled suit that we wore a few days earlier, or the jeans and casual shirt that works on a casual Friday.

AC: We could take yesterday’s sweatpants, the ripped jeans that don’t smell too bad, or stay in the pajamas we wore to bed.

What should we do when we see people we know on the sidewalk?

BC: We slow our walk, smile, shake hands or hug and ask how they are doing.

AC: We run across the street, yell in their general direction and wave as we make the same joke we made the day before about the need for social distancing.

How do we start emails?

BC: We might dive right in, ask an important question or ease into it, hoping all is well.

AC: We often start emails by hoping the person we’re writing to and their family are safe.

How should we check on our college-age children?

BC: We can call them or FaceTime to see how they are doing and listen attentively as they share the excitement about school.

AC: We can call or FaceTime them from behind their locked door in our house and ask them how they are doing.

What do we do about the polarizing president?

BC: If we love him, we can find others who admire him. If we hate him, we can blame him for climate change, relaxing regulations, and changing the tone of discourse in Washington.

AC: If we love him, we can thank our lucky stars that he’s leading us and the economy out of this pandemic. If we hate him, we can blame him for our slow reaction and hold him to account for everything he and his administration haves said or didn’t say in connection with the COVIDcovid-19 response.

What do we do if someone sneezes?

BC: We offer a polite “God bless you” or, if we’re fans of “Seinfeld,” we say, “You are so good looking.”

AC: We drop anything we’re carrying and race across the room. When we’re a safe distance, we turn around scornfully, particularly if the person didn’t sneeze into anhis or her  elbow.

What do we think is funny?

BC: We follow our own sense of humor, reserving the right to laugh only when we feel compelled.

AC: We look at a picture of Winnie-the- Pooh and Piglet. We see Winnie telling Piglet to “Back the f$#@$ off,” and we laugh and send it to everyone who won’t get in trouble for receiving an email in which someone curses, after we ask if they and their family are safe.

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By Leah S. Dunaief

Leah Dunaief

If you are feeling a mite anxious these days, just know that you are like the rest of us. According to a Siena College poll released Monday, New York State residents are “deeply worried,” with 92 percent of those polled saying they were “very” or “somewhat” concerned about coronavirus. That’s as quoted by The New York Times. The poll was conducted between March 22 and 26 and surveyed 566 NYS registered voters by telephone.

Maybe we would feel better if we thought of this time as extended snow days? After all, remarkably we had no snow days this winter. I confess that’s something of a disappointment for me. I enjoy snow days — if they happen to occur on days when no one is inconvenienced. I accept them as a gift of time, like maybe one or two days to be homebound. That’s a chance to answer emails and cook a new recipe. But this coronavirus distancing is too much of a good thing; rather it’s a wicked thing. It’s scary because people are sickening and dying, and the governmental projections of casualties for the next two weeks are pouring oil on the fire.

There are two parts to our fear. 

Health, of course, is the first. We should all do what we are urged to do: Stay indoors to the fullest extent possible, wash our hands, use hand sanitizer when we can’t, don’t assemble in groups of any sort, even neighbors or relatives beyond our nuclear families and stay occupied — with work or entertainment.

The second part is economic. We read or hear that thousands are losing their jobs as business slows to a crawl or stops altogether. Businesses have no revenues with which to pay their employees. When companies like Macy’s and the Gap are furloughing most of their 125,000 and 80,000 workers respectively, how about the small business owner? They are all wondering how they will pay their rents, utilities and vendors. With no rents coming in, landlords worry about how they will make their mortgage, taxes, maintenance and insurance payments. And on and on, it’s a game of economic dominoes.

There are federal loans available, ranging from a maximum of $25,000 as bridge loans for disaster-related purposes to $210 million for disaster loans. These are made possible through the U.S. Small Business Administration (SBA), and for more information go to their website, www.sba.gov/disaster, or they can be reached  by phone or email for an appointment and advice. The trouble with loans, of course, is that they have to be repaid and with interest. That is more than most small businesses would be able to do, especially those already hit by the retail downturn.

While this is all incredibly worrisome, it might help to project into the future. How will we live differently? How will we work differently? Even, how will we shop for food differently? The world will change. Can we make it for the better?  

Irritable bowel syndrome (IBS) is a common disorder that affects the large intestine. Stock photo
Lifestyle plays an important role in reducing symptoms

By David Dunaief, M.D.

Dr. David Dunaief

According to estimates, 10 to 15 percent of the population suffers from irritable bowel syndrome (IBS) symptoms, although only five to seven percent have been diagnosed (1). The general perception is that IBS symptoms are somewhat vague. They include cramping, abdominal pain, bloating, constipation and diarrhea. 

Physicians use the Rome III criteria, an international effort to create scientific data to help diagnose and treat functional gastrointestinal disorders, plus a careful history and physical exam for diagnosis. 

What epitomizes IBS is the colonoscopy study, where IBS patients who underwent colonoscopy had diagnostic findings of nil. This tended to frustrate patients more, not reduce their worrying, as the study authors had hoped (2).

Rather, it plays into that idea that patients don’t have diagnostic signs, like in inflammatory bowel disease, yet their morbidity (sickness) has a profound effect on their quality of life. Socially, it is difficult and embarrassing to admit having IBS. Plus, with a potential psychosomatic component, it leaves patients wondering if it’s “all in their heads.”

So, what can be done to improve IBS? There are a number of possibilities to consider.

Mental state’s effect

The “brain-gut” connection is real. It refers to the direct connection between mental state, such as nervousness or anxiety, to gastrointestinal issues, and vice versa.

Mindfulness-based stress reduction was used in a small, but randomized, eight-week clinical trial with IBS (3). Those in the mindfulness group (treatment group) showed statistically significant results in decreased severity of symptoms compared to the control group, both immediately after training and three months post-therapy.

Those in the treatment group were instructed to do meditation, gentle yoga and “body scanning” — focusing on one area of the body for muscle tension detection. The control group attended an IBS support group once a week.

A preliminary study has suggested there may be a link between IBS and migraine and tension-type headaches. The study of 320 participants, 107 with migraine, 107 with IBS, 53 with episodic tension-type headaches (ETTH), and 53 healthy individuals, identified significant occurrence crossover among those with migraine, IBS and ETTH. Researchers also found that these three groups had at least one gene that was different from that of healthy participants. Their hope is that this information will lead to more robust studies that could result in new treatment options (4).

The role of gluten

In a small randomized clinical trial, patients who were given gluten were more likely to complain of uncontrolled symptoms than those who were given a placebo (68 percent vs. 40 percent, respectively).

These results were highly statistically significant (5). The authors concluded that nonceliac gluten intolerance may exist. Gluten sensitivity may be an important factor in the pathogenesis of a portion of IBS patients (6).

I suggest to my patients that they might want to start avoiding gluten and then add it back into their diets to see the results.

Fructose intolerance

Some IBS patients may suffer from fructose intolerance. In a prospective (forward-looking) study, IBS patients were tested for this with a breath test. The results showed a dose-dependent response. When patients were given a 10 percent fructose solution, only 39 percent tested positive for fructose intolerance, but when they were given a 33 percent solution, 88 percent of patients tested positive.

The symptoms of fructose intolerance included flatus, abdominal pain, bloating, belching and alternating bowel habits. The authors concluded that avoidance of fructose may reduce symptoms in IBS patients (7).

According to another study, about one-third of IBS patients are fructose intolerant. When on a fructose-restricted diet, symptoms appeared to improve (8). Foods with high levels of fructose include certain fruits, like apples and pears, but not bananas.

What is the role of lactose?

Another small study found that about one-quarter of patients with IBS also have lactose intolerance. Two things are at play here. One, it is very difficult to differentiate the symptoms of lactose intolerance from IBS. The other is that most IBS trials are small and there is a need for larger trials.

Of the IBS patients who were also lactose intolerant, there was a marked improvement in symptomatology at both six weeks and five years when placed on a lactose-restrictive diet (9).

Though small, the trial results were statistical significant, which is impressive. Both the durability and the compliance were excellent, and visits to outpatient clinics were reduced by 75 percent. This demonstrates that it is most probably worthwhile to test patients for lactose intolerance who have IBS.

Do probiotics help?

Treatment with probiotics from a study that reviewed 42 trials shows that there may be a benefit to probiotics, although the endpoints were different in each trial. The good news is that most of the trials reached one of their endpoints (10).

Probiotics do show promise, including the two most common strains, Lactobacilli and Bifidobacteri, which were covered in the review.

All of the above gives IBS patients a sense of hope that there are options for treatments that involve modest lifestyle changes. I believe there needs to be a strong patient-doctor connection in order to choose the appropriate options that result in the greatest symptom reduction.

References:

(1) American College of Gastroenteroloy [GI.org]. (2) Gastrointest Endosc. 2005 Dec;62(6):892-899. (3) Am J Gastroenterol. 2011 Sep;106(9):1678-1688. (4) American Academy of Neurology 2016, Abstract 3367. (5) Am J Gastroenterol. 2011 Mar;106(3):508-514. (6) Am J Gastroenterol. 2011 Mar;106(3):516-518. (7) Am J Gastroenterol. 2003 June;98(6):1348-1353. (8) J Clin Gastroenterol. 2008 Mar;42(3):233-238. (9) Eur J Gastroenterol Hepatol. 2001 Aug;13(8):941-944. (10) Aliment Pharmacol Ther. 2012 Feb;35(4):403-413.

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.