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Consuming four or more servings of legumes per week has shown to reduce the risk of heart disease. Stock photo
Even small dietary changes move us closer to being ‘heart attack proof’

By David Dunaief, M.D.

Dr. David Dunaief

We can significantly reduce the occurrence of heart disease, the number one killer in the United States, by making modest lifestyle changes.

Heart disease is a term that captures a number of disorders, from coronary artery disease, which can cause heart attacks, to valve issues and heart failure, which is a problem with the pumping mechanism. Here, our focus will be on coronary artery disease and their resulting heart attacks.

According to the Centers for Disease Control and Prevention, there are 805,000 heart attacks in the U.S.  annually, and 200,000 of these occur in those who’ve already had a first heart attack (1). Here, I will provide specifics on how to make changes to protect you and your family, regardless of family history.

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

Treat yourself – cocoa’s benefits

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

I usually recommend that patients have one to two squares – about one-fifth to two-fifths of an ounce – of high-cocoa-content dark chocolate daily. Who says prevention has to be painful?

Increase your fiber intake

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

The average American consumes about 16 grams per day of fiber (4). The Academy of Nutrition and Dietetics recommends 14 grams of fiber for each 1,000 calories consumed, or roughly 25 grams for women and 38 grams for men (5). Therefore, we can significantly reduce our risk of heart disease if we increase our consumption of fiber to reach the recommended levels. Good sources of fiber are fruits and vegetables with the edible skin or peel, beans and lentils, and whole grains.

Legumes’ impact

In a prospective (forward-looking) cohort study, the First National Health and Nutrition Examination Survey Epidemiologic Follow-up Study (NHEFS), legumes reduced the risk of coronary heart disease by a significant 22 percent. Those who consumed four or more servings per week, compared to those who consumed less than one serving, saw this effect. The legumes used in this study included beans, peas and peanuts (6). There were over 9,500 men and women involved, spanning 19 years of follow-up.

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

A nutty solution

In a study with over 45,000 men, there were significant reductions in coronary heart disease with omega-3 polyunsaturated fatty acids (PUFAs). Both plant-based and seafood-based omega-3s showed these effects (7). Good sources of omega-3s from plant-based sources include nuts, such as walnuts, and ground flaxseed.

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

References:

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

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

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Northern Mockingbird

By John L. Turner

A fact about living in suburbia is the presence of neighbors and we are blessed in having a bunch of wonderful neighbors in the Setauket neighborhood in which we live.

Lately though, I have become aware of, and begun to appreciate, another set of neighbors: those of the feathered kind. We are neighbors to the birds and this spring I’ve watched families of birds, going about their lives, amidst our property and that of some of our neighbors. Our human properties are embedded within the “properties” in which they nest.

In a side shrub a pair of Song Sparrows made a nest while in a front yard shrub it was a Robin. On an eye-level branch of a Norway Spruce located along a boundary of the backyard I watched a pair of Mourning Doves raise a pair of young that successfully fledged, and further back in a blackberry bramble was a Catbird nest.

We also routinely see several woodpeckers species feeding in the yard and have Carolina Wrens, Northern Cardinals, Black-capped Chickadees, for whom our property is a cafeteria. Most recently, we’ve been witness to a family of Screech Owls — two parents and three young — as they have begun, on silent wings, to expand their world.

But the most conspicuous neighbor of all has been a pair of Northern Mockingbirds. I haven’t located their nest but our property along with the neighbors that flank each side are within the pair’s territory as evidenced by the trees the male alternates flying to and singing from the tops of.

And, wow, do Mockingbirds sing. They are most well-known for “mocking” or copying the songs of other songbirds, with some birds having a repertoire of several dozen songs absconded from others. In total, Mockingbirds can sing hundreds of different phrases — a combination of unique calls interspersed with the mimicked songs of others.

About a month ago the male sat atop a tall Spruce tree along my northern border and enthusiastically sang continuously for 20 minutes. In his long song sequence I discerned songs that included the Eastern Phoebe, Northern Cardinal, Carolina Wren, Killdeer, Great Crested Flycatcher and two different Blue Jay calls. On several occasions it quacked like a duck! (Many years ago I heard a Mockingbird singing along the edge of a field in Hauppauge making a sound that sounded exactly like a car alarm!! I wouldn’t have believed it if I didn’t directly witness the sound emanating from the open and moving bill of the bird).

Their scientific name — Mimus polyglottis — literally means “many throated mimic,” an obvious reference to their ability to sing other bird songs.

That the Northern Mockingbird is a feathered virtuoso has long been recognized by professional ornithologists and curious naturalists alike. J.P. Giraud in his seminal 1842 work “The Birds of Long Island” noted: “It is the nightingale of America, and according to those who have heard the native notes of both, its voice, both in variety and fullness, is superior to that of Europe’s sweetest songster. Its power of imitation is so great, that this highly gifted bird runs over the varied notes of all our songsters, and executes with so much skill, that it would seem as if Nature had so attuned its voice that it might exceed all of the feather choir.”

Frank Chapman, the longtime curator of Ornithology at the American Museum of Natural History, and the father of the National Audubon Society’s Annual Christmas Bird Count, wrote: “The Mockingbird might be called our national song-bird; his remarkable vocal powers have made him famous the world over … He is a good citizen, and courting rather than shunning public life, shows an evident interest in the affairs of the day. He lives in our gardens, parks, and squares, and even in the streets of the town …” and in regard to his singing Chapman notes: “… if his song does not thrill you then confess yourself deaf to Nature’s voices.” — an opinionated but accurate statement if their boisterous singing fails to put a smile on your face!

But why is it that Mockingbirds, a rarity among songbirds in singing the songs of other birds, evolved this fascinating behavior of vocal mimicry? For the same reasons that other male birds sing — to defend a breeding territory and attract a mate. They’ve just taken it to a new level driven by the fact that females are apparently attracted to males with larger song repertoires.

This new level includes singing at night, especially on nights when the moon is strong. While I’ve not yet heard “our” birds singing at night, I had night singing Mockingbirds routinely while I lived for many years in Massapequa Park and before that during my childhood in Smithtown.

Mockingbirds are related to two other songbird species native to Long Island with which you might be familiar: the Gray Catbird and the Brown Thrasher. All three belong to the family Mimidae, the Mimic Thrushes, and they all mimic other birds, although the Mockingbird stands alone in its skill.

With a little bit of effort you can see them. The Brown Thrasher prefers wilder habitat. It is a fairly common breeding bird in the vast expanses of the Pine Barrens, where it prefers to lurk about in the understory while Catbirds and Mockingbirds frequent the suburban habitat around your home.

If you have a Mockingbird as a neighbor, perhaps the “Many-throated Mimic” will grace you with his night-time serenade on a moonlit night.

A resident of Setauket, John Turner is conservation chair of the Four Harbors Audubon Society, author of “Exploring the Other Island: A Seasonal Nature Guide to Long Island” and president of Alula Birding & Natural History Tours.

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Felicia Allard

By Daniel Dunaief

Stony Brook University recently added a wife and husband team to its Pathology Department. Felicia Allard and Eric Yee are joining SBU from the University of Arkansas.

Allard and Yee will “replace an individual who had moved to a leadership position at another institution and to meet increased caseloads in surgical pathology and cytopathology,” Ken Shroyer, the chairman of the Pathology Department, explained in an email.

Times Beacon Record News Media will profile Allard and Yee over the next two weeks.

Felicia Allard

Eric Yee and Felicia Allard. Photo by Joshua Valencia

A self-described “mountain girl” from Colorado, where she attended medical school and met her husband Eric Yee, Felicia Allard had only been to Long Island three times before accepting a job at Stony Brook.

She came once when she was interviewing for a residency and twice during the interview process.

Allard and Yee accepted the jobs in the middle of February and weren’t able to look at potential homes during the height of the lockdown caused by COVID-19.

For now, the couple have moved into temporary housing in Port Jefferson Station, as they look for longer term living options.

Allard, who will be an Associate Professor at SBU, said the move started with Pathology Department Chair Ken Shroyer, who was looking to fill two positions and reached out to Yee.

Shroyer was involved in a type of cancer work that interested her.

“The active pancreatic cancer research group was a big draw for me as I am hoping to expand my research career,” Allard explained in an email.

Allard said she was particularly interested in pancreatic cancer, in large part because of its intractability and the poor prognosis for most patients.

“It was clear to me that this is one of the areas where we had a lot of work to do in terms of being able to offer any type of meaningful treatment to patients,” she said.

Allard said she, like so many others in the medical community, entered the field because she wanted to make a difference. She searched for areas where the “greatest good could be done, and pancreatic cancer is still one of those.”

In her initial research, she studied the pancreatic neoplasm, exploring how cells went from pre-invasive to invasive to metastatic conditions. She is interested in how the tumor interacts with the patient’s immune system.

While Allard will continue to provide clinical services, she plans to collaborate with Shroyer in his lab. “I’m hoping naturally to be integrating into Dr. Shroyer’s group,” Allard said.

Shroyer welcomed Allard to the department and to his research team.

Allard is “a highly-qualified surgical pathologist with subspecialty expertise in GI tract pathology,” Shroyer wrote in an email. “She has a specific interest in pancreatic cancer, which will also complement our translational research program,” he said.

Shroyer expects that Allard will be integrated into several cancer research programs and he is “looking forward to having her join my team that is focused on the validation of prognostic and predictive biomarkers for pancreatic cancer.”

Shroyer’s lab, which includes Luisa Escobar-Hoyos, who is an Assistant Professor in the Department of Pathology, will work with Allard to advance the translational aspects of keratin 17 research, building on earlier work to understand the mechanisms through which K17 causes tumor aggression, he explained.

As for her clinical work, Allard said she analyzes biopsies and resections from the esophagus, stomach, intestines, liver, and pancreas. She has also used cytopathology to look at pap smears and to analyze salivary tumor aspirations.

The time to consider any of these slides varies broadly. Sometimes, she receives a slide and the diagnosis is unequivocal within 30 seconds. Other times, a biopsy from a six-month old patient with diarrhea, for example, can have an extensive list of differentials. In that case, the diagnosis can take considerably longer, as a baby could be sick because of an autoimmune disorder, inflammatory bowel disease or an infection.

She said she can “perseverate for hours or even days” over the subtle clues that may help with a diagnosis.

Allard likened the diagnostic process to reading a detective novel, in which the reader might figure out the perpetrator on page three, while other times, the culprit isn’t discovered until page 300.

Allard said she and her husband have a similar clinical background.

Yee is “more of a tech geek than I am,” she said. “He understands artificial intelligence, computer science and bioinformatics more than I do. He is also interested in administrative and leadership to a greater degree.”

Allard said she and Yee may have professional overlaps, but they have unique interests, backgrounds and perspectives that they bring to work that give them each different strengths.

Allard said she knew she wanted to go into medicine in her junior year of high school. When Doctors Without Borders won the Nobel Peace Prize in 1999, she recalls being impressed with that distinction.

In medical school, she said the field of pathology appealed to her because she appreciated the marriage of clinical care and basic science in the field.

She and Yee started dating just before medical school started for her. Yee was two years ahead in school. They continued their relationship from a distance while he did his residency at Beth Israel Deaconess Medical Center at Harvard Medical School. While she was a resident, Allard said Yee had the “distinct pleasure of trying to train me.”

She likes to explore the boundaries of diagnosis to understand the nuances and all the data that factor into interpretations, to tease the art from the science.

Outside of her work, Allard enjoys reading and calls her Kindle one of her favorite possessions. She hopes to learn how to sail while a resident of Long Island.

Allard is excited to start working at Stony Brook. Shroyer was “very persistent and once he got us up to New York to interview, he was persuasive with respect to the type of career growth we could both potentially have,” she said.

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Photo by David Ackerman

When The New York Times recently published an editorial titled “Don’t Cancel That Newspaper Subscription,” it caught our attention. Not just because of the subject matter — anything about the general decline of local newspapers is, of course, something we’re very concerned about — but because of the struggles each reporter and editor faces while trying to do their jobs.

The beginning of the editorial tells the story of John Seigenthaler, initially a young reporter with The Tennessean who saved the life of a man he was interviewing back in the 1950s. Seigenthaler went on to become editor and then publisher for the local paper and was at the forefront of civil rights coverage in the heart of the segregated South. However, the piece is not a love letter to the local papers of the 20th century; it’s a cry for help for the publications of today.

The editorial touches on how newspapers and their newsrooms have become smaller over time, even before the coronavirus pandemic diminished the amount of advertising, the main source of revenue papers rely on. Over the years, local publications have been suffering as more and more readers take to the internet to get their daily or weekly dose of news. It also doesn’t help that the false moniker of “fake news” is thrown around by too many without a care for the consequences such an impetuous statement can create.

According to the editorial, newsrooms across the country lost half their journalists between 2008-19. Citing a recent Business Insider article, the writer Margaret Renkl, said “a staggering” 7,800 journalists lost their jobs in 2019.

The writer goes on to tell the story of how The Tennessean recently ran an ad that many found appalling and racist, but she urged people not to cancel their subscriptions. She not only cited how the publisher quickly tried to rectify the situation by pulling it from future editions and firing the sales manager that approved it, but she pointed out many other things, too. Despite the extreme lack of judgment in placing the ad, even with a shortage of journalists due to cutbacks over the years, the paper still covers and publishes a variety of topics that show it is still doing everything in its power to maintain a balanced and reputable publication.

We get this. There have been times when some may not have been pleased with an article, letter or editorial in our newspapers. That is perfectly fine, and we invite reasoned criticism from all in our letters to the editor. But as Renkl wrote in her editorial, “As the ‘first rough draft of history’ journalism will always be prone to mistakes.” We, perhaps beyond any other industry, not only invite justified review of our papers, but we also actively try to improve, working many, many hours to try to get the story of local happenings. We cannot be everywhere and cover everything, but we do our best.

Canceling your subscription to a newspaper only hastens the death of journalism. We’ve written it before on this page, and we’ll put it out there again: If newspapers and journalists didn’t exist, who would tell you what leaders are up to? Who would be there to challenge their responses when something doesn’t sound quite right? And this is even more important with our local leaders, especially as more news networks focus on the national side of our society.

Without local papers, where would readers go to find out what fun activities are going on right in their own town? Who would celebrate the academic and athletic achievements of our local students?

Unfortunately, the days of local newsrooms brimming over with editors and reporters, who could run out and cover every incident in town, may be over, but pulling out a newspaper from the mailbox or picking one up on the newsstand doesn’t need to end.

Let’s work together to keep local journalism alive. With each subscription, just like with each ad, we are empowered to continue and enabled to cover more of our communities’ activities for the benefit of all.

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METRO photo

By Daniel Dunaief

Daniel Dunaief

Look, we’re out of practice. It’s totally normal. We’ve spent so much time talking to kids who don’t listen, to pets who need a break from us and to computers that seem determined to sabotage our efforts to work from home that we may have lost a step or two in our social graces.

Slowly, like hermit crabs emerging from their shells, we are stepping out into the phased world, in which we can do this, but can’t do that and where we are seeing more three-dimensional people and not those two-dimensional figures who flash across all manner of electronic devices.

As a quick refresher, I’d like to offer a reminder of the things that should give us pause if we’re about to share them with others who may be a bit sensitive.

The following should serve as verbal red flags:

Not that I’m looking, but … if whatever comes next is something you shouldn’t be staring at, such as anatomical areas, private letters or emails, you shouldn’t finish the sentence.

Don’t take this the wrong way … well, if a part of you recognizes that what you’re about to say could be problematic or painful for the listener, consider saying it in a different way or not saying it at all.

Obviously … this can go in one of two directions. A truly obvious statement doesn’t need sharing. A statement you think is obvious but isn’t so clear to the listener becomes a way to offend that person, who may have a reflexive defensive response.

I’m no expert, but … we all often talk about subjects in which we have no expertise. We might be anywhere from slightly informed to ill informed. We should be able to share what we think we might know, but we may not want to challenge someone who designs buildings on the best way to put together a LEGO house.

This is such a minor point that I hesitate to bring it up … maybe instead of hesitating, you should just not. Correcting the day of the week on a story about an event that occurred over 10 years ago seems unnecessary and distracting.

I don’t want to take the wind out of your sails … you’re probably about to do what you say you’re not doing, so own it and say you disagree completely or let me continue to sail off into my happy sunset.

What do I know, but … This expression suggests that you are about to do one of two things. You’re likely preparing to deliver serious criticism, but want to couch it by suggesting that it might not be based on anything other than a disdain for you, your wardrobe choices, your career path, or anything in between. Alternatively, you’re about to say something that seems supportive — “what do I know, but your idea for submersible homes seems compelling to me”  — but that really suggests that you’re hiding behind false humility. If someone follows your advice, the “what do I know” expression is your way of dodging any responsibility for their mistakes.

I don’t mean to offend you, but … this is one of my favorites. It suggests that you know you are about to be offensive and that you don’t mean it, but you just can’t help it. You’re about to share something that may dress up as helpful, like a Trojan horse, perhaps, but that will likely cause damage.

Holding our tongues can be incredibly difficult, especially when we’d like to tell the person in front of us how we want to make a minor, but likely obvious point that we hope doesn’t take the wind out of their sails or offend them. We also don’t know what we’re talking about because we’re not experts. Still, it was sort of good to see them.

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By Leah S. Dunaief

Leah Dunaief

Those businesses that qualified for a paycheck protection program (PPP) loan have had a bit of a honeymoon from the novel coronavirus these last eight weeks. They were allowed to apply to the government for two months plus 50 percent of their labor costs. From that money they had to pay at least 60 percent to workers to cover payroll, with the remainder underwriting other expenses like utilities, payroll taxes and leases.

So the employers who received the payments could relax during those two months, and the employees could also stop holding their breaths, knowing that their salaries would be paid. And the government would keep the workers employed. At least that was how it was supposed to work, and it did, except when the weekly unemployment insurance payments were greater than the weekly salaries and proved too much of a temptation to the employee. In those cases, the employer was in competition with the government and, depending on the worker’s loyalty and long term concern about holding onto a job, the employer would often lose. 

But the program was essentially a good one. The funds, paid to the businesses and-in turn to their employees, kept the work force together and saved the workers from the frustrations of trying to collect unemployment. 

The original thinking was that the pandemic would probably lessen after two months and businesses could resume as normal. Well, we now know how that turned out. The pandemic is still with us, although New York is in a much better condition at the moment than most of the rest of the country, but economic activity has not returned to anything like normal, and with social distancing, looks unlikely to return soon. 

For many of those businesses, the PPP honeymoon is almost over. How do we prevent a return to the layoffs, loss of company health insurance and nail biting of the pre-PPP days? 

The good thing about a pandemic is that the whole world is in the same situation, and we can look around and see how other countries are coping or trying to cope. The U.S. has relied on an expanded program of unemployment insurance to tide over workers until the economy resurrects itself. Many European countries have prevented joblessness by essentially nationalizing payrolls and enabling workers to continue to be paid and businesses to resume whenever that happy day comes, without having to rehire and possibly retrain. Workers are often furloughed if there is no work at the shuttered shops and factories, meaning that their jobs will be held for them and they continue to receive their salary, although generally at a reduced amount. 

In short, Europeans have been pursuing an extended PPP. Workers have not overwhelmed the unemployment insurance system, caused websites to crash, phones to go unanswered, lost health coverage, nor have they stood the requisite six feet apart in the hot sun on long lines in parking lots, waiting to get into benefit offices. There is also the intangible but priceless advantage of workers not feeling jobless, with the fear and loss of identity that often brings. 

And today, many feel just that. The U.S. number in June for jobless was 11.1 percent. That’s an increase of some eight percent since February. In the aforementioned European countries, the jobless rate has increased by less than 1 percent. In human terms, that means some 20 million Americans are unemployed. While that’s better than 23 million in April, probably almost all of those people have families who also will feel the effects as tenants begin to be evicted and queues form for food banks. 

We don’t know what is going to happen in the next few weeks, as government programs for business and unemployment benefits run out if not extended. The $600 federal unemployment boost is supposed to end July 31. Congress is debating whether to extend the time or modify the payout, even as some worry that paying workers more than their salary is a disincentive to work.

Just remember, we are in this together. Hang on and stay safe.

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Early diagnosis is crucial to treatment success

By David Dunaief, M.D.

Dr. David Dunaief

Diabetic retinopathy is an umbrella term for microvascular complications of diabetes that can lead to blurred vision and blindness. There are at least three different disorders that comprise it: dot and blot hemorrhages, proliferative diabetic retinopathy and diabetic macular edema. The latter two are the ones most likely to cause vision loss. Our focus for this article will be on diabetic retinopathy as a whole and on diabetic macular edema, more specifically.

Diabetic retinopathy is the number one cause of vision loss in those who are 25 to 74 years old (1). Risk factors include duration of diabetes, glucose (sugar) that is not well-controlled, smoking, high blood pressure, kidney disease, pregnancy and high cholesterol (2).

What is diabetic macula edema, also referred to as DME? Its signature is swelling caused by extracellular fluid accumulating in the macula (3). The macula is the region of the eye with greatest visual acuity. A yellowish oval spot in the central portion of the retina — in the inner segment of the back of the eye —it is sensitive to light. When fluid builds up from leaking blood vessels, there is potential for vision loss.

Those with the longest duration of diabetes have the greatest risk of DME (4). Unfortunately, many patients are diagnosed with DME after it has already caused vision loss. If not treated early, patients can experience permanent loss of vision (5). Herein lies the challenge.

In a cross-sectional study (a type of observational study) using NHANES data from 2005-2008, among patients with DME, only 45 percent were told by a physician that diabetes had affected their eyes (6). Approximately 46 percent of patients reported that they had not been to a diabetic nurse educator, nutritionist or dietician in more than a year — or never.

The problem is that the symptoms of vision loss don’t necessarily occur until the latter stages of the disorder. According to the authors, there needs to be an awareness campaign about the importance of getting your eyes examined on an annual basis if you have diabetes. Many patients are unaware of the association between vision loss and diabetes.

Treatment options                                             

While DME is traditionally treated with lasers, intravitreal (intraocular — within the eye) injections of a medication known as ranibizumab (Lucentis) may be as effective.

The results from a randomized controlled trial, the gold standard of studies, showed that intravitreal (delivery directly into the eye) injections with ranibizumab, whether given prompt laser treatments or treatments delayed for at least 24 weeks, were equally effective in treating DME (7).

Increased risk with diabetes drugs

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

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

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

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

Diet

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

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

References:

(1) Diabetes Care. 2014;37 (Supplement 1):S14-S80. (2) JAMA. 2010;304:649-656. (3) www.uptodate.com. (4) JAMA Ophthalmol online. 2014 Aug. 14. (5) www.aao.org/ppp. (6) JAMA Ophthalmol. 2014;132:168-173. (7) ASRS. Presented 2014 Aug. 11. (8) Arch Intern Med. 2012;172:1005-1011. (9) Arch Ophthalmol. 2010 March;128:312-318. (10) Arch Intern Med. 2012;172:1011-1013. (11) www.nei.nih.gov. (12) OJPM. 2012;2:364-371. (13) Am J Clin Nutr. 2009;89:1588S-1596S.

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

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By Nancy Burner, Esq.

Nancy Burner, Esq.

Federal and state funding of COVID-19 related relief will likely require major budget overhauls and could potentially change the estate and gift tax landscape.

On the federal level, the 2017 Tax Cuts and Jobs Act doubled the estate and gift tax exclusion from $5,000,000 to $10,000,000, as adjusted for inflation, for decedents passing away between 2018 and 2025. However, the increase in the exclusion amount is temporary and is scheduled to sunset on December 31, 2025 and revert back to $5,000,000 (adjusted for inflation).

Currently, the federal 2020 lifetime exclusion amount is $11,580,000 per person, which can be utilized to transfer assets during life or upon death, free of federal estate or gift tax. In New York, the current estate tax exclusion is $5,850,000. New York does not impose a gift tax, although gifts made within three years of death are brought back into the estate for estate tax purposes.

Portability on the federal level allows a surviving spouse to use the deceased spouse’s unused federal lifetime exclusion. Therefore, if the first spouse to die has not fully utilized his or her federal estate tax exclusion, the unused portion, called the “DSUE amount,” can be transferred to the surviving spouse. The surviving spouse’s exclusion then becomes the sum of his or her own exclusion plus the DSUE amount. 

To take advantage of the DSUE amount, a timely filed federal estate tax return must be filed within 9 months from the deceased spouse’s date of death, or within 15 months pursuant to an extension request. Many surviving spouses may not be aware of this requirement or fail to see how filing a return would be beneficial at the time of the first spouse’s death with the current exclusion amount being so high. If ignored, upon the death of the surviving spouse, his or her estate is unable to utilize the DSUE amount unless other specific actions are taken. New York State does not currently have portability.

With the looming sunset, practitioners were concerned with what exclusion amount would be used to calculate the estate tax for a decedent dying after January 1, 2026 who made gifts between 2018 and the end of 2025, or the DSUE amount for the spouse that died between these dates that filed a return for portability. Finally, on November 26, 2019, the Treasury

Department and IRS issued regulations clarifying that the estate tax and DSUE amount will be calculated using the increased exclusion amount that was in place between December 31, 2017 and January 1, 2026, confirming that there will be no “claw back.”

Increased spending associated with COVID-19 will likely leave the government searching for revenue. One such avenue could be a reduction in the exclusion amount on the federal and/or state level, even prior to the current federal sunset date. It is more important than ever for an executor to file a federal estate tax return on the death of the first spouse to lock in the higher DSUE amount. 

Additionally, individuals with high net worth should consider gifting assets now to reduce their taxable estate on both the federal and state levels. 

With so many political and social changes on the horizon, it is of paramount important to work with an experienced estate planning attorney to discuss these issues, review your estate plan and potentially revise your current estate planning documents to include provisions for estate tax planning on the death of the first spouse. The potential to be subject to estate tax could increase for a significant number of individuals if the exclusion amount is lowered in the future.

Nancy Burner, Esq. practices elder law and estate planning from her East Setauket office. Visit www.burnerlaw.com.

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Father Frank joined the Black Lives Matter protest on June 18. Photo by Drew Biondo

By Fr. Francis Pizzarelli

Father Frank Pizzarelli

The pandemic has changed the world as we know it forever. As we attempt to go back to a new normal, many of us will not look at life in the same way. Many families are closer. So many have reassessed what is important and who is important. The workplace has changed. School, colleges, universities will never be the same.

Hopefully these new challenges will empower us to become the best version of ourselves. It has been amazing driving through Port Jefferson Village and seeing so many families sitting on their porches and lawns actually talking and laughing with each other and not texting!

In an instant, we in college education went from in-class human contact to a virtual classroom. It’s a whole new experience, a whole different way of teaching and learning.

Life is dynamic. We need to be more flexible and more willing to adapt to change. Too often we get set in a pattern of doing and thinking that is not always life-giving.

In recent weeks the already challenging landscape became more toxic with the unfortunate and tragic loss of life at the hands of law enforcement. This social unrest has given birth to the Black Lives Matter Movement. This movement has spread across the country challenging all fair-minded people to think about systemic racism and discrimination.

On June 18, students from Stony Brook University organized a Black Lives Matters protest in Port Jefferson. We were almost 400 strong as we met at the Port Jefferson train station. We walked down Main Street to Village Hall. We were White, Black, Latino, Asian and Indian chanting and talking. When we reached Infant Jesus Church, we were asked to kneel. The silence was deafening.

What was amazing during those moments of silence were two small children standing in front of me hugging each other; one was black, the other was white. When they turned around and I could see their faces, they both had on t-shirts that said “All Life Matters.” As we continued to walk, I could not help but think about that statement. Blacks, browns, documented, undocumented, Asians, Indians, Native Americans, whites, gays, lesbians, bisexuals and transgendered people — they all matter.

This is a powerful moment in history. We need to confront systemic prejudice and discrimination everywhere. Most religions call us to a higher standard, but are equally guilty of discrimination, oppression and prejudice. Our schools and universities, law enforcement in almost every social entity that deals with people needs to step back and look at how they do what they do.

The social unrest confronting our nation is an opportunity for systemic change and reform across the spectrum of all human interactions; every system needs to be held accountable. No one should ever be above that standard.

When we arrived at Village Hall, the speakers thanked the police for their service and thanked all of us for standing together in solidarity. As I left, I did the same. I thanked each police officer for his or her service. I also realized that we need to see with different eyes; we need to hear and listen with different ears. As Gandhi said, we must “be the change that we wish to see in the world!”

Fr. Pizzarelli, SMM, LCSW-R, ACSW, DCSW, is the director of Hope House Ministries in Port Jefferson.

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