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Eczema is more common in women than it is in men. METRO photo
Treatments are continually evolving

By David Dunaief, M.D.

Dr. David Dunaief

The causes of eczema are unknown, but it is thought that nature and nurture are both at play (1). Essentially, it is a chronic inflammatory process that involves symptoms of rashes, itching, pain and redness (2).

It’s estimated that over seven percent of the U.S. adult population suffers from eczema (3), with twice as many females as males affected (4).

While there is no cure, there are treatments its symptoms. These range from over-the-counter creams and lotions to prescription steroid creams to oral steroids and injectable biologics. Antihistamines can also be used to treat itchiness. Some use phototherapy for severe cases, but research on its effectiveness is scant. Interestingly, lifestyle, specifically diet, may play an important role.

Two separate studies have shown an association between eczema and fracture risk, which we will investigate further.

Let’s look at the evidence.

Does diet play a role?

Eczema is more common in women than it is in men. METRO photo

In a Japanese study involving over 700 pregnant women and their offspring, results showed that when the women ate either a diet high in green and yellow vegetables, beta carotene or citrus fruit there was a significant reduction in the risk of the child having eczema of 59 percent, 48 percent and 47 percent, respectively, when comparing highest to lowest consumption quartiles (5).

Elimination diets may also play a role. One study’s results showed when eggs were removed from the diet in those who were allergic, according to IgE testing, eczema improved significantly (6).

From an anecdotal perspective, I have seen very good results when treating patients who have eczema with dietary changes. My patient population includes about 15 to 20 percent of patients who suffer some level of eczema. For example, a young adult had eczema mostly on the extremities. When I first met the patient, these were angry, excoriated, erythematous and scratched lesions. However, after several months of a vegetable-rich diet, the patient’s skin significantly improved.

What about supplements?

There are two well-known supplements for helping to reduce inflammation, evening primrose oil and borage oil. Are these supplements a good replacement for – or addition to – medications? The research is really mixed, leaning toward ineffective – and with some important concerns.

In a meta-analysis of seven randomized controlled trials, evening primrose oil was no better than placebo in treating eczema (7). The researchers also looked at eight studies of borage oil and found there was no difference from placebo in terms of symptom relief. While these supplements only had minor side effects in the study, they can interact with other medications. For example, evening primrose oil in combination with aspirin can cause clotting problems (8).

The upshot? Don’t expect supplements to provide significant help. If you do try them, be sure to consult with your physician first.

Biologics

Injectable biologics are among the newest treatments and are generally recommended when other treatment options have failed (9). There are two currently approved by the FDA, dupilumab and tralokinumab-ldrm, with the latter recently approved in December 2021.

In trials, these injectable drugs showed good results, improving outcomes for moderate to severe eczema sufferers when topical steroids alone were not effective. Like any drug therapy, it does have side effects.

Deeper impacts of eczema

Eczema may be related to broken bones, according to several studies. For example, one observational study of 34,500 patients showed that those with eczema had a 44 percent increased risk of injury causing limitation and an even more disturbing 67 percent risk of bone fracture and bone or joint injury for those 30 years and older (10).

And if you have both fatigue or insomnia and eczema, you are at higher risk for bone or joint injury than having one or the other alone. The researchers postulated that the use of corticosteroids in treatment could be one reason for increased fracture risk, in addition to chronic inflammation, which may also contribute to the risk of bone loss.

Steroids may weaken bone, ligaments and tendons and may cause osteoporosis by decreasing bone mineral density.

A recently published study of over 500,000 patients tested this theory and found that the association between major osteoporotic fractures and atopic eczema remained, even after adjusting for a range of histories with oral corticosteroids (11). Also, fracture rates were higher in those with severe atopic eczema.

For those who have eczema, it may be wise to have a DEXA (bone) scan.

Eczema exists on a spectrum from annoying to significantly affecting a patient’s quality of life (12). Supplements may not be the solution, at least not borage oil or evening primrose oil. However, there may be promising medications for the hard to treat. It might be best to avoid long-term systemic steroid use, because of the long-term side effects. Lifestyle modifications appear to be very effective, at least at the anecdotal level.

References: 

(1) Acta Derm Venereol (Stockh) 1985;117 (Suppl.):1-59. (2) uptodate.com. (3) J Inv Dermatol. 2017;137(1):26-30. (4) BMC Dermatol. 2013;13(14). (5) Allergy. 2010 Jun 1;65(6):758-765. (6) J Am Acad Dermatol. 2004;50(3):391-404. (7) Cochrane Database Syst Rev. 2013;4:CD004416. (8) mayoclinic.org (9) Medscape.com. (9) JAMA Dermatol. 2015;151(1):33-41. (10) J Allergy Clin Immunol Pract. 2021 Sep 24;S2213-2198(21)01018-7. (11) nationaleczema.org. (12) Contact Dermatitis 2008; 59:43-47.

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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Dr. John Clarke. Photo from BNL

By Daniel Dunaief

Live from Upton, New York, it’s … Dr. John Clarke.

While the arrival of the new Occupational Medicine Director and Chief Medical Officer at Brookhaven National Laboratory doesn’t involve late-night comedy, or a live studio audience, it does bring a medical doctor with a passion for bringing his rap and musical skills to a health care audience.

Dr. John Clarke. Photo from BN

Formerly the director of occupational medicine at Cornell University, Dr. Clarke joined the Department of Energy lab as Occupational Medicine Director and Chief Medical Officer for BNL in June..

“My role is to help maintain safety and wellness among the workers,” said Dr. Clarke. “If we have employees who start coming in for some sort of complaint and we see a pattern, that may help us identify who could be at risk of something we didn’t know about that we are detecting.”

A doctor who served as chief resident at New York Medical College in family residency and Harvard University in occupational & environmental medicine, Dr. Clarke said he plans to support a range of preventive efforts.

“I’m excited about the potential to engage in what’s considered primary prevention,” said Clarke, which he defined as preventing a disease from occurring in the first place.

Through primary prevention, he hopes to help the staff avoid developing chronic illnesses such as cancer, while also ensuring the health and responsiveness of their immune systems.

Through physical fitness, a plant-based diet including fruits and vegetables, adequate sleep and hydration with water, people can use lifestyle choices and habits to reduce their need for various medications and enable them to harness the ability of their immune systems to mount an effective response against any threat.

“Modifying your lifestyle is the therapy,” he said. “If you engage [in those activities] in the right way, that is the treatment.”

Dr. Clarke added that the severity and stage of a disease may impact the effectiveness of such efforts. For any vaccine and for the body’s natural immunity to work, people need a healthy immune system.

When Dr. Clarke practiced family medicine, he saw how patients lost weight through a diet that reduced the need for medication for diabetes and high blood pressure.

“Losing weight and staying active does provide a therapeutic impact, where you could be medication free,” he said.

To be sure, living a healthier lifestyle requires ongoing effort to maintain. After reaching a desired weight or cholesterol level, people can backslide into an unhealthier state or condition, triggering the occurrence or recurrence of a disease.

In the vast majority of cases, Clarke said, “you have to make a permanent lifestyle change” to avoid the need for pharmaceutical remedies that reduce the worst effects of disease.

BNL has an exercise physiologist on staff who “we hope to engage in consultations with employees,” said Clarke. He would like the exercise physiologist to go to the gym with staff to show them how to use equipment properly to get the maximum benefit.

BNL already has some classes and various initiatives that promote wellness. “One of the things we’d like to do is coordinate and try to publicize it enough where employees are aware” of the options available at the lab to live a healthier and balanced life, he added.

BNL also has a dietician on staff. Dr. Clarke has not worked with the dietician yet, but hopes it will be part of an upcoming initiative. As he and his staff respond to the demand, they will consider bringing on other consultants and experts to develop programs. 

Covid concerns

Like others in his position in other large employers around Long Island, Dr. Clarke is focused on protecting workers from any ongoing threat from Covid-19.

“We’re still learning more as [SARS-CoV2, the virus that caused the pandemic] evolves,” he said. BNL does a “great job about monitoring the prevalence and the numbers of cases in Suffolk County and among workers.”

Dr. Clarke said he and others at BNL are following the Department of Energy, New York State and Centers for Disease Control and Prevention guidance on these issues.

If the numbers of infections and hospitalizations increase in the coming months, as people move to more indoor activities, BNL may consider deploying a strategy where the lab provides more opportunities for staff to work remotely.

Prior to his arrival at BNL, Dr. Clarke worked as a consultant for a company that was looking to create numerous permanent jobs that were remote.

He suggested that workers need to remain aware of their remote surroundings and shouldn’t work near a furnace or any heater that might release dangerous gases like carbon monoxide. 

Additionally, people should avoid working in areas that aren’t habitable, such as in an attic. Dr. Clarke urges people to notify and consult their employer if they have concerns about working safely at home or on site.

Music vs. medicine

A native of Queens who spent three years of his childhood in Barbados, Dr. Clarke attended Columbia University, where he majored in sociology and music while he was on a pre-med track.

While he was an undergraduate, Dr. Clarke wrote, produced and performed original music. An independent label was going to help secure a major label deal.

He chose to attend medical school at Icahn School of Medicine at Mount Sinai.

Dr. Clarke has championed a program he calls “health hop,” in which he has used rap to reach various audiences with medical care messages. In 2009, he won a flu prevention video contest sponsored by the Department of Health and Human Services for an “H1N1 rap.”

Train commuters may also recognize him from his work for the Long Island Railroad, for which he created a “gap rap.” The public service announcement was designed to protect children from falling into or tripping over the gap between the train and the platform.

Dr. Clarke has produced music for numerous genres, including for a children’s album and a Christian album.

As for life outside BNL, Dr. Clarke is married to Elizabeth Clarke, who is a nurse practitioner and is in the doctorate of nursing practice and clinical leadership program at Duke University.

When he’s not spending time with his wife or their children, he enjoys home projects like flooring and tiling.

Dr. Clarke is pleased to be working at the national Department of Energy lab.“BNL is a great place, because the science and the work they do has an impact,” he said.

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Gina

MEET GINA!

This week’s shelter pet is Gina, a brown tabby cat who arrived at the Smithtown Animal Shelter in late August after being abandoned outside a local grocery store.

Gina was a little shell shocked initially, but as she learns to trust, she is becoming a sweet little lady. She is approximately two years old and has no medical issues. She would do best in a quiet home.

If you would like to meet Gina, please call ahead to schedule an hour to properly interact with her in a domestic setting.

The Smithtown Animal & Adoption Shelter is located at 410 Middle Country Road, Smithtown. Visitor hours are currently Monday to Saturday from 10 a.m. to 3 p.m. (Sundays and Wednesday evenings by appointment only). For more information, call 631-360-7575 or visit www.townofsmithtownanimalshelter.com.

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Purple cauliflower. Pixabay photo

By Barbara Beltrami

Once upon a time, many years ago, the East End of Long Island was densely populated with farms that grew potatoes and cabbages and cauliflower. Even though most of them have become vineyards, there are still a few that continue to produce the original crops, and Long Island cauliflower, whether the familiar white common variety or the purple, green or orange ones that are the harbingers of autumn, tastes virtually the same, although some people say the purple has a slightly nuttier taste. All are members of the cruciferous family which makes them great sources of vitamin C, and purple cauliflower is especially good for the anti-oxidants it contains. Whatever color you choose, you’re in for a veggie treat and a good dose of healthy nutrients.

Roasted Purple Cauliflower

YIELD: Makes 6 to 8 servings

INGREDIENTS: 

1 large head purple cauliflower

1/4 cup extra virgin olive oil

Salt and freshly ground pepper to taste

2/3 cup grated Parmigiano cheese

1/3 cup toasted pignoli nuts

DIRECTIONS:

Preheat oven to 400 F. Line a baking sheet with parchment. Slice cauliflower lengthwise through the core into 4 to 6 one-inch steaks. Brush both sides with olive oil, sprinkle with half the salt and pepper, then half the cheese. Bake about 15 minutes, until top is golden, then flip, sprinkle with remaining salt and pepper and cheese and bake another 15 minutes or so until that surface is golden and bubbly. Remove from oven, transfer to serving dish and sprinkle with toasted pignoli nuts. Serve with any meat, fish, poultry or vegetable protein.

Giardiniera

YIELD: Makes 6 to 8 cups

INGREDIENTS: 

1/2 head cauliflower cut into small florets

2 carrots, peeled and cut diagonally into 1/4” slices

2 celery ribs, trimmed and cut into 1/4” slices

1 red bell pepper, seeded and diced

2 garlic cloves, sliced thin

1 jalapeno pepper, seeded and minced

2 cups white vinegar

1 cup water

2 tablespoons sugar

Kosher salt to taste

2 bay leaves

2 teaspoons celery seeds

2 teaspoons fennel seeds

1 tablespoon dried marjoram

DIRECTIONS:

In a large bowl, toss together cauliflower, carrots, celery, bell pepper, garlic, and jalapeño pepper; pack into glass jars. In a medium saucepan over medium heat, combine vinegar, water, sugar, salt, bay leaves, celery seeds, fennel seeds and marjoram; stir well and bring to a boil. Once it boils, remove from heat, remove bay leaves and pour liquid over vegetables in jars. Let cool completely, place lids on jars, and refrigerate for up to one week. Serve with assorted salamis, prosciutto, and hard cheeses.

Cream of Cauliflower Soup

YIELD: Makes 4 to 6 servings

INGREDIENTS: 

1/4 cup unsalted butter

White part only of one leek, rinsed and sliced

1/4 cup flour

1 quart chicken broth

1 head cauliflower broken into bite-size florets

1 potato, peeled and diced

Freshly ground white pepper

2 cups cream

1 tablespoon minced fresh sage leaves

1 tablespoon snipped fresh chives

DIRECTIONS:

In a large saucepan, melt butter over medium heat, add leeks and saute until tender, about 6 minutes. Stirring constantly, add flour until mixture forms a paste, then, still stirring constantly, gradually add chicken broth, cauliflower, potato and  ground pepper. Bring mixture to a boil; reduce heat to medium-low and simmer about 15-20 minutes, until cauliflower and potato are very tender. Remove from heat and let sit to cool slightly. In small batches ladle into bowl of food processor and puree; return pureed mixture to saucepan. Stirring constantly, add cream and bring just to a simmer; reduce heat to low and simmer about 15 minutes, until it starts to thicken. Stir in herbs and serve hot, cold or at room temperature with focaccia.

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Go Green. Pixabay photo

Last month, President Joe Biden (D) signed the Inflation Reduction Act, a comprehensive investment package which covers taxes, health care and climate measures, too.

The climate portion of this act provides coastal communities across the U.S. with access to $2.6 billion over five years in federal funding through grants distributed by the National Oceanographic and Atmospheric Administration, or NOAA. These funds can be used for projects not only in response to sea-level rise and heavy storms but also to help communities to become more resilient against such disturbances.

Green infrastructure is a new trend in coastal resiliency that offers an alternative to traditional, human-engineered construction, also known as gray infrastructure. These are nature-based solutions, working with rather than against the natural terrain to battle the negative effects of climate change and related issues.

It is vital that Long Island communities make an aggressive plea for green infrastructure funding offered through the recent federal act. 

Instead of resigning ourselves to unsightly, inflexible, retrograde man-made sea walls to fight beach erosion, municipalities should explore more natural solutions for coastal hardening. 

According to the U.S. Environmental Protection Agency in July, “During the 20th century, global sea level rose by roughly 7 inches. Global temperatures are expected to continue to climb, resulting in rising sea levels, amplified storm surges, greater frequency and intensity of storms.”

Our era will be defined by these changes. Entire communities may soon be washed away. As shorelines continue to erode, homes and critical infrastructure will follow suit. 

The EPA suggests measures such as using plants, reefs, sand and natural barriers to create a living shoreline which in turn can reduce erosion and flooding. Wave heights can be reduced by restoring wetlands that serve as buffers against the water’s velocity and intensity.

Vegetative shorelines also help to improve water quality, aquatic habitat and carbon sequestration. Living shorelines also don’t have to be one thing. Designers can use native wetland plants, stones and rocks, oyster reefs, mussel beds and more to create different shorelines.

In many cases, natural solutions can be more cost-effective than gray infrastructure. Structures such as seawalls can deteriorate quickly after they are constructed, and they can be difficult and costly to repair and replace. Green alternatives can be more cost-effective, even though some critics say it is time consuming to replenish them. 

Of course, while choosing natural resources may work in some situations, in certain circumstances a home may be ready to fall in the water, and a seawall may be the only or quickest answer to saving the property. 

To meet the demands of this century, we must radically adjust our thinking. We are competing with other coastal communities nationwide for limited grant funding. If we choose to avoid the difficult environmental realities of our time, we are going to get passed by. In the intermunicipal survival of the fittest, communities that adapt themselves to the changing circumstances will survive and thrive. Those that don’t will wither away with the coastline.

To survive, we must adapt to the new pressures of an ever-changing environment. Moving forward, rigidity and narrow-mindedness will be our worst impediments, adaptability and realism our greatest resources.

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Facebook photo/New York Yankees

By Daniel Dunaief

Daniel Dunaief

If I were pitching to Yankees outfielder Aaron Judge, I would probably take a long pause before throwing my first pitch.

I know it’s absurd to think of this older man who never threw a ball much harder than low high school level pitching to a generational legend, but let’s play out the fantasy for a laugh or two.

I wouldn’t pause so I could figure out how to get him out. Sure, it’d be nice to do my job well and my teammates might appreciate it if I gave us a better chance to win a game.

Instead, I would need to ponder the moment that history might be calling. I’d be thinking about the best choreographed reaction to him hitting a home run. I mean, after all, the pitchers who surrender his long home runs are, in their own way, famous.

They share the moment between when they release the ball, and he obliterates it into the night sky, sending thousands of people screaming out of their seats, arms in the air, sharing in the majesty that wouldn’t be possible without my meatball pitch sputtering, laughably, towards his powerful bat.

If he sent a ball out of the stadium, I would be joining select company, with so many pitchers around the majors surrendering home runs in a historic year.

I’d be thinking about how I’d look in newsreels or newscasts or digital versions of the Aaron Judge year to remember.

I could imagine ways to overreact. I could throw my glove on the mound, gesture wildly by putting my hands in the air, or shake my head so violently that my manager and the trainer would have to waddle out to the mound to put me in a neck brace.

Or, maybe I’d hold my glove up to my face and appear to yell a stream of expletives into my mitt, as if, somehow, I knew I should have thrown a different pitch in a different spot.

Then again, I could rub my fingers in some dirt and write a capital “AJ” on my uniform, like scarlet letters, except it wouldn’t be anything puritanical, and I would be acknowledging my inferiority.

None of that seems like me, even in my fantasy world.

Being stoic would make me too much of a personality-less pitcher. Let’s face it: even in my imaginary moment of being an above average starter or relief pitcher, the time to focus on me would be incredibly short.

Let’s say I didn’t blink after he hit the home run. Or, maybe, I tracked the flight of the ball carefully, like a zebra eyeing a lion suspiciously in the Serengeti. That might get me on TV and make me more than just another guy who gave up a home run to Aaron Judge.

Maybe I’d wait at home plate and give him a high five or a fist bump to acknowledge a full season worth of greatness. While kids do that in Little League, professional players generally don’t acknowledge the remarkable achievements of their opponents.

When he reached second base, I could put down my glove and clap from the mound, ever so briefly. Then, perhaps, I’d take off my hat and salute him.

Or, maybe I could take a page out of the more subtle but celebrated Mona Lisa textbook. I could give just a hint of a smile as if I were saying, “you beat me and you’re a pretty spectacular hitter. There’s no shame in losing this battle and now we’re weirdly connected, like we’re kind of twins, except that you’re great and going to be remembered forever and I’m just going to be remembered for starting the ball on its magical journey into the history books.”

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METRO photo

By Leah S. Dunaief

Leah Dunaief

Have you ever heard of reflective listening? While I like to think of myself as being a good listener, and really I should ask others who speak to me to make that determination, I came upon this new technique and thought I would share it with you.

Reflective listening is a communications strategy that involves two steps. The first is, if you are the listener, seeking to understand what the speaker is saying. So many times in our lives, we think we hear what the other person is saying, and it turns out we didn’t hear that person correctly at all. I think that is particularly true when on the phone or when reading a text or an email. We don’t have the benefit of seeing facial expressions or body language. And even when on Zoom, we don’t get a good look at the other person, nor do they have a good read of us.

Then the second step is to offer back the thought, and even the words of the speaker, to confirm that his or her idea was understood. Here is just a simple example between two people who sometimes quarrel that could be misunderstood.

“Do you want to go to a Yankee game with me Friday night for a change?” asks the speaker. 

The listener hears, “Do you want to go to a Yankee game with me?” as opposed to with another person Friday night, and so reflects back the question accordingly by repeating, “Do I want to go to a Yankee game with you?”

The speaker can then clarify with, “Yes, do you want to go to a Yankee game Friday night instead of going bowling?”

By repeating the words, the listener has given the speaker a second chance at making his meaning clear. The listener then answers, “Yes, I would like to go to a Yankee game with you Friday night.”

This is probably an oversimplification of how a speaker might be misunderstood, but the essence of the reflective listening is to pay respectful attention to the content and the feelings expressed by the speaker. The listener hears and then understands what is being said and lets the speaker know that she has gotten the message.

This kind of “checking out” requires responding actively while keeping focused completely on the speaker. It’s a step beyond what is normally thought of as listening. It’s reflecting back accurately on both content and feeling levels.

Reflective listening offers a number of benefits.  It lets the speaker know that they have been heard, understood, and perhaps, even cared for and supported, depending on the nature of the exchange. It gives the speaker feedback on what he or she said and how it was understood. 

It allows the listener to check his or her own accuracy in hearing what the speaker said. It avoids the illusion of understanding. It helps prevent what has been termed the “mental vacation” in which the listener is inattentive during conversation. It can give the speaker a second chance to focus on self, vent, sort out issues, express feelings and deal more effectively with emotions. 

It allows the speaker to move to deeper levels of expression at his or her own pace. It can help the speaker to articulate more clearly. It may help the speaker to arrive at a solution to a problem being voiced. It helps the listener clarify what is expected of him or her. It helps the listener to deal effectively with the issue, problem or needs the speaker raised.

In a confrontational exchange, it gives a couple of seconds pause, which might enable a cooling down.

In a social situation, it can create a climate of warmth between speaker and listener. In another situation, directions can be clarified by the listener. And as a technique in leading a group discussion, effective hearing, then repeating all points of view, is certainly required.

I hope you can see why I thought this one communication technique was worth sharing.

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Pixabay photo

By Fr. Francis Pizzarelli

Father Frank PizzarelliPlain Talk:

On Sept. 25 a few hundred people gathered to dedicate and bless Our Lady of Hope Grotto and the Garden of Hope located in Mount Sinai on the grounds of Little Portion Friary, a former Anglican Franciscan Monastery.

Historically, it was the site of the first Hope House founded in 1980. For more than four decades, Hope House Ministries has reached out to the most vulnerable among us. Presently, the heart of this social outreach is providing residential and outpatient services for those among us who are battling addiction.

This nontraditional residential treatment program for addictions is located on the grounds of the former monastery. Since beginning there five years ago, more than 600 men have reclaimed and transformed their lives.

The heroin and fentanyl epidemic is crippling our nation and our larger community. The Grotto and Garden of Hope have become a safe place for people to gather who have members in their family are struggling with addiction and for those growing number of families who have lost loved ones to this god-awful affliction.

The Garden of Remembrance has more than 120 crosses honoring those who have died in our larger community. Unfortunately, requests for crosses continue to come in every week.

The heroin and fentanyl epidemic continues to spiral out of control for number of reasons. We still attach a terrible stigma to people who battle addiction. Addicts and their families continue to struggle with shame and guilt which too often paralyzes those who need help from getting help.

Support services for addiction treatment is grossly inadequate. We need more detox beds, more residential treatment beds that provide more than 11 days of care, or outpatient treatment and more trained, licensed treatment professionals to provide counseling and support.

If you are uninsured or poorly insured, you don’t have a chance at quality treatment. The insurance industry seems to hold all the power and they know little or nothing about addiction and treatment for the chronic relapser and hard-core heroin addict.

Until we take the power out of the insurance companies’ hands and put it in the hands of treatment professionals, we’re going to continue to bury people that need not die. We need to draw on the evidence-based research for treatment if you want people to recover. Our insurance dollars need to be well spent. Look at the recidivism rate across the country. It is out of control and scandalous. We clearly need to do things differently.

As I write this column, a young man that I’ve worked with for more than 20 years since he was a teenager has overdosed. He is someone’s son, someone’s brother, someone’s cousin, someone’s father. He was doing extremely well over an extended period of time. He developed a successful business, owns his own home and is an active member in the recovery community. It took only a moment and a poor choice; now he is on life support fighting for his life.

Hope lives on and love remains!

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

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5 to 10 minutes of daily running, regardless of the pace, can have a significant impact on life span by decreasing cardiovascular and all-cause mortality. METRO photo
Modest lifestyle changes can add quality years

By David Dunaief, M.D.

Dr. David Dunaief

This past Monday, Canada honored the life of Queen Elizabeth II. Among other tributes, there was a 96-shot salute, with one shot for each year of her life. As you might imagine, it took a while.

While living to 96 was once unusual, it’s becoming more common. According to the National Institutes of Health, those in the U.S. who were more than 90 years old increased by 2.5 times over a 30-year period from 1980 to 2010 (1). This group is among what researchers refer to as the “oldest-old,” which includes those aged 85 and older.

What do these people have in common? According to one study, they tend to have fewer chronic morbidities or diseases. Thus, they tend to have a better quality of life with greater physical functioning and mental acuity (2).

In a study of centenarians, genetics played a significant role. Characteristics of this group were that they tended to be healthy and then die rapidly, without prolonged suffering (3). In other words, they grew old “gracefully,” staying mobile and mentally alert.

Factors that predict one’s ability to reach this exclusive club may involve both genetics and lifestyle choices. Let’s look at the research.

Get at least modest exercise

We are told repeatedly to exercise. Here’s one reason. Results of one study showed that 5 to 10 minutes of daily running, regardless of the pace, can have a significant impact on life span by decreasing cardiovascular and all-cause mortality (4).

Amazingly, even if participants ran fewer than six miles per week at a pace slower than 10-minute miles, and even if they ran only one to two days a week, there was still a decrease in mortality compared to nonrunners. Those who ran for this very short amount of time potentially added three years to their life span. There were 55,137 participants ranging in age from 18 to 100 years old.

An accompanying editorial to this study noted that more than 50 percent of people in the United States do not meet the current recommendation of at least 30 minutes of moderate exercise per day (5).

A study presented this past August at the European Society of Cardiology Congress looked at the role of simple physical activity in the elderly (6). It found that those 85 and older reduced the risk of all-cause mortality 40 percent by walking just 60 minutes a week. This is physical activity that does not actually qualify as exercise.

Eat less animal protein

A long-standing paradigm has been that we need to eat sufficient animal protein. However, cracks have developed in this theory, especially as it relates to longevity.

In an observational study using NHANES III data, results show that those who ate a high-protein diet (greater than 20 percent of calories from protein) had a twofold increased risk of all-cause mortality, a four-times increased risk of cancer mortality, and a four-times increased risk of dying from diabetes (7). This was over a considerable duration of 18 years and involved almost 7,000 participants ranging in age at the start of the study from 50 to 65.

However, this did not hold true if the protein source was plants. In fact, a high-protein plant diet may reduce the risks, not increase them. The reason, according to the authors, is that animal protein may increase insulin growth factor-1 and growth hormones that have detrimental effects on the body.

The Adventists Health Study 2 trial reinforced this data. It looked at Seventh-day Adventists, a group that emphasizes a plant-based diet, and found that those who ate animal protein once a week or less had a significantly reduced risk of dying over the next six years compared to those who were more frequent meat eaters (8). This was an observational trial with over 73,000 participants and a median age of 57 years old.

Reduce systemic inflammation

In the Whitehall II study, a specific marker for inflammation was measured, interleukin-6. The study showed that higher levels did not bode well for participants’ longevity (9). In fact, if participants had elevated IL-6 (>2.0 ng/L) at both baseline and at the end of the 10-year follow-up period, their probability of healthy aging decreased by almost half.

The good news is that inflammation can be improved significantly with lifestyle changes.

The takeaway from this study is that IL-6 is a relatively common biomarker for inflammation. It can be measured with a simple blood test offered by most major laboratories. This study involved 3,044 participants over the age of 35 who did not have a stroke, heart attack or cancer at the beginning of the study.

The bottom line is that, although genetics are important for longevity, so too are lifestyle choices. A small amount of exercise and replacing animal protein with plant protein can contribute to a substantial increase in healthy life span. IL-6 may be a useful marker for inflammation, which could help predict healthy or unhealthy outcomes. Therefore, why not have a discussion with your doctor about testing to see if you have an elevated IL-6? Lifestyle modifications may be able to reduce these levels.

References: 

(1) nia.nih.gov. (2) J Am Geriatr Soc. 2009;57:432-440. (3) Future of Genomic Medicine (FoGM) VII. Presented March 7, 2014. (4) J Am Coll Cardiol. 2014;64:472-481. (5) J Am Coll Cardiol. 2014;64:482-484. (6) European Society of Cardiology Congress, Aug. 28, 2022. (7) Cell Metab. 2014;19:407-417. (8) JAMA Intern Med. 2013;173:1230-1238. (9) CMAJ. 2013;185:E763-E770.

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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Margarita
Bob Lipinski

By Bob Lipinski

“One tequila, two tequila, three tequila, floor.”  — George Carlin

There are many stories as to the origin of the Margarita cocktail. One story states that Danny Negrete, the manager at the Garci Crespo Hotel in Puebla, Mexico, created it for his girlfriend in 1936. Others believe it was created in 1938 in Rosarito Beach, Tijuana and named after showgirl Marjorie King, who was allergic to many distilled spirits except tequila. Danny (Carlos) Herrera, the bartender, kept inventing new and exciting ways to serve tequila so Marjorie would not be bored.

Another story has it created by a Virginia City bartender in memory of his girlfriend who was accidentally shot during a barroom brawl. A further legend places the birth of this cocktail in Hollywood in the 1940s by Enrique Bastante Gutierrez, a former cocktail champion who mixed drinks for some of the world’s most famous film stars. Actress Rita Hayworth (whose real name was Margarita Carmen Cansino) was one of his loyal customers and he invented the drink especially for her.

Another version of its origin has the cocktail made by bartender Don Carlos Orozco at Hussong’s Cantina, in Ensenada, Mexico, who named it after his girlfriend. Yet another story takes place on July 4, 1942, in Juárez, Mexico, where Francisco “Pancho” Morales, a bartender in Tommy’s Place, a favorite hangout for GIs from Fort Bliss, concocted the cocktail. According to Pancho, a woman entered the premises and ordered a cocktail called a Magnolia. He didn’t know the ingredients, so he whipped together his own version of a Magnolia and called it a Margarita, Spanish for daisy. 

The most plausible version has the Margarita created in 1948 in Acapulco, Mexico, by a San Antonio, Texas socialite Margarita Sames. To impress Nicky Hilton, of the Hilton Hotel family, she mixed three parts tequila, two parts Cointreau, and one-part lime juice.

Margarita
Margarita

Yield: Makes one cocktail

Ingredients:

1-1/2 ounces tequila

1-ounce triple sec liqueur (minimum 60 proof)

3/4 ounce freshly squeezed lime (or lemon juice)

coarse salt for the rim of the glass

crushed ice

slice of lemon as a garnish

Directions:

Either shake the ingredients or put into a blender.  Then, take a wide-brim glass and place it upside down in a small bowl containing lemon or lime juice and then into another bowl that contains salt to a depth of ¼-inch, which leaves a thin layer on the rim of the glass. Fill the glass and garnish with lime or lemon slice and serve.

Bob Lipinski is the author of 10 books, including “101: Everything You Need To Know About Whiskey” and “Italian Wine & Cheese Made Simple” (available on Amazon.com). He consults and conducts training seminars on Wine, Spirits, and Food and is available for speaking engagements. He can be reached at www.boblipinski.com OR [email protected].

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