Health

About 70% of people with Parkinson’s experience a tremor at some point in the disease. Stock photo
Much new research focuses on dietary approaches

By David Dunaief

Dr. David Dunaief

Parkinson’s disease is a neurodegenerative disease, most often associated with a movement disorder, or tremors. According to the Parkinson’s Foundation, roughly 60,000 Americans are diagnosed with Parkinson’s disease (PD) each year, and approximately one million Americans are living with PD (1).

Patients with PD suffer from a collection of symptoms caused by the breakdown of brain neurons. In medicine, we know the most common symptoms by the mnemonic TRAP: tremors while resting, rigidity, akinesia/bradykinesia (inability/difficulty to move or slow movements) and postural instability or balance issues. It can also result in a masked face, one that has become expressionless, and potentially dementia.

There are several different subtypes of PD; the diffuse/malignant phenotype has the highest propensity toward cognitive decline (2).

There’s a lot we still don’t know about the causes of PD; however, risk factors may include head trauma, reduced vitamin D, milk intake, well water, being overweight, high levels of dietary iron, and migraine with aura in middle age.

The part of the brain most affected is the basal ganglia, and the prime culprit is dopamine deficiency that occurs in this brain region (3). Adding back dopamine has been the mainstay of medical treatment, but eventually the neurons themselves break down, and the medication becomes less effective. Is there hope? Yes, in the form of medications and deep brain stimulatory surgery, but also with lifestyle modifications. Lifestyle factors include iron, vitamin D and CoQ10. The research, unfortunately, is not conclusive, though it is intriguing.

Reducing iron in the brain

This heavy metal is potentially harmful for neurodegenerative diseases such as Alzheimer’s disease, macular degeneration, multiple sclerosis and, yes, Parkinson’s disease. The problem is that this heavy metal can cause oxidative damage.

In a small, yet well-designed, randomized controlled trial (RCT), researchers used a chelator to remove iron from the substantia nigra, a specific part of the brain where iron breakdown may be dysfunctional. An iron chelator is a drug that removes the iron. Here, deferiprone (DFP) was used at a modest dose of 30 mg/kg/d (4). This drug was mostly well-tolerated.

The chelator reduced the risk of disease progression significantly on the Unified Parkinson Disease Rating Scale (UPDRS) during the 12-month study. Participants who were treated sooner had lower levels of iron compared to a group that used the chelator six months later. A specialized MRI was used to measure levels of iron in the brain.

The iron chelator does not affect, nor should it affect, systemic levels of iron, only those in the brain specifically focused on the substantia nigra region. The chelator may work by preventing degradation of the dopamine-containing neurons. It also may be recommended to consume foods that contain less iron.

Does CoQ10 slow progression?

When we typically think of using CoQ10, a coenzyme found in over-the-counter supplements, it is to compensate for depletion from statin drugs or due to heart failure. Typical doses range from 100 to 300 mg. However, there is evidence that CoQ10 may be beneficial in Parkinson’s at much higher doses.

In an RCT, results showed that those given 1,200 mg of CoQ10 daily reduced the progression of the disease significantly based on UPDRS changes, compared to the placebo group (5). Other doses of 300 and 600 mg showed trends toward benefit, but were not significant. This was a 16-month trial in a small population of 80 patients. Unfortunately, results for other CoQ10 studies have been mixed. In this study, CoQ10 was well-tolerated at even the highest dose. Thus, there may be no downside to trying CoQ10 in those with PD.

Is Vitamin D part of the puzzle?

In a prospective study, results show that vitamin D levels measured in the highest quartile reduced the risk of developing Parkinson’s disease by 65 percent, compared to the lowest quartile (6). This is quite impressive, especially since the highest quartile patients had vitamin D levels that were what we would qualify as insufficient, with blood levels of 20 ng/ml, while those in the lowest quartile had deficient blood levels of 10 ng/ml or less. There were over 3,000 patients involved in this study with an age range of 50 to 79.

While many times we are deficient in vitamin D and have a disease, replacing the vitamin does nothing to help the disease. Here, it does. Vitamin D may play dual roles of both reducing the risk of Parkinson’s disease and slowing its progression.

In an RCT, results showed that 1,200 IU of vitamin D taken daily may have reduced the progression of Parkinson’s disease significantly on the UPDRS compared to a placebo over a 12-month duration (7). Also, this amount of vitamin D increased the blood levels by almost two times from 22.5 to 41.7 ng/ml. There were 121 patients involved in this study with a mean age of 72.

So, what have we learned? Though medication with dopamine agonists is the gold standard for the treatment of Parkinson’s disease, lifestyle modifications can have a significant impact on both prevention and treatment of this disease. Each lifestyle change in isolation may have modest effects, but cumulatively their impact could be significant. The most exciting part is that lifestyle modifications have the potential to slow the disease progression and thus have a protective effect.

References:

(1) parkinson.org. (2) JAMA Neurol. 2015;72:863-873. (3) uptodate.com. (4) Antioxid Redox Signal. 2014;10;21(2):195-210. (5) Arch Neurol. 2002;59(10):1541-1550. (6) Arch Neurol. 2010;67(7):808-811. (7) Am J Clin Nutr. 2013;97(5):1004-1013.

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. 

The standard American diet is very low in nutrients. METRO photo
Nutrient intake is stunningly low in the United States

By David Dunaief, M.D.

Dr. David Dunaief

Most chronic diseases, including common killers, such as heart disease, stroke, diabetes and some cancers, can potentially be prevented, modified and even reversed with a focus on nutrients, according to the Centers for Disease Control and Prevention (CDC). 

Here’s a stunning statistic: 60 percent of American adults have a chronic disease, with 40 percent of adults having more than one (1). This is likely a factor in the slowing pace of life expectancy increases in the U.S., which have plateaued in the past decade at around 78.8 years old (2).

The truth is that many Americans are malnourished, regardless of socioeconomic status and, in many cases, despite being overweight or obese. The definition of malnourished is insufficient nutrition, which in the U.S. results from low levels of much-needed nutrients. Sadly, the standard American diet is very low in nutrients, so many have at least moderate malnutrition.

I regularly test patients’ carotenoid levels. Carotenoids are nutrients that are incredibly important for tissue and organ health. They are measurable and give the practitioner a sense of whether the patient may lack potentially disease-fighting nutrients. Testing is often covered by insurance if the patient is diagnosed with moderate malnutrition. A high nutrient intake dietary approach can resolve the situation and increase, among others, carotenoid levels.

High nutrient intake is important

A high nutrient intake diet is an approach that focuses on micronutrients, which literally means small nutrients, including antioxidants and phytochemicals – plant nutrients. Micronutrients are bioactive compounds found mostly in foods and some supplements. While fiber is not considered a micronutrient, it also has significant disease modifying effects. Micronutrients interact with each other in synergistic ways, meaning the sum is greater than the parts. Diets that are plant-rich raise the levels of micronutrients considerably in patients.

In a 2017 study that included 73,700 men and women who were participants in the Nurses’ Health Study and the Health Professionals Follow-up Study, participants’ diets were rated over a 12-year period using three established dietary scores: the Alternate Healthy Eating Index–2010 score, the Alternate Mediterranean Diet score, and the Dietary Approaches to Stop Hypertension (DASH) diet score (3).

A 20 percent increase in diet scores (indicating an improved quality of diet) was significantly associated with a reduction in total mortality of 8 to 17 percent, depending on whether two or three scoring methods were used. Participants who maintained a high-quality diet over a 12-year period reduced their risk of death by 9 to 14 percent more than participants with consistently low diet scores over time. By contrast, worsening diet quality over 12 years was associated with an increase in mortality of 6 to 12 percent. Not surprisingly, longer periods of healthy eating had a greater effect than shorter periods.

This study reinforces the findings of the Greek EPIC trial, a large prospective (forward-looking) cohort study, where the Mediterranean-type diet decreased mortality significantly – the better the compliance, the greater the effect (4). The most powerful dietary components were the fruits, vegetables, nuts, olive oil, legumes and moderate alcohol intake. Low consumption of meat also contributed to the beneficial effects. Dairy and cereals had a neutral or minimal effect.

Quality of life

Quality of life is also important, though. Let’s examine some studies that examine the impact of diet on diseases that may reduce our quality of life as we age.

A study showed olive oil reduces the risk of stroke by 41 percent (5). The authors attribute this effect at least partially to oleic acid, a bioactive compound found in olive oil. While olive oil is important, I recommend limiting olive oil to one tablespoon a day. There are 120 calories per tablespoon of olive oil, all of them fat. If you eat too much, even of good fat, it defeats the purpose. The authors commented that the Mediterranean-type diet had only recently been used in trials with neurologic diseases and results suggest benefits in several disorders, such as Alzheimer’s. 

In a case-control study that compared those with and without disease, high intake of antioxidants from food was associated with a significant decrease in the risk of early Age-related Macular Degeneration (AMD), even when participants had a genetic predisposition for the disease (6). AMD is the leading cause of blindness in those 55 years or older.

There were 2,167 people enrolled in the study with several different genetic variations that made them high risk for AMD. Those with a highest nutrient intake, including B-carotene, zinc, lutein, zeaxanthin, EPA and DHA- substances found in fish, had an inverse relationship with risk of early AMD. Nutrients, thus, may play a role in modifying gene expression. 

Though many Americans are malnourished, nutrients that are effective and available can alter this predicament. Hopefully, with a focus on a high nutrient intake, we can improve life expectancy and, on an individual level, improve our quality of life.

References:

(1) cdc.gov. (2) macrotrends.net. (3) N Engl J Med 2017; 377:143-153. (4) BMJ. 2009;338:b2337. (5) Neurology June 15, 2011. (6) Arch Ophthalmol. 2011;129(6):758-766.

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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Sen. Mario Mattera. File photo

Senator Mario R. Mattera (2nd Senate District) recently announced that he is hosting a “Shed the Meds” event, in conjunction with the Suffolk County Sheriff’s Office on Saturday, July 24, from 11 a.m. to 1:00 p.m. at the Half Hollow Hills Community Library at 600 South Service Road in Dix Hills.

The event will provide residents with an easy, confidential and safe way properly dispose of unused or expired medications.  Residents are encouraged to drop off expired and unused medications and sharps at the event site.

Residents who wish to participate can simply drive up, drop off their old or unused medications, and drive away.  All collected medication will be safely disposed of by the Suffolk County Sheriff’s Office to help keep these medications from polluting our environment and help eliminate the risk of these drugs getting into the hands of small children or those who might misuse them.

The event will also help raise awareness of the dangers of flushing medications down the toilet.  Improperly disposed medications pose a problem to the community’s water supply and environment.

“I thank the Suffolk County Sheriff’s office for partnering with us on this event to provide a safe way for the community to dispose of unwanted drugs and pharmaceuticals.  Participation in this program is a confidential way for everyone to safely get these substances out of their homes to protect their family, safeguard our local waterways and preserve Long Island’s water supply,” stated Senator Mattera.  “Thank you to the Library and the Sheriff’s Office for partnering with us and I invite everyone to join our office on July 24.”

Residents should contact Senator Mattera’s office at 631-361-2154 or visit mattera.nysenate.gov for additional information.

Pixabay photo
Dr. On Chen. Photo from Stony Brook Medicine

Now that temperatures are on the rise and humidity is surging , it is important to protect our hearts from the hazards of the summer sun. On Chen, MD, interventional cardiologist and Director of the CCU and Telemetry Units, Outpatient Cardiology Services and the Lipid Program at Stony Brook Medicine, has some suggestions to help you stay heart-safe all summer long.

People with an existing heart condition need to be careful with warmer temperatures, but even a healthy heart can be put under stress when temperatures climb. Following are tips for helping to make your summer heart-safe:

  1. Hydrate. Adequate hydration is nothing less than your best friend as the summer heat moves in. Drinking plenty of water helps regulate your temperature, helps your heart pump more easily and keeps all your organs functioning properly. Remember to drink before you are thirsty, and avoid alcohol and caffeinated beverages, which can dehydrate the body. And, it is important to know that some common heart medications can make you more vulnerable to high heat and increase your hydration needs. Talk to your doctor about your specific hydration needs.

  2. Staying Cool. If you don’t have access to air conditioning, cold compresses (an ice-pack or ice-water filled bottle) applied to your ‘pulse points’ — the areas where your veins are closest to your skin’s surface, including wrists, neck, temples and armpits — can help you cool down.

  3. Eat Water-Rich Foods. You get about 20 percent of your water from the foods you eat. A hot weather diet that emphasizes cold soups, salads and fruits can both satisfy hunger and provide extra fluid. Strawberries, watermelon, peaches, cucumbers, celery, tomatoes, peppers and spinach, are all fruits and veggies that are 90 percent or more water.

  4. Know Heat Illness Warning Signs. Spending too much time in extreme heat may lead to heat exhaustion and, in turn, heatstroke, two serious heat-related illnesses in which your body can’t control its temperature.

    1. Heat Exhaustion Symptoms: Heavy sweating, nausea or vomiting, muscle cramps, tiredness, dizziness and fainting. Treatment: Move to a cool place, loosen clothing, use cold compresses, sip cool (not cold) water. If symptoms persist, call 911.

    2. Heatstroke (also called Sunstroke) Symptoms: Fever of 104 degrees or more; severe headache; behavioral changes; confusion; hot, red skin; no sweating; rapid heartbeat and loss of consciousness. Treatment: Heatstroke is a life-threatening medical emergency. Call 911 immediately. Quickly move the individual to a cooler place, use cold compresses, do not give anything to drink.

  5. Know Your Numbers. See your doctor to get a careful look at your “numbers,” including your cholesterol and triglyceride levels, your blood pressure and more. Knowing your numbers and your risk factors are an important part of heart health, especially before engaging in warm-weather activities.

  6. Timing is Everything. Avoid being outdoors during the hottest times of the day, when the sun is at its strongest and temps are at their highest. Your cardiovascular system has to work harder on a hot day in an effort to keep your body cool. In fact, for every degree that your body temperature rises, your heart has to pump an additional ten beats per minute. Everyone is at risk in extreme heat, but high temperatures and humidity are particularly stressful for those who already have a weakened heart.

  7. Be Sun Savvy. A sunburn can dehydrate you and impede your body’s ability to cool. If you’re going to be outside during the peak sun of the day, be sure to apply sunscreen 30 minutes before you head out. Reapply every couple of hours.

  8. Dress for Sun-cess. Think loose, light-colored clothing (to help reflect heat) that is made of a lightweight, breathable fabric like cotton. Add well-ventilated shoes, a wide-brimmed hat, shades and sunscreen and you’re good to go.

  9. Pace Yourself. Make your warm weather workouts shorter and slower, aim for morning or evening when the temps and humidity are lower, choose shady pathways and trails or an air-conditioned space. Work with your healthcare team to develop a plan that is best for you.

  10. Listen to your body. If you aren’t used to regular exercise, are over 50, have heart disease or have questions about your heart health, see your doctor before participating in any strenuous outdoor summer activities.

Although anyone can be affected by heat illness, people with heart disease are at greater risk.

For more information, visit www.heart.stonybrookmedicine.edu or call (631) 44-HEART.

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Avoid calcium supplements and fortified foods

By David Dunaief, M.D.

Dr. David Dunaief

Kidney stones are relatively common, occurring more often in men than women (1). I have seen many patients who have a history of forming these stones. Unfortunately, once a patient forms one stone, the incidence of another increases significantly over time. However, there are several ways to reduce your risk.

Kidney stones, or nephrolithiasis, can have no symptoms, but more often they present with the classic symptoms of blood in the urine and colicky pain. Pain can be intermittent or constant, ranging from dull to extremely painful, described by some as being worse than giving birth, shot or burned. The pain may radiate from the kidneys to the bladder and even to the groin in males, depending on the obstruction (2). Stones are usually diagnosed through clinical suspicion and abdominal x-rays and/or non-contrast CT scans.

Unfortunately, the first line treatment for passing kidney stones – at least small ones – involves supportive care. This means that patients are given pain medications and plenty of fluids until the stone(s) pass. Usually stones that are <4mm pass spontaneously. Location is an important factor as well, with stones closest to the opening of the urethra more likely to pass (3). In the case of a stone too large to pass naturally, a urologist may use surgery, ultrasound, or a combination of methods to break it into smaller pieces, so it can be passed.

Stay hydrated

The good news is there are lifestyle changes that can reduce the risk of kidney stones. First, it is very important to stay hydrated, drinking plenty of fluids, especially if you have a history of stone formation (4).

 

Consume calcium from diet, not supplements

Pain from kidney stones can be intermittent or constant, ranging from dull to extremely painful.

One of the simplest methods is to reduce your intake of calcium supplements, including foods fortified with calcium. There are two types of stones. Calcium oxalate is the dominant one, occurring approximately 80 percent of the time (5). Calcium supplements, therefore, increase the risk of kidney stones. When physicians started treating women for osteoporosis with calcium supplements, the rate of kidney stones increased by 37 percent (6). According to findings from the Nurses’ Health Study, those who consumed highest amount of supplemental calcium were 20 percent more likely to have kidney stones than those who consumed the lowest amount (7). It did not matter whether participants were taking calcium citrate or calcium carbonate supplements.

Interestingly, calcium from dietary sources actually has the opposite effect, decreasing risk. In the same study, those participants who consumed the highest amount of dietary calcium had a 35 percent reduction in risk, compared to those who were in the lowest group. Calcium intake should not be too low, for that also increases kidney stone risk. However, the source of calcium is a key to preventing kidney stones.

Reduce sodium

Another modifiable risk factor is sodium. It’s important to reduce sodium for many reasons, but this provides one more. Again, in the Nurses’ Health Study, participants who consumed 4.5 g sodium per day had a 30 percent higher risk of kidney stones than those who consumed 1.5 g per day (7). The reason is that increased sodium causes increased urinary excretion of calcium. When there is more calcium going through the kidneys, there is a higher chance of stones.

Pain from kidney stones can be intermittent or constant, ranging from dull to extremely painful. METRO photo

Limit animal protein

Animal protein also seems to play a role. In a five-year, randomized clinical trial, men who consumed small amounts of animal protein, approximately two ounces per day, and lower sodium were 51 percent less likely to experience a kidney stone than those who consumed low amounts of calcium (8). These were men who had a history of stone formation. The reason animal protein may increase the risk of calcium oxalate stones more than vegetable protein is that its higher sulfur content produces more acid, which is neutralized by release of calcium from the bone (9).

Reduce blood pressure naturally

Some medical conditions may increase the likelihood of stone formation. For example, in a cross-sectional study with Italian men, those with high blood pressure had a two times greater risk of kidney stones than those who had a normal blood pressure (10). Amazingly, it did not matter if the patients were treated for high blood pressure with medications; the risk remained. This is just one more reason to treat the underlying cause of blood pressure, not the symptoms.

The most productive way to avoid the potentially excruciating experience of kidney stones is to make these relatively simple lifestyle changes. The more changes that you implement, the lower your risk of stones.

References:

(1) Kidney Int. 1979;16(5):624. (2) emedicine January 1, 2008. (3) J Urol. 2006;175(2):575. (4) J Urol. 1996;155(3):839. (5) N Engl J Med. 2004;350(7):684. (6) Kidney Int 2003;63:1817–23. (7) Ann Intern Med. 1997;126(7):497-504. (8) N Engl J Med. 2002 Jan 10;346(2):77-84. (9) J Clin Endocrinol Metab. 1988;66(1):140. (10) BMJ. 1990;300(6734):1234. 

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. 

*We invite you to check out our new weekly Medical Compass MD Health Videos on www.tbrnewsmedia.com.

In addition to the bypass surgery, Stony Brook surgeons regularly perform the full spectrum of cardiac lifesaving procedures including Transcatheter Aortic Valve Replacement (TAVR), Mitral Valve Repair, Electrophysiology and Cardiac Catheterization. Photo from Stony Brook Medicine

The Cardiothoracic Surgery Division at Stony Brook University Heart Institute has earned a distinguished three-star rating from The Society of Thoracic Surgeons (STS) for its patient care and outcomes in isolated coronary artery bypass grafting (CABG) procedures in 2020. The three-star rating, which denotes the highest category of quality, places Stony Brook University Hospital among the elite for heart bypass surgery in the United States and Canada. The Stony Brook Heart Institute received two back-to-back three-star ratings from The Society of Thoracic Surgeons (STS) in 2017 and 2018, and now an overall three-star rating for 2020.

This elite rating is reflective of our entire organization’s commitment to quality and safety — from preoperative planning to thorough coordination among multidisciplinary team members — for the optimal outcome for the patient receiving cardiac care,” says Margaret McGovern, MD, PhD, Dean for Clinical Affairs and Vice President, Health System Clinical Programs.

“At Stony Brook, we take great pride in our comprehensive heart program that has a long legacy of bringing the highest quality standards to benefit our patients and their families,” says Carol Gomes, Chief Executive Office, Stony Brook University Hospital. “And we remain laser-focused on serving our community with the most advanced technology, our outstanding cardiovascular staff and the full spectrum of lifesaving cardiac interventions.”

“The three-star rating is a testament to our team’s deep commitment to bringing the best in cardiac care to our community,” says Henry J. Tannous, MD, Co-Director of the Heart Institute, Chief of Cardiothoracic Surgery and General T.F. Cheng Chair, Cardiothoracic Surgery, Renaissance School of Medicine at Stony Brook University. “Patients can have peace of mind knowing they’re getting care from one of the top-rated facilities in the nation.”

The STS star rating system is one of the most sophisticated and highly regarded overall measures of quality in health care, rating the benchmarked outcomes of cardiothoracic surgery programs across the United States and Canada. The star rating is calculated using a combination of quality measures for specific procedures performed by an STS Adult Cardiac Surgery Database participant. For 2020, 6.1% of participants received the three-star rating for isolated CABG surgery.

“The Society of Thoracic Surgeons congratulates STS National Database participants who have received three-star ratings,” said David M. Shahian, MD, chair of the Task Force on Quality Measurement. “Participation in the Database and public reporting demonstrates a commitment to quality improvement in health care delivery and helps provide patients and their families with meaningful information to help them make informed decisions about health care.”

The STS National Database was established in 1989 as an initiative for quality improvement and patient safety among cardiothoracic surgeons. The Database includes four components: the Adult Cardiac Surgery Database (ACSD), the Congenital Heart Surgery Database (CHSD), the General Thoracic Surgery Database (GTSD), and the mechanical circulatory support database (Intermacs). The STS ACSD houses approximately 7.4 million surgical records and gathers information from more than 3,500 participating physicians, including surgeons and anesthesiologists from more than 90% of groups that perform heart surgery in the US. STS public reporting online enables STS ACSD participants to voluntarily report to each other and the public their heart surgery scores and star ratings.

“The STS rating is based on the Division of Cardiothoracic Surgery’s experience in coronary artery bypass grafting (CABG) surgery, and we believe that the quality and expertise illustrated by the top rating is reflective of the entire Heart Institute’s dedication to excellence in patient care,” says Dr. Tannous.

About Stony Brook University Heart Institute:

Stony Brook University Heart Institute is located within Stony Brook University Hospital as part of Long Island’s premier university-based medical center. The Heart Institute offers a comprehensive, multidisciplinary program for the prevention, diagnosis and treatment of cardiovascular disease. The staff includes full-time and community-based, board-certified cardiologists and cardiothoracic surgeons, as well as specially trained anesthesiologists, nurses, physician assistants, nurse practitioners, respiratory therapists, surgical technologists, perfusionists, and other support staff. Their combined expertise provides state-of-the-art interventional and surgical capabilities in 24-hour cardiac catheterization labs and surgical suites. And while the Heart Institute clinical staff offers the latest advances in medicine, its physician-scientists are also actively enhancing knowledge of the heart and blood vessels through basic biomedical studies and clinical research. To learn more, visit www.heart.stonybrookmedicine.edu.

About STS:

The Society of Thoracic Surgeons (STS) is a not-for-profit organization that represents more than 7,500 surgeons, researchers, and allied health care professionals worldwide who are dedicated to ensuring the best possible outcomes for surgeries of the heart, lung, and esophagus, as well as other surgical procedures within the chest. The Society’s mission is to advance cardiothoracic surgeons’ delivery of the highest quality patient care through collaboration, education, research, and advocacy.

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Starting on July 23, Tokyo will host the Summer Olympic Games with athletes from around the world without any spectators.

Medical director of Healthcare Epidemiology at Stony Brook University Hospital

Already postponed a year amid the COVID-19 pandemic, the games will look much more like the National Basketball Association bubble games and Major League Baseball’s empty stadiums than the current version of professional American sports.

“There is tremendous vaccination disparity throughout the globe,” said Susan Donelan, medical director of Healthcare Epidemiology at Stony Brook University Hospital, in an email. “Despite what many Americans believe, the global pandemic is very much alive and problematic. Superimpose this on the fact that another state of emergency has just been declared in Tokyo due to rising COVID-19 cases, and it is not difficult to understand how this decision was arrived at.”

Indeed, the Olympics draw athletes from close to 200 countries and territories, with thousands of competitors representing themselves, their families and their countries.

In Japan, just over 15% of the population is fully vaccinated, which is still “low compared with 47.4% in the United States and almost 50% in Britain, according to Sunil Dhuper, chief medical officer at St. Charles Hospital. “That greatly increases the probability of an explosion in the number of Covid infection cases especially if the Olympic stadiums are packed or even at 50% capacity.”

While people in the United States are increasingly relaxing restrictions after the increasing availability of vaccines, health officials throughout the world have not only had to contend with the uneven availability of the vaccine in different countries, but also with the spread of the more infectious delta variant.

The original virus, or so-called wild type, came from Wuhan, China. Over time, viruses mutate, typically during replication, when they incorrectly copy one or more of the base pairs in their genes.

Sunil Dhuper, chief medical officer at St. Charles Hospital

While most mutations are harmless, some can make a virus more problematic. Termed variants, viruses that differ from the original can produce different symptoms or have different qualities.

The delta variant, which started in India in December of 2020, has become the dominant strain in the United States and, likely in Suffolk County, in part because an infected person can transmit it much more easily.

The delta variant “concentrates in the upper respiratory cells, which is one of the reasons why it transmits so much easier among people and why it’s a concern,” said Adrian Popp, chair of Infection Control at Huntington Hospital/Northwell Health and associate professor of medicine at Hofstra School of Medicine.

Indeed, the delta variant is 50% more transmissible than the alpha, or UK variant, which was about 50% more transmissible than the original, Donelan wrote.

Boosters

Amid the spread of the delta variant, companies like Pfizer have been meeting with federal health officials to discuss the potential need for a booster shot.

Pfizer’s rationale for a booster is that the vaccine’s ability to prevent infection and symptomatic disease seems to wane six months after vaccination, citing data from the Israel Ministry of Health, according to Dhuper.

The World Health Organization, however, indicates that “more data are needed before reaching the same conclusion,” Dhuper explained in an email. A recent study in the journal Nature found evidence that the immune response to vaccines is “strong and potentially long lasting,” which is based on the data that the germinal centers in the lymph nodes are producing immune cells directed at COVID-19.

At this point, officials from the Food and Drug Administration and the Centers for Disease Control and Prevention are unwilling to provide an emergency use authorization for a booster.

These government agencies believe people who have been vaccinated are protected from severe disease and death, including variants like delta, Dhuper wrote.

Adrian Popp, chair of Infection Control at Huntington Hospital/Northwell Health

Popp expressed confidence in the CDC to determine when a booster might be necessary, as the national health organization reviews data for the entire country.

Someone who is vaccinated in the United States should have “decent immunity” against this altered virus, according to Popp. The immunity will vary from person to person depending on the underlying health and immunity.

Indeed, Popp said several vaccinated people who have come to Huntington Hospital recently have tested positive for the virus.

The hospital discovered the cases, all but two of which were asymptomatic, because they tested for the virus for people who were coming to the hospital for other reasons, such as a broken hip. Two of the cases had mild symptoms, while the others were asymptomatic.

“The effectiveness of the current COVID vaccines is quite high,” Dhuper wrote. “In fact, it is much higher than some other vaccines we commonly receive.”

He contrasted this with the annual flu vaccine, which has an effectiveness of around 40 to 60% from year to year.

Dhuper also explained that antibodies are only part of the immune response that makes vaccines effective. T-cells and memory B cells are also involved. Some researchers have found that T cells in the blood of people who recovered from the original version of COVID-19 recognized the three mutant strains of the virus, which could reduce the severity of any subsequent infection.

Based on the available data and current information in Japan, Popp said he would likely participate in the Olympics in Tokyo if he were a member of an Olympic team.

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In honor of our frontline workers, Suffolk County Legislator Kara Hahn, Brookhaven Town Councilmember Jonathan Kornreich, and the Port Jefferson Station / Terryville Chamber of Commerce will host a Community Blood Drive at the Polish American Independent Club, 35 Jayne Blvd, Port Jefferson Station on Wednesday, July 14 from 2 to 8 p.m.

All donors will receive a FREE box of Girl Scout Cookies!!! Appointments preferred, walk-ins allowed if capacity permits. Please remember to eat, drink, and bring your donor ID card or ID with name and photo. To make an appointment, visit  www.nybc.org/donate or call (800)933-BLOOD.

For more information, call 631-821-1313.

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Mouthwatering barbeque options can decrease health risks

By Daniel Dunaief

Dr. David Dunaief

What better way than the unofficial launch of summer holidays – and summer barbeques – to kick-start you on the path to preventing chronic diseases? In the past, I have written about the dangers of processed meats in terms of causing chronic diseases, such as cancer, diabetes, heart disease and stroke. These are foods commonly found at barbeques and picnic meals. Therefore, I think it is only fair to talk about healthier alternatives and the evidence-based medicine that supports their benefits. The Mediterranean-style diet is a key to success. It is composed of thousands of beneficial nutrients that interact with each other in synergistic ways. 

The Mediterranean-style diet, as I have mentioned previous articles, includes green leafy vegetables, fruit, nuts and seeds, beans and legumes, whole grains and small amounts of fish and olive oil. We all want to be healthier, but these are the summer holidays – doesn’t healthy mean tasteless? Not at all!

At a memorable family barbeque, we had a bevy of choices that were absolutely succulent. These included a three-bean salad, mandarin orange salad with mixed greens and a light raspberry vinaigrette, ratatouille with eggplant and zucchini, salmon fillets baked with mustard and slivered almonds, roasted corn on the cob, roasted vegetable shish kebobs, and large bowl of melons and berries. I am drooling at the memory of this buffet. Let’s look at the scientific evidence that explains why these foods help us.

Cancer prevention

Fruits and vegetables may help prevent pancreatic cancer. This is very important, since by the time there are symptoms, the cancer has spread to other organs and the patient usually has less than 2.7 years to live (1). Five-year survival is only five percent (2). In a case control (epidemiological observational) study, cooked vegetables showed a 43 percent reduction and non-citrus fruits showed an even more impressive 59 percent reduction in risk of pancreatic cancer (3). Interestingly, cooked vegetables, not just raw ones, had a substantial effect.

Garlic plays an important role in reducing the risk of colon cancer. In the IOWA Women’s Health Study, a large prospective (forward-looking) trial involving 41,837 women, there was a 32 percent reduction in risk of colon cancer for the highest intake of garlic compared to the lowest. Vegetable consumption also showed a statistically significant reduction in the disease, as well (4). Many of my patients find that fresh garlic provides a wonderful flavor when cooking vegetables.

Diabetes – treatment and prevention

Fish plays an important role in reducing the risk of diabetes. In a large prospective study that followed Japanese men for five years, those in the highest quartile of intake of fish and seafood had a substantial decrease in risk of type 2 diabetes (5). Smaller fish, such as mackerel and sardines, had a slightly greater effect than large fish and seafood in potentially preventing the disease. Therefore, there is nothing wrong with some grilled fish on the “barbie” to help protect you from developing diabetes. 

Nuts are beneficial in the treatment of diabetes. In a randomized clinical trial (the gold standard of studies), mixed nuts led to a substantial reduction of hemoglobin A1C, a very important biomarker for sugar levels for the previous three months (6). As an added benefit, there was also a significant reduction in LDL, bad cholesterol, which reduced the risk of cardiovascular disease.

The nuts used in the study were raw almonds, pistachios, pecans, peanuts, cashews, hazelnuts, walnuts and macadamias. How easy is it to grab a small handful of unsalted raw nuts, about 2 ounces, on a daily basis to help treat diabetes?

Stroke prevention

Olive oil appears to have a substantial effect in preventing strokes. The Three City study showed that olive oil may have a protective effect against stroke. There was a 41 percent reduction in stroke events in those who used olive oil (7). Study participants, who were followed for a mean of 5.2 years, did not have a history of stroke at the start of the trial.

Though these are promising results, I caution you to use no more than one tablespoon of olive oil per day, since there are 120 calories in a tablespoon. 

It is not difficult to substitute the valuable Mediterranean-style diet for processed meats, or at least add them to the selection. This plant-based diet offers a tremendous number of protective elements in the prevention of many chronic diseases. So this Independence Day and beyond, plan to have on hand some mouth-watering healthy choices.

References:

(1) Nature. 2010;467:1114-1117. (2) Epidemiol Prev Anno 2007;31(Suppl 1). (3) Cancer Causes Control. 2010;21:493-500. (4) Am J Epidemiol. 1994 Jan 1;139(1):1-15. (5) Am J Clin Nutr. 2011 Sep;94(3):884-891. (6) Diabetes Care. 2011 Aug;34(8):1706-11. (7) Neurology. 2011 Aug 2;77(5):418-25.

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. 

Dominick Pernice. Photo from St. Catherine of Siena

Dominick Pernice, RT, MBA, has been named chief operating officer at Catholic Health’s St. Catherine of Siena Hospital (SCSH). For the past 13 years, Mr. Pernice has served as the administrative director of imaging services and cardiac catheterization at SCSH and St. Charles Hospital in Port Jefferson. 

In his new role, Mr. Pernice will oversee SCSH’s daily hospital operational and administrative functions; design and implement business strategies, plans and procedures; set comprehensive goals for performance and growth across all clinical services lines; and continue to ensure patient safety and patient satisfaction. 

“We are very fortunate to have Mr. Pernice as part of St. Catherine’s senior leadership team,” said James O’Connor, SCSH president. “Over Mr. Pernice’s long career at St. Catherine and St. Charles hospitals, he has proven his steadfast leadership, strategic planning and keen decision-making skills in addressing various operational issues. In addition, Mr. Pernice was instrumental in developing the imaging services at Ambulatory Care in Commack. As St. Catherine’s COO, Mr. Pernice will further enhance our hospital’s mission in providing the highest quality of care to our patients.”

Prior to joining Catholic Health, Mr. Pernice served as assistant director of radiology, supervisor of magnetic resonance imaging and ultrasound, evening imaging supervisor and radiologic technologist at Long Island Jewish Medical Center in New Hyde Park. Mr. Pernice earned his Master of Business Administration at C.W. Post University and is a Six Sigma Green Belt.