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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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Twilight Zone. Pixabay photo

By Daniel Dunaief

Daniel Dunaief

Conversations with friends, relatives and neighbors have taken a turn into “The Twilight Zone” episodes recently.

Decades ago, when I spoke with my friends, we discussed our activities, ambitions and plans. We might have complained about our bosses, described a business trip, shared an encounter with a stranger on a plane or train, or described our frustrations with our favorite sports teams.

Sure, we still do that, but, as the years pass, the discussions drift. This is where I’d cue the music.

In Episode One, we have two college friends who shared a room for several years, who sweated through a spectacularly hot summer in Boston with no air conditioning, and who, over the decades, visited each other’s homes with and without our wives and children.

So, these two friends recently started catching up.

“I can’t stand the hair that’s coming out of my ears,” I offered. “It makes it harder to hear and to be taken seriously by anyone looking at me.”

“Yeah, that’s pretty unwelcome,” my friend laughed. “My back is killing me. I wake up every morning and it takes me a while to feel comfortable enough to stand and shuffle to the bathroom.”

“My hip has been a problem,” I reply.

“I also don’t see particularly well. I don’t like driving when it’s dark,” he added.

“My knee is sore,” I added, “but I think that’s from compensating for my hip.”

And so it went, for about 10 minutes, until we broke the description of all that ails us and transitioned to a discussion of all that inspires, and worries, us about our college-age children.

“I hope you feel better soon,” I offered as we got off the phone.

“At this point, I’d just take not feeling worse,” he said.

Okay, so that wasn’t too terrifying, right? Two 50-ish guys chatted and shared personal details about the aging vessels that carry us through life.

That takes us to Episode Two. Imagine, if you will, a group of older adults, representing the 50ish and the 80ish generation, chatting in person together.

“Have you been to the doctor recently?” one of the people asked.

“Which one? For what?” a second one replied.

“How many doctors do you have?” a third one asked.

And that is where the conversation became a competition. Each person, slowly and deliberately, shared the number of doctors he or she visits.

“I’ve had kidney stones, so I have a urologist,” I offered, as if I were recounting trophies on a shelf or comparing the number of friends I have with someone else in fourth grade rather than recalling a specialist who helped me deal with excruciating agony.

“Do you have an ENT doctor? I have one,” someone else said.

My competitive spirit again got the best of me.

“I have the best GI guy, who gave me a great colonoscopy. I had such a nice rest while I was under anesthesia,” I said.

I pictured a younger version of me, sitting with the group, staring, open-mouthed at the enthusiasm with which all of us, me included, counted our doctors and the reason we needed them.

In Episode Three, a man in his 30s walked his dog, limping along with a supportive black boot on his leg. Another man (me) appeared, pulled along by his oversized dog.

“Not to get too personal,” I said, “but your shoes don’t match.”

The good-natured man smiled and said he thought he had shin splints from running, but discovered he had a hairline fracture that required several weeks of rest in a boot.

“I went to my parents’ house in New Hampshire and ran over five miles on an uneven road. The next day, I could barely move. I have to rest it for six weeks,” he said.

I nodded and wished him a speedy recovery.

“Well, maybe it hurts just because I’m older,” he offered.

You have no idea, I thought, as I could feel the urge to hold back a clock that pushes each of us forward through time. 

Cue the music.

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Pixabay photo

By Leah S. Dunaief

Leah Dunaief

COVID caught me. After two and a half years of bobbing and weaving, trying to elude the virus, I finally have been felled. It’s like being shot on the last day of the war. 

I did all the right things. I avoided crowds, driving back from my South Carolina vacation at the outbreak of the pandemic in March 2020 instead of using my return plane ticket. I stopped going to the opera and to Broadway shows in New York City. I didn’t eat in restaurants, even after they reopened, for fear of who might be harboring pathogens at the next table. We closed the office to all but those with appointments. We ordered masks for the staff by the dozens and hand sanitizer by the gallon. We practiced social distancing at the bank, that is, before the bank closed its doors and moved away. We stopped holding events, such as “People of the Year” and “Cooks, Books and Corks” and “Reader’s Choice” that might turn into superspreaders. My family and I zoomed rather than visited. Our family holiday celebrations and vacations were suspended. And we took to our computers, to the extent we were able, for everything from classroom learning to shopping for toilet paper.

Remember all that?

Well, as much as we would like to declare the pandemic over, as President Joe Biden (D) recently did, the virus is still with us. I stopped social distancing, then recently became casual about wearing my mask. I started getting together, first with family, then with close friends, then with business colleagues. Recently, I have been eating inside a couple of restaurants. I stopped asking every repairman to please wear a mask in my house. I pushed COVID phobia way down in my consciousness.

Then I got it.

There are, of course, some differences between catching COVID early on and now. The health care professionals know so much more now about treating the disease. Hospitalizations are fewer but still some 32,000 daily, intubations are less common. But people are still dying, some 400-500 a day, to put numbers on it. Through Sept. 19, Suffolk County reported more than one death per day for the month, according to the Suffolk County Department of Health.

“We’ve had two million cases reported over the last 28 days, and we know underreporting is substantial,” Dr. Michael T. Osterholm, an infectious disease specialist at the University of Minnesota, was quoted in the Tuesday edition of The New York Times. He continued that COVID-19 was the No. 4 cause of death in the country.

Many of us were feeling what Biden was expressing. Yes, we have vaccines and medicines now that successfully hold the pathogen at bay, and most people have every expectation of recovering. Nonetheless, it has been a dreaded disease, especially for those of a certain age or with underlying conditions. With me, it started as a little dry cough throughout the afternoon, hardly noticeable. By nightfall, the cough had deepened and a headache began. The next day, the miserable irritation at the back of the throat started. By the end of the day, my temperature began to climb, eventually four degrees, and my body ached.

Of course, my doctor was on vacation that week, but the backup staff responded valiantly. They called me in for THE test, and when it was positive, they gave me three options. I could go to the Emergency Room and get an infusion of monoclonal antibodies, which would take an hour (not including the inevitable wait.) They could phone in a prescription for paxlovid, and I could take three pills in the morning, then three at night, for five days. They spelled out the side effects of both treatments, which didn’t sound too cheerful. Or I could just monitor the situation, drinking plenty of liquids, taking some Tylenol and see how it goes.

I chose the paxlovid.

Yes, it causes a metallic taste after it’s ingested. But it seems to have worked. 

Will I be as cavalier about relaxing precautions? No, I don’t think so. It is possible to get it again, and I REALLY don’t want it again.  I will get the next booster when I am eligible, I will continue to wear a mask regardless of what those around me are doing, and I will limit my dining, to the extent possible, to the great outdoors.

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Diabetes. METRO Photo
In some patients, small amounts of wine may reduce cardiovascular risks

By David Dunaief, M.D.

Dr. David Dunaief

Our understanding of diabetes — its risks and treatment paradigms — is continually evolving and improving. This is good news, since the current rate of diabetes among the U.S. adult population is 13 percent, while another estimated 88 million U.S. adults have prediabetes (1).

What is prediabetes? Typically, it’s when fasting glucose levels (HbA1C) sit in the 5.7 and 6.4 percent range.

With diabetes comes a host of other health complications, including increased heart attack risk. However, cardiovascular risk and its severity may not equally affect men and women. In two trials, women with type 2 diabetes had greater cardiovascular risk than men. In one retrospective study, women with diabetes were hospitalized due to heart attacks at a higher rate than men, although both had substantial risk increases, 162 percent and 96 percent, respectively (2).

What might reduce our risks for diabetes or its complications? Fortunately, we have options. These include diet improvements, timing of blood pressure medications, and, oddly, modest wine consumption.

Diet bests metformin for diabetes prevention

All too often in the medical community, we are guilty of reaching for drugs and either overlooking lifestyle modifications or expecting that patients will fail with them. This is a disservice; lifestyle changes may be more effective in preventing this disease.

In a head-to-head comparison study, diet plus exercise outperformed metformin for diabetes prevention (3). This study was performed over 15 years of duration in 2,776 participants who were at high risk for diabetes because they were overweight or obese and had elevated sugars.

There were three groups in the study: one received a low-fat, low-calorie diet with 15 minutes of moderate cardiovascular exercise; one took metformin 875 mg twice a day; and one was a placebo group. Diet and exercise reduced diabetes risk by 27 percent, while metformin reduced it by 18 percent over the placebo, both reaching statistical significance. Note that, while these are impressive results that speak to the use of lifestyle modification and to metformin, the diet they used was not an optimal diabetes diet.

Blood pressure medications’ timing

Interestingly, taking blood pressure medications at night has an odd benefit, lowering the risk of diabetes (4). In a study, there was a 57 percent reduction in the risk of developing diabetes in those who took blood pressure medications at night rather than in the morning.

It seems that controlling sleep-time blood pressure is more predictive of diabetes risk than morning blood pressure or 48-hour ambulatory blood pressure. This study had a long duration of almost six years with about 2,000 participants.

Researchers used three blood pressure medications in the trial: ACE inhibitors, angiotensin receptor blockers (ARBs) and beta blockers.

The first two have their effect on the renin-angiotensin-aldosterone system (RAAS) of the kidneys. According to the researchers, these had the most powerful effect on preventing diabetes. Furthermore, when sleep systolic (top number) blood pressure was elevated one standard deviation above the mean, there was a 30 percent increased risk of type 2 diabetes.

Interestingly, the RAAS-blocking drugs are the same drugs that protect kidney function when patients have diabetes.

Can wine help?

Diabetes patients are often warned to limit or eliminate alcohol. A significant part of the reasoning relates to how the body metabolizes alcohol and sugars. So, the results of a study that showed small amounts of wine could have benefits in reducing diabetes-associated complications among those whose sugars were well-controlled sent ripples throughout the medical community.

The CASCADE trial, a randomized controlled trial, shows wine may have heart benefits in well-controlled patients with type 2 diabetes by altering the lipid (cholesterol) profile (5).

Patients were randomized into three groups, each receiving a drink with dinner nightly. One group received five ounces of red wine, another five ounces of white wine, and the control group drank five ounces of water. Those who drank the red wine saw a significant increase in their “good cholesterol” HDL levels, an increase in apolipoprotein A1 (the primary component in HDL) and a decrease in the ratio of total cholesterol-to-HDL levels compared to the water-drinking control arm. In other words, there were significant beneficial cardiometabolic changes.

White wine also had beneficial cardiometabolic effects, but not as great as red wine. However, white wine did improve glycemic (sugar) control significantly compared to water, whereas red wine did not. Also, slow metabolizers of alcohol in a combined red and white wine group analysis had better glycemic control than those who drank water. This study had a two-year duration and involved 224 patients. All participants were instructed to follow a Mediterranean-type diet.

Does this mean diabetes patients should start drinking wine? Not necessarily. This was a small study, and participants were well-controlled type 2 diabetes patients who generally were nondrinkers.

We need to reverse the trend toward higher diabetes prevalence. The good news is that we’re continuing to learn what lowers diabetes risk and, for those with Type 2 diabetes, what can improve cardiovascular risks.

References: 

(1) cdc.gov. (4) Journal of Diabetes and Its Complications 2015;29(5):713-717. (3) Lancet Diabetes Endocrinol. Online Sept. 11, 2015. (4) Diabetologia. Online Sept. 23, 2015. (5) Ann Intern Med. 2015;163(8):569-579.

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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Photo from Town of Smithtown
Photo from Town of Smithtown
Photo from Town of Smithtown
Photo from Town of Smithtown

Local officials joined together with the Daniela Conte Foundation, Thomas Scully Foundation, Smithtown Children‘s Foundation, Smithtown Central School District, local parent advocate Amy Beach, families and friends to kick off Childhood Cancer Awareness Month with the annual ‘Go Gold’ Tree lighting ceremony at Town Hall on Sept. 7.

The tree at Town Hall was adorned in gold bows, bearing the names of local children who are actively fighting cancer, in remission or have since passed away. The lights and ribbons were donated to the Town courtesy of Katia Conte, founder of the Daniela Conte foundation in 2021. Each year, new bows with the names of local kids are added. Additionally, giant gold awareness ribbons, donated courtesy of the Thomas Scully Foundation are on display at the Smithtown Bull Monument, at Town Hall, the Parks Department and at the Highway Department through the month of September. Local mom and advocate Amy Beach was on hand to distribute gold laces as a part of the “Lace up for Kids” partnership, in honor of her son Dylan, with the Smithtown Central School District.

“The month of September is Childhood Cancer Awareness Month. But as many of the families here with us tonight will tell you, cancer affects us all 24/7… year round. Tonight we kick off a year of awareness. However… We are also here as one community, one family, to let every parent, or caregiver, who has a child diagnosed with cancer know something…You are not alone. We are here to fight for you, cry with you, laugh with you, pray for you and share our love with you. Thanks to organizations like the Daniela Conte Foundation, the Thomas Scully Foundation, the Smithtown Children‘s Foundation and the work that Parent Advocates like Amy Beach do, there are local resources and an entire community of people who are ready to help. Whether it’s financial assistance, help dealing with insurance companies, hospital administrations, a hand getting dinner on the table or an extra hand around the house… You will not go through this alone. That is our promise to you,” said Supervisor Ed Wehrheim .

Each year, the Town of Smithtown raises awareness for Childhood Cancers in the month of September through various activities and events. These efforts are intended to help fund and raise awareness, identify breakthroughs and fill gaps in the treatment landscape, and direct research to the areas with the greatest need. This year the call for action in addition to advocacy and awareness rang clear from Amy Beach, who spoke on behalf of Katia Conte and Debbie Scully.

“Pediatric Cancer has to be funded by nationwide and local groups. We run, walk, shave our heads, play golf, host gala’s and have community involvement to raise research dollars. Leave it up to the parents… As of today, hospitals are still using 30 year old toxic treatments on children that cause a lifetime of medical problems for survivors. Kids deserve the very best in cures, treatments and protocols that science can offer and that means investing in research… When you think about why it’s so important to go gold in September, then think about the statistics and how underfunded childhood cancer really is. And be truly thankful if you haven’t had to endure the worst thing a parent can go through.,” said Katia Conte of the Daniela Conte Foundation.

“The mission of the Thomas Scully Foundation is to  bring A Little Bit of Happiness to children with cancer today, while supporting a cure for tomorrow. The foundation delivers care packages to bring comfort and joy to children, while they’re in local NY hospitals. They also support a cure for tomorrow, by providing A Little Bit of Hope grants. These are given to families seeking innovative treatments for their child… The Thomas Scully Foundation would like to thank the Town of Smithtown, for helping to bring awareness to childhood cancer by going gold for the third year in a row. Not only are you helping to bring awareness but you’re also letting everyone know that you support those children and families who have been affected. We thank you for that,” added Debbie Scully of the Thomas Scully Foundation.

“Less than 4% of the federal budget for cancer research in the United States of America is dedicated to childhood cancer. Solving Kids Cancer is an organization that finds, funds and advocates for breakthrough treatment options to cure children with the most fatal pediatric cancers. They help accelerate new, next generation treatments, including immunotherapy, cancer vaccines and new drugs, by applying an understanding of the entire childhood cancer landscape to wisely invest in innovative projects… This September, we are proud to have the Smithtown Slammers U14 flash girls soccer team participating in their sixth season of Lace Up for Kids, Nesaquake Middle School has been a wonderful partner since 2018 and we are excited to announce that all of Smithtown Central School District schools will be participating again in 2022… Friday, September 16th will be a district-wide Go Gold Day. And we invite all of you as well to care, wear and share your gold throughout this month of September. Last year, we stood in front of this tree, as so many of you pledged support for these Children and their families battling the unimaginable. It has been 370 days… Support is more than a photo opp. Tonight lets shift from awareness to action. Because every kid deserves a chance to grow up. We look forward to many years of partnership, awareness and advocacy until one day, there is a cure. Be Bold. Go Gold,” said Amy Beach, a childhood cancer research advocate and Smithtown parent. 

“This ceremony here tonight, the support and awareness is invaluable to the children we’re trying to support, those to come and to those who we have lost. The Smithtown Children Foundation was founded in 2008. What many don’t know is that the motivation and inspiration in creating the foundation, was a five year old little girl who was diagnosed with neuroblastoma and who sadly we lost a year later. While we support the community through a number of initiatives, the plight of childhood cancer awareness, of supporting families who are battling this, is one that is very close to our hearts at the foundation. We are here to provide financial, and emotional support, to provide resources, help for some of the ins and outs for families who are going through this and may be a little overwhelmed. We support your foundations wholeheartedly, we support awareness and we support the individual families to help you in any way we can,” said  Krissy Lonetto, of the Smithtown Children‘s Foundation.

“We all know cancer is an insidious disease. But when it impacts our children, it is especially devastating. Amy’s message tonight really hits home… of turning advocacy into action. That is certainly what we are hoping to do! In the next few days and throughout the month, you will see gold ribbons at each of our schools, and increase advocacy with a path towards action. Also, the Lace Up for Kids initiative in schools and at our East/West football game, will pay particular attention to this cause on Friday night. I applaud all the foundations involved here, and the Town for your continued advocacy.,” sadid Superintendent Dr. Mark Secaur, Smithtown Central School District.

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Antioxidant diet may improve outcomes

By David Dunaief, M.D.

Dr. David Dunaief

Heart failure (HF) occurs when the heart’s pumping is not able to keep up with the body’s demands for blood and oxygen and may decompensate. Unlike a heart attack, which is acute, heart failure develops slowly and may take years to become symptomatic.

There are two types of heart failure, systolic and diastolic. The basic difference is that the ejection fraction, the output of blood with each contraction of the left ventricle of the heart, is more or less preserved in diastolic HF, while it can be significantly reduced in systolic HF.

We have more medical research on systolic heart failure. Fortunately, both types can be diagnosed with the help of an echocardiogram, an ultrasound of the heart. The signs and symptoms of both include shortness of breath on exertion or when lying down, edema or swelling, reduced exercise tolerance, weakness and fatigue.

Major lifestyle risk factors for heart failure include obesity; smoking; poor diet, including consuming too much sodium; being sedentary; and drinking alcohol excessively. Conditions that increase your risk include diabetes, coronary artery disease and high blood pressure.

Typically, heart failure is treated with blood pressure medications, such as beta blockers, ACE inhibitors and angiotensin receptor blockers. We are going to look at how diet and iron levels can affect heart failure outcomes.

Increasing antioxidants in the diet

If we look beyond the usual risk factors mentioned above, oxidative stress may play an important role as a contributor to HF.

In a population-based, prospective study, the Swedish Mammography Cohort, results show that a diet rich in antioxidants reduces the risk of developing HF (1). In the group that consumed the most nutrient-dense foods, there was a significant 42 percent reduction in the development of HF, compared to the group that consumed the least. According to the authors, the antioxidants were derived mainly from fruits, vegetables, whole grains, coffee and chocolate. Fruits and vegetables were responsible for the majority of the effect.

What makes this study so impressive is that it is the first of its kind to investigate antioxidants from the diet and their impacts on heart failure prevention.

This was a large study, involving 33,713 women, with good duration — follow-up was 11.3 years. There are limitations to this study, because it is observational and the population involved only women. Still, the results are very exciting, and it is unlikely there is a downside to applying this approach to the population at large.

Addressing iron deficiencies

An observational study that followed 753 heart failure patients for almost two years showed that iron deficiency without anemia increased the risk of mortality in heart failure patients by 42 percent (2).

In this study, iron deficiency was defined as a ferritin level less than 100 μg/L (the storage of iron) or, alternately, transferrin saturation less than 20 percent (the transport of iron) with a ferritin level in the range 100–299 μg/L. The authors conclude that iron deficiency is potentially more predictive of clinical outcomes than anemia, contributes to the severity of HF and is common in these patients.

These studies suggest that we should try to prevent heart failure through dietary changes, including high levels of antioxidants, because it is not easy to reverse the disease. Those with HF should have their ferritin and iron levels checked, because these can be addressed with medical supervision.

References: 

(1) Am J Med. 2013 Jun:126(6):494-500. (2) Am Heart J. 2013;165(4):575-582.

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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Photo from Deposit Photos

Now available at a doctor’s office or pharmacy near you: the latest COVID-19 booster.

Last week, the Food and Drug Administration gave Pfizer and Moderna Emergency Use Authorization to start distributing their newest COVID booster, which includes protection against the highly infectious Ba.4 and Ba.5 strains of omicron.

A few days later, the Centers for Disease Control and Prevention approved the administration of the booster.

Area doctors welcomed the news and suggested the newest booster would be helpful for certain groups.

“I suspect that, at a minimum, those who needed to get a fourth booster (elderly, comorbidity, immune issues) should get” it, explained Dr. Sharon Nachman, chief of the Division of Pediatric Infectious Diseases at Stony Brook Children’s Hospital, in an email. “I believe that its approval will include all individuals over age 12.”

Dr. Adrian Popp, chair of Infection Control at Huntington Hospital/ Northwell Health, agreed that senior citizens and immunocompromised people should consider the latest booster.

With other shots available until now, residents may need to consider how much time to wait between boosters.

People are eligible for another booster two months after a previous COVID vaccine, according to the FDA website.

The FDA authorized single doses of Moderna’s booster for people 18 and over and Pfizer’s booster for those 12 and older.

The incidence of hospitalizations among people who have COVID at area hospitals has remained fairly stable during the summer. Stony Brook University Hospital has about 50 COVID inpatients each day, while Huntington Hospital has about 11.

Doctors cautioned, however, that those numbers include people who are hospitalized for other procedures or treatments and who test positive as a part of the hospital’s effort to monitor the pandemic.

“The vaccines, to a large extent (primary series plus a booster-protection) are working quite well” at preventing the need for hospitalizations, Nachman wrote.

Doctors urged people to take steps to protect themselves, their families, and their communities against contracting the virus.

“With the virus changing, it’s even more important to keep yourself and your family safe from getting COVID again and remain vigilant about taking precautions, i.e. hand washing, social distancing, mask wearing,” Nachman added.

A minority of residents treated with Pfizer’s antiviral therapy Paxlovid have experienced a rebound, testing positive days or even a week or more after receiving the antiviral treatment.

“Viral rebound occurs in about 10%” for those who have taken Paxlovid, with the majority in the older age groups, Nachman wrote. Having said that, the rebound we are seeing has not led to Emergency Department visits or hospitalizations.” 

As for mental health issues, residents of Suffolk County, as with other communities, have generally seen an improvement amid a relaxation of restrictions that limited social contact and kept people from their routines.

“Mental health issues were mostly related to the isolation mandates that were required to slow the spread of COVID,” Popp explained. “The reduction in restrictions has improved the mental health issues for many people.”

Monkeypox vigilance

Area hospitals continue to remain on the lookout for potential outbreaks of monkeypox.

“We are aggressively evaluating all suspected cases of monkeypox and have protocols in place for testing as well as treatment,” Nachman wrote. “We will be rolling out a [National institutes of Health] funded clinical trial for treating individuals across the ages with TPOXX.”

Huntington Hospital has had two confirmed cases of monkeypox. Popp expects the virus will “likely continue to spread.”

Several medical facilities continue to administer the limited monkeypox vaccines.

SBUH is working with the Suffolk County Department of Health to provide vaccinations at the Edie Windsor Healthcare Center in Hampton Bays.

On the official Suffolk County website, eligible residents can schedule monkeypox vaccinations through Northwell Health at the Bayshore Mall on Sunrise Highway.

As for the flu, Nachman urged residents to get their vaccines prior to the start of the seasonal flu season, sometime between now and November.

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METRO photo

Mather Hospital in Port Jefferson has announced a new free training program for Certified Nurse Assistants (CNA) that will pay students during their training and guarantee them a position at the hospital upon successful completion of the course and New York State certification exam.

“Today’s healthcare workforce shortage is not just a regional or statewide issue; it is a global concern that presents challenges for patient care delivery. There is  a significant shortage of ancillary support staff such as CNAs, who are needed to assist our professional healthcare team in delivering the care that we are committed to providing to our community residents,” said Mather Hospital CNO/ VP for Nursing Marie Mulligan, PhD, RN.

“Individuals who successfully complete the four-week program and pass the New York State CNA exam  will be offered entry level healthcare jobs. Participants who successfully complete the  Certified Nursing Assistant program will have employment and benefits that will open opportunities for them to advance in their healthcare careers,” she said.

John R. Balcuk, MSN, RN, NPD-BC, Assistant Director of Nursing Talent, Nursing Recruitment and Retention, said the program will follow the American Red Cross training program, but instead of being an online course, students will learn in-person at the hospital. The trainees will be paid as Safety Care Associates – a new position at the hospital – and will meet their required 30 hours of clinical experience with patients in the hospital’s Transitional Care Unit.

The program, named the Mather Assistant Nurse Institute, will utilize supplemental curriculum designed by the American Red Cross that is used nationwide to train CNA’s. Trainees will learn from Mather Hospital’s clinical nurse educators who are trained American Red Cross CNA program instructors.

The program is scheduled to begin in November. Anyone interested should contact Balcuk at 631-473-1320, ext. 5636, or [email protected]

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Pixabay photo
Simple changes can help you improve lung function

By David Dunaief, M.D.

Dr. David Dunaief

As we are learning to live alongside COVID-19, we also have a heightened awareness of the importance of strong lung function. For those with chronic obstructive lung diseases such as chronic obstructive pulmonary disease (COPD) and asthma, as well as those who smoke and vape, the consequences of COVID-19 are especially severe.

The good news is that we can improve lung function with simple lifestyle modifications including exercising, eating a plant-based diet with a focus on fruits and vegetables, expanding lung capacity with an incentive spirometer, and quitting smoking and vaping, which damage the lungs (1). Not only people with compromised lungs will benefit from these techniques, studies suggest everyone will benefit.

Improving asthma

In a randomized controlled trial of asthma patients, results show that after 14 days those who ate a high-antioxidant diet had greater lung function than those who ate a low-antioxidant diet (2). Additionally, those who were in the low-antioxidant diet group also had higher inflammation at 14 weeks. Inflammation was measured using a c-reactive protein (CRP) biomarker. Those who were in the low-antioxidant group also were over two-times more likely to have an asthma exacerbation. 

The good news is that the difference in behavior between the high- and low-antioxidant groups was small. The high-antioxidant group had a modest five servings of vegetables and two servings of fruit daily, while the low-antioxidant group ate no more than two servings of vegetables and one serving of fruit daily. Carotenoid supplementation, instead of antioxidant foods, made no difference in inflammation. The authors concluded that an increase in carotenoids from diet has a clinically significant impact on asthma and can be seen in a very short period. 

Focusing on COPD

Several studies demonstrate that higher consumption of fiber from plants decreases the risk of COPD in smokers and ex-smokers. Bear with me, because the studies were done with men or women, not both at the same time.

In one study of men, for example, results showed that higher fiber intake was associated with significant 48 percent reductions in COPD incidence in smokers and 38 percent incidence reductions in ex-smokers (3). The high-fiber group ate at least 36.8 grams per day, compared to the low-fiber group, which ate less than 23.7 grams per day. Fiber sources were fruits, vegetables and whole grain, essentially a whole foods plant-based diet. The high-fiber group was still below the American Dietetic Association-recommended 38 grams per day. This is within our grasp. 

In another study, women had a highly significant 37 percent decreased risk of COPD among those who consumed at least 2.5 serving of fruit per day compared to those who consumed less than 0.8 servings per day (4).

The highlighted fruits shown to reduce COPD in both men and women included apples, bananas, and pears.

Using incentive spirometry

An incentive spirometer is a device that helps expand the lungs by inhaling through a tube and causing a ball or multiple balls to rise in a tube. This action opens the alveoli and may help you breathe better. 

Incentive spirometry has been used for patients with pneumonia, those who have chest or abdominal surgery and those with asthma or COPD, but it has also been useful for healthy participants (5). A small study showed that those who trained with an incentive spirometer for two weeks increased their vital capacity, right and left chest wall motion, and right diaphragm motion. This means it improved lung function and respiratory motion. Participants were 10 non-smoking healthy adults who were instructed to take five sets of five deep breaths twice a day, totaling 50 deep breaths per day. The brands used in the study are inexpensive and easily accessible, such as Teleflex’s Triflo II.

In another small, two-month study of 27 patients with COPD, the incentive spirometer improved blood gases, such as partial pressure carbon dioxide and oxygen, in COPD patients with exacerbation (6). The authors concluded that it may improve quality of life for COPD patients.  

Increasing exercise

Exercise can have a direct impact on lung function. In a study involving healthy women ages 65 years and older, results showed that 20 minutes of high-intensity exercise three times a day improved FEV1 and FVC, both indicators of lung function, in as little as 12 weeks (7). Participants began with a 15-minute warm-up, then 20 minutes of high-intensity exercise on a treadmill, followed by 15 minutes of cool-down with stretching.

What is impressive is that it was done in older adults, not those in their twenties and not in elite athletes.

Note that you don’t need a treadmill to do aerobic exercise. You can walk up steps or steep hills in your neighborhood, do jumping jacks, or even dance in your living room. Whatever you choose, you want to increase your heart rate and expand your lungs. If this is new for you, consult a physician and start slowly. You’ll find that your stamina improves rather quickly with consistency.

We all should be working to strengthen our lungs. This three-pronged approach of lifestyle modifications – diet, exercise and incentive spirometer – can help without expending significant time or expense.

References: 

(1) Public Health Rep. 2011 Mar-Apr; 126(2): 158-159. (2) Am J Clin Nutr. 2012 Sep;96(3):534-43. (3) Epidemiology Mar 2018;29(2):254-260. (4) Int J Epidemiol Dec 1 2018;47(6);1897-1909. (5) Ann Rehabil Med. Jun 2015;39(3):360-365. (6) Respirology. Jun 2005;10(3):349-53. (7) J Phys Ther Sci. Aug 2017;29(8):1454-1457. 

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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Photo from Stony Brook Medicine

The American College of Cardiology has recognized Stony Brook University Hospital as the only hospital on Long Island to have achieved the prestigious Chest Pain Center with Primary Percutaneous Coronary Intervention & Resuscitation designation in 2022. The designation recognizes the high-level of staff expertise and exceptional integration of the Stony Brook Cardiology Program, Emergency Medical Services and Cardiovascular Surgery Program. The accreditation also recognizes Stony Brook Medicine’s commitment to treating patients with chest pain. Stony Brook University Hospital is the only facility on Long Island to have received this accreditation during back-to-back cycles.

“Our ACC designation affirms that Stony Brook provides the most advanced and timely evidence-based heart attack or cardiac arrest care to the patients in our community,” saysRobert T. Pyo, MD, Director, Interventional Cardiology; Medical Director, Structural Heart Program and Associate Professor, Renaissance School of Medicine at Stony Brook University. “This can only be achieved through the exceptional skill of our cardiac and emergency services teams in offering the best quality emergency cardiac care available anywhere.”

The Chest Pain Center with Primary Percutaneous Coronary Intervention & Resuscitation designation means that Stony Brook University Hospital is optimally equipped, trained and staffed to care for patients during or after a heart attack or during a sudden cardiac arrest (when the heart malfunctions and suddenly stops beating). Patients arriving at Stony Brook University Hospital’s ER with symptoms of a cardiac emergency are treated according to quality-of-care measures that are proven to achieve better patient outcomes.

Dr. William Lawson, Vice Chair, Department of Medicine, Renaissance School of Medicine at Stony Brook University, noted that “Using Stony Brook’s “Code H” protocol, the Stony Brook Heart Institute has reduced the amount of time between a heart attack patient coming into the hospital to the opening and clearing of the blocked arteries with a stent or balloon-tipped catheter (angioplasty) to an average of just 54 minutes. This is a spectacular achievement, being over thirty minutes sooner than the 90 minutes or less specified in American Heart Association guidelines.”

“If you’re having a heart attack, every second counts,” says Julie Mangum, RN, Stony Brook Heart Institute’s Chest Pain Coordinator. “The key is to get treated as quickly as possible so there is less chance of heart muscle damage. Few hospitals can offer the diagnostic testing and the complete array of on-site interventional options that are available at Stony Brook.” In addition, for patients suffering from a cardiac arrest, Stony Brook University Hospital provides a robust hypothermia program that lowers a patient’s body temperature allowing for the best possible chance of meaningful recovery.

Hospitals that have earned ACC Chest Pain Center with Primary PCI and Resuscitation Accreditation have proven exceptional competency in treating patients with heart attack symptoms and have primary PCI (percutaneous coronary intervention) available 24/7 every day of the year. In addition, Stony Brook maintains a “No Diversion Policy” for out-of-hospital cardiac arrest patients which means that at no time are ambulances diverted away from our emergency department.

“By earning this distinguished chest pain center accreditation at Stony Brook, we’re again demonstrating to Long Island that we provide the highest level of cardiac care, even in the most complex cases,” noted Hal Skopicki, MD, PhD, Co-Director, Stony Brook Heart Institute and the Ambassador Charles A. Gargano Chair of Cardiology at Renaissance School of Medicine at Stony Brook University. “When having a heart attack, It is crucial to immediately seek care from the closest and most skilled facility available. For our community, I’m proud to say, that’s Stony Brook University Hospital.”

For more information about what it means for Stony Brook Heart Institute to be the region’s only accredited Chest Pain Center, visit this link.

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’s 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 the American College of Cardiology:

The American College of Cardiology envisions a world where innovation and knowledge optimize cardiovascular care and outcomes. As the professional home for the entire cardiovascular care team, the mission of the College and its 54,000 members is to transform cardiovascular care and to improve heart health. The ACC bestows credentials upon cardiovascular professionals who meet stringent qualifications and leads in the formation of health policy, standards and guidelines. The College also provides professional medical education, disseminates cardiovascular research through its world-renowned JACC Journals, operates national registries to measure and improve care, and offers cardiovascular accreditation to hospitals and institutions. For more, visit acc.org.

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