Health

From left, Stony Brook University President Maurie McInnis, Stony Brook Medicine Vice President for Health System Clinical Programs and Strategy Dr. Margaret McGovern, 25,000 COVID-19 Vaccine recipient and Southampton resident Veronica Lang with her husband James, Wolfie, and Lisa Santeramo, assistant secretary for intergovernmental affairs.

Stony Brook University reached a major milestone in the COVID-19 vaccine distribution process on Thursday, February 18 when it administered the 25,000th vaccine at its state-run mass vaccination site. The site, established under the leadership of Governor Cuomo, opened on January 18. As the continued demand for COVID-19 vaccinations grows, Stony Brook University and Stony Brook Medicine have responded to the community’s need. Playing a critical role in carrying out New York State’s vaccination plans and contributing its R&D Park as an on-campus point of distribution (POD), staff went to work alongside the State to bring peace of mind to many people in an array of at-risk groups.

From right, Dr. Maurie McInnis, President Of Stony Brook University, Wolfie and Dr. Margaret McGovern, Stony Brook Medicine Vice President for Health System Clinical Programs and Strategy, thank healthcare workers who are giving their time to help vaccinate Long Island.

“I am so proud of the milestone Stony Brook University, under Governor Cuomo’s leadership, has reached today in administering its 25,000th COVID-19 vaccine. This comes just one month after we opened the mass vaccination site at the University’s R&D Park on January 18. The efficient and effective administration of the vaccine is an example of the excellent work the University and Stony Brook Medicine have been doing to help stop the spread of COVID-19 and bring this pandemic to an end,” says President Maurie McInnis.

Widely regarded as a flagship campus for the State University of New York (SUNY) system, Stony BrookUniversity is bringing the full strength of its leadership, expertise, resources and quality care to further New York State’s goal of delivering life-saving vaccines to those who need it most.

The State also turned to Stony Brook University Hospital to assist in successfully developing community PODs as pop-up sites in underserved communities on Long Island, to reach communities of color and the elderly, as well as help build trust, recognizing that the vaccine is one of the best ways to protect ourselves, our families and our communities from this serious infectious disease.

Stony Brook Medicine Vice President for Health System Clinical Programs and Strategy Dr. Margaret McGovern adds, “Our success in administering vaccines at Stony Brook is a testament to our robust COVID-19 response activities, talent and expertise that are hallmarks of this University and premier academic medical center. It exemplifies how quickly and well we can coordinate our resources to best serve our community, on campus and off. We are continuing to administer as many doses of the COVID-19 vaccine as possible based on New York State eligibility requirements, distribution guidelines and vaccine supplies, and we will continue to lead all efforts we can to help ensure the health, safety and well-being of our local communities.”

To mark this occasion, Stony Brook University’s very own Wolfie joined public officials to show appreciation to all of the frontline workers manning the mass vaccination site.

Photos courtesy of Stony Brook University. 

VIDEO: Please see link to B-Roll here. Video courtesy of Stony Brook University. 

Yoga can improve balance and strength, which are risk factors for falls. METRO photo
Fear of falling can lead to greater risk

By David Dunaief, M.D.

Dr. David Dunaief

Earlier in life, falls usually do not result in significant consequences. However, once we reach middle age, falls become more substantial. Even without icy steps and walkways, falls can be a serious concern for older patients, where consequences can be devastating. They can include brain injuries, hip fractures, a decrease in functional ability and a decline in physical and social activities (1). Ultimately, a fall can lead to loss of independence (2).

Contributors to fall risk

Many factors contribute to fall risk. A personal history of falling in the recent past is the most prevalent. But there are many other significant factors, such as age and medication use. Some medications, like antihypertensive medications used to treat high blood pressure and psychotropic medications used to treat anxiety, depression and insomnia, are of particular concern. Chronic diseases can also contribute.

Circumstances that predispose us to falls also involve weakness in upper and lower body strength, decreased vision, hearing disorders and psychological issues, such as anxiety and depression (3).

Simple fall prevention tips

Of the utmost importance is exercise. But what do we mean by “exercise”? Exercises involving balance, strength, movement, flexibility and endurance all play significant roles in fall prevention (4).

Many of us in the Northeast are also low in vitamin D, which may strengthen muscle and bone. This is an easy fix with supplementation. Footwear also needs to be addressed. Nonslip shoes are crucial indoors, and outside in winter, footwear that prevents sliding on ice is a must. Inexpensive changes in the home, like securing area rugs, can also make a big difference.

Medication side-effects

There are a number of medications that may heighten fall risk. As I mentioned, psychotropic drugs top the list. But what other drugs might have an impact?

High blood pressure medications have been investigated. A propensity-matched sample study (a notch below a randomized control trial in terms of quality) showed an increase in fall risk in those who were taking high blood pressure medication (5). Those on moderate doses of blood pressure medication had the greatest risk of serious injuries from falls, a 40 percent increase.

While blood pressure medications may contribute to fall risk, they have significant benefits in reducing the risks of cardiovascular disease and events. Thus, we need to weigh the risk-benefit ratio in older patients before considering stopping a medication. When it comes to treating high blood pressure, lifestyle modifications may also play a significant role in treating this disease (6).

How exercise helps

All exercise has value. A meta-analysis of a group of 17 trials showed that exercise significantly reduced the risk of a fall (7). If the categories are broken down, exercise led to a 37 percent reduction in falls that resulted in injury and a 30 percent reduction in those falls requiring medical attention. Even more impressive was a 61 percent reduction in fracture risk.

Remember, the lower the fracture risk, the more likely you are to remain physically independent. Thus, the author summarized that exercise not only helps to prevent falls but also fall injuries.

Unfortunately, those who have fallen before, even without injury, often develop a fear that causes them to limit their activities. This leads to a dangerous cycle of reduced balance and increased gait disorders, ultimately resulting in an increased risk of falling (8).

What types of exercise?

Tai chi, yoga and aquatic exercise have been shown to have benefits in preventing falls and injuries from falls.

A randomized controlled trial showed that those who did an aquatic exercise program had a significant improvement in the risk of falls (9). The aim of the aquatic exercise was to improve balance, strength and mobility. Results showed a reduction in the number of falls from a mean of 2.00 to a fraction of this level — a mean of 0.29. There was also a 44 percent decline in the number of exercising patients who fell during the six-month trial, with no change in the control group.

If you don’t have a pool available, Tai Chi, which requires no equipment, was also shown to reduce both fall risk and fear of falling in older adults in a randomized control trial of 60 male and female participants (10).

Another pilot study used modified chair yoga classes with a small assisted living population (11). Participants were those over 65 who had experienced a recent fall and had a resulting fear of falling. While the intention was to assess exercise safety, researchers found that participants had less reliance on assistive devices and three of the 16 participants were able to eliminate their use of mobility assistance devices.

Thus, our best line of defense against fall risk is prevention. Does this mean stopping medications? Not necessarily. But for those 65 and older, or for those who have arthritis and are at least 45 years old, it may mean reviewing your medication list with your doctor. Before considering changing your blood pressure medications, review the risk-to-benefit ratio with your physician.

References:

(1) MMWR. 2014; 63(17):379-383. (2) J Gerontol A Biol Sci Med Sci. 1998;53(2):M112. (3) JAMA. 1995;273(17):1348. (4) Cochrane Database Syst Rev. 2012;9:CD007146. (5) JAMA Intern Med. 2014 Apr;174(4):588-595. (6) JAMA Intern Med. 2014;174(4):577-587. (7) BMJ. 2013;347:f6234. (8) Age Ageing. 1997 May;26(3):189-193. (9) Menopause. 2013;20(10):1012-1019. (10) Mater Sociomed. 2018 Mar; 30(1): 38–42. (11) Int J Yoga. 2012 Jul-Dec; 5(2): 146–150.

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. 

Stony Brook University's COVID-19 testing site. Photo by Matthew Niegocki
Updated February 18, 2021
The COVID-19 testing site at Stony Brook University’s South P-lot will be closing at 1 p.m. on February 18 due to the snowstorm. There is an anticipated delayed opening Tomorrow, February 19 with timing yet to be determined.
For further updates and more information about Stony Brook’s coronavirus drive-through testing, click here.
New York State has partnered with Stony Brook University to provide drive-through testing for the coronavirus at Stony Brook University’s South P Lot off Stony Brook Road. Walk-ins are accepted, but appointments are strongly encouraged and can be made by phone at 888-364-3065 or online at covid19screening.health.ny.gov.

 

Beginning Sunday, February 14, the COVID-19 testing site at Stony Brook University’s South P-lot will be operating from 8 a.m. to noon  on Sundays.

Operating hours are now:
Monday through Friday, 8 a.m. to 6 p.m.
Saturday, 8 a.m. to 3 p.m.
Sunday, 8 a.m. to noon.

Anyone who believes they’re at risk should call the Department of Health Hotline, 888-364-3065, and talk to experts to determine if and how they should be tested.

Test results are not provided by Stony Brook University Hospital. They can be obtained through BioReference at bioreference.com/patient-portal or by calling the New York State DOH Hotline at 888-364-3065.

Click here for a map and directions to the testing site.

Coronavirus Hotline

Updated January 8, 2021
For people who have questions about symptoms, testing, vaccines and more, Stony Brook Medicine’s coronavirus phone line is here as a resource for you:

Coronavirus Hotline
(631) 638-1320

Staffed by registered nurses, the hotline is available daily from 8 am to 4:30 pm. Callers will be evaluated and directed to the appropriate healthcare setting for assistance, as needed.

Stock photo

Building heart-healthy habits improves the likelihood we’ll be around for those we love

By David Dunaief, M.D.

Dr. David Dunaief

This February, we celebrate both Valentine’s Day, an opportunity to celebrate those we love, as well as American Heart Month, a chance for us to build awareness of heart-healthy habits.

The good news is that heart disease is on the decline due to a number of factors, including better awareness in lay and medical communities, improved medicines, earlier treatment of risk factors and lifestyle modifications. We are headed in the right direction, but we can do better. Heart disease is something that is eminently preventable.

Reducing our risks

Risk factors for heart disease include obesity, high cholesterol, high blood pressure, smoking and diabetes. Unfortunately, both obesity and diabetes are on the rise. For patients with type 2 diabetes, 70 percent die of cardiovascular causes (1). However, high blood pressure, high cholesterol and smoking have declined (2).

Inactivity and the standard American diet, rich in saturated fat and calories, also contribute to heart disease risk (3). The underlying culprit is atherosclerosis, fatty streaks in the arteries.

Another potential risk factor is a resting heart rate greater than 80 beats per minute (bpm). In one study, healthy men and women had 18 and 10 percent increased risks of dying from a heart attack, respectively, for every increase of 10 bpm over 80 (4). A normal resting heart rate is usually between 60 and 100 bpm. Thus, you don’t have to have a racing heart rate, just one that is high-normal. All of these risk factors can be overcome.

When medication helps reduce risk

Cholesterol and blood pressure medications have been credited to some extent with reducing the risk of heart disease. The compliance with blood pressure medications has increased over the last 10 years from 33 to 50 percent, according to the American Society of Hypertension.

In terms of lipids, statins have played a key role in primary prevention. Statins are effective at not only lowering lipid levels, including total cholesterol and LDL — the “bad” cholesterol — but also inflammation levels that contribute to the risk of cardiovascular disease. The Jupiter trial showed a 55 percent combined reduction in heart disease, stroke and mortality from cardiovascular disease in healthy patients — those with a slightly elevated level of inflammation and normal cholesterol profile — with statins.

The downside of statins is their side effects. Statins have been shown to increase the risk of diabetes in intensive dosing, compared to moderate dosing (5).

Unfortunately, many on statins also suffer from myopathy (muscle pain). I have had a number of patients who have complained of muscle pain and cramps. Their goal when they come to see me is to reduce and ultimately discontinue their statins by following a lifestyle modification plan involving diet and exercise. Lifestyle modification is a powerful ally.

Making lifestyle changes

The Baltimore Longitudinal Study of Aging, a prospective (forward-looking) study, investigated 501 healthy men and their risk of dying from cardiovascular disease. The authors concluded that those who consumed five servings or more of fruits and vegetables daily with <12 percent saturated fat had a 76 percent reduction in their risk of dying from heart disease compared to those who did not (6). The authors theorized that eating more fruits and vegetables helped to displace saturated fats from the diet. These results are impressive and, to achieve them, they only required a modest change in diet.

The Nurses’ Health Study shows that these results are also seen in women, with lifestyle modification reducing the risk of sudden cardiac death (SCD). Many times, this is the first manifestation of heart disease in women. The authors looked at four parameters of lifestyle modification, including a Mediterranean-type diet, exercise, smoking and body mass index. There was a decrease in SCD that was dose-dependent, meaning the more factors incorporated, the greater the risk reduction. There was as much as a 92 percent decrease in SCD risk when all four parameters were followed (7). Thus, it is possible to almost eliminate the risk of SCD for women with lifestyle modifications.

Monitoring your risk of heart disease

To determine your progress, we use cardiac biomarkers, including inflammatory markers like C-reactive protein, blood pressure, cholesterol and body mass index. 

In a cohort study of high-risk participants and those with heart disease, patients implemented extensive lifestyle modification: a plant-based, whole foods diet accompanied by exercise and stress management. The results showed an improvement in biomarkers, as well as in cognitive function and overall quality of life. The best part is the results occurred over a very short period to time — three months from the start of the trial (8). Many patients I have seen have had similar results.

Ideally, if patient needs to use medications to treat risk factors for heart disease, it should be for the short term. For some patients, it may be appropriate to use medication and lifestyle changes together; for others, lifestyle modifications may be sufficient, as long as patients take an active role.

By focusing on developing heart-healthy habits, we can improve the likelihood that we – and those we love – will be around for a long time.

References:

(1) Diabetes Care. 2010 Feb; 33(2):442-449. (2) JAMA. 2005;293(15):1868. (3) Lancet. 2004;364(9438):93. (4) J Epidemiol Community Health. 2010 Feb;64(2):175-181. (5) JAMA. 2011;305(24):2556-2564. (6) J Nutr. March 1, 2005;135(3):556-561. (7) JAMA. 2011 Jul 6;306(1):62-69. (8) Am J Cardiol. 2011;108(4):498-507.

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. 

Photo by Pixabay

By Leah S. Dunaief

Leah Dunaief

Last Saturday I received my first of the required two vaccines against COVID-19. The inoculation itself was painless. The person who administered the shot was a broad-shouldered young man with curly black hair, deep brown eyes and prominent cheekbones that led to a white-tooth smile. He pinched the skin of my arm just below my left shoulder, and I knew the deed was done only when he discarded the needle into the red can. I think you can see why the entire experience was painless.

As you, who have tried undoubtedly know, it was not easy to get an appointment for the vaccine. My family and friends and the children of my friends were all on the phone or on their computer keyboards for hours trying over and over again to make contact with the right person in a reasonably close location to schedule the vaccination. Finally, the daughter of a close friend secured a time slot for me at the Javitz Center in New York City, and then my son found one sooner at Jones Beach.

I know that some people are passing up the opportunity to get vaccinated. They are concerned, among other reasons, that it has not been tested sufficiently since it was developed with unprecedented speed. What will the long term effects of the vaccine be? No one knows because there has not been a long term so far; we do know that the immediate effects have been studied for the short term in thousands of patients in clinical trials. The results and the efficacy have been excellent. So I decided that I would risk any unknown long term negative effects from the vaccine against the already known long-haul negative consequences from the disease and go for it.

I had heard that after-effects were not uncommon during the 24 hours following the vaccination, and indeed I did experience a couple. Two or three hours after I returned home, and after my dinner, I suddenly was enormously fatigued. I managed to climb the stairs to the bedroom, despite feeling light-head, and I slid into bed, where I then spent the night and enjoyed a sound sleep. I awoke to an aching arm, but that wasn’t the main problem. When I tried to walk, my right leg was, I thought, in spasm. I assumed I had slept in an awkward position and that I could walk it off, but the pain intensified. As the day went by, I endured only with the help of repeated Tylenol capsules, vitamins, a banana and ultimately the distraction of the big football game.

The next day, little more than 24 hours later, I felt perfectly fine. I was timid about walking, but there was no problem. Do I know that the leg pain was the after effect of the shot? I don’t, of course. 

I do have a date for the second shot, which is scheduled for early next month, and apparently there is a dose reserved for me to receive at that time. Will the vaccine protect me? From what I have read and been told, it takes about two weeks before the body develops any immunity, and with the one shot, that is perhaps only 50 or 60 percent. The second vaccination brings the immune system to about 94 percent — or so the evidence has shown. Now, with the new mutations that are freely developed by the viruses with each reproduction in new victims, the scientists are not sure. Vaccinations are racing against viral reproduction.

There can be many minute mutations of the viruses’ genetic sequences. More worrisome is recombination. That means the coronavirus mixes large chunks of its genome upon reproduction, and that is common and surely happening. Recombination might enable different tiny variants to combine and make the virus more potent inside a victim’s body.

The question is, will the vaccine hold these newly minted intruders off? Scientists are studying variants and recombination, but they don’t yet know. So far, so good.

A 42-year-old pastor from Long Island gets a special thank you from a New York Jets legend after battling COVID-19 at Stony Brook University Hospital (SBUH).

At the height of the pandemic, Doug Jansson organized prayer parades with his church, Living Word Church, at a few locations on Long Island, including Stony Brook University Hospital, where his mother-in-law was being treated for COVID-19 back in March. Doug, his wife Kelly and members of their church would drive around the hospital, signs and all, and stop to pray for staff and the patients they were treating. Their kindness didn’t stop there as they even organized grocery donations and drop-offs across Long Island.

Things came full circle on December 12, 2020 when Doug was admitted to SBUH after testing positive for COVID-19. Doug wound up in the ICU and on Christmas Eve he was intubated and placed on life support. The people he had been praying for were now caring for him.

Led by Dr. Paul Strachan and Dr. Allison McLarty, staff from nearly every division and department at SBUH helped care for Doug. Teams in pulmonary, CT surgery, ID, Medicine, Psychiatry/palliative care, GI, Hematology, Cardiology, Vascular and more helped on his road to recovery.

Doug was taken off ECMO on December 29 and extubated on January 5, 2021 before being discharged on February 3, 2021. He and his wife say the staff of every unit became like family and it seemed that the entire hospital was involved and routing for his recovery.

“The staff at Stony Brook were fighting for Doug and rooting him on. They were so encouraging to us. I am speechless over the care we’ve received,” said Kelly Jansson.

Rob Nocito, a resident in Emergency Medicine at SBUH, was one of the physicians who assisted in taking Doug off the ventilator. Nocito noticed Jansson was a hardcore New York Jets fan from the team’s memorabilia hanging in his room. Nocito happens to be good friends with Erik Coleman, a former defender on the Jets. He gave Coleman a call and he quickly agreed to talk to Jansson.

“My job is to make people feel better, and that doesn’t always mean medicine,” said Nocito.

Jansson was speechless as he met the NFL star via FaceTime. Coleman wished Jansson well and thanked him for everything he has done. See the moment here.

His wife Kelly couldn’t believe somebody would be so kind and do this for him. “We are so grateful to the staff at Stony Brook. They go above and beyond every single day,” she said.

As Doug was discharged, staff lined the hallways to wish him well.

Doug now looks forward to returning home to his wife and three children as well as getting back to the work he loves with his church.

Photos courtesy of SBUH

As we continue to deal with the COVID-19 crisis, the need for blood donations has hit a crisis level due to the lack of donors.  To help assist the New York Blood Center (NYBC) increase their blood supply, Senator Mario R. Mattera (2nd Senate District) is sponsoring a blood drive on Sunday, February 14, at the Smith Haven Mall in Lake Grove.  This donation drive will take place from noon to 6 p.m. in the mall’s Center Court.

With nearly 2,000 donations needed every day in New York and New Jersey alone, the current shortage has the potential to have a real effect on those who need blood transfusions.  Every single donation can save up to three lives.

Those most in need of blood include cancer patients, accident, burn, or trauma victims, newborn babies as well as mothers delivering babies, transplant recipients, surgery patients, chronically transfused patients suffering from sickle cell disease or thalassemia, and many more.

Potential donors are required to meet certain criteria including:
• Bring NYBC Blood Donor Card or ID with signature or photo.
• Minimum weight 110 lbs. or more.
• Eligible ages are 16 to 75.  Anyone donating who is 16 years old must have parental permission and anyone who is age 76 and over is required to supply a doctor’s note.
• No tattoos for past 3 months

All donors will receive a New York Blood Center t-shirt and a coupon for Auntie Annie’s pretzels.  Additionally, the NYBC will be doing free COVID anti-body testing for anyone who participates in the blood drive with results being provided via mail.

The entire donation process takes less than an hour and appointments are recommended to ensure minimal waiting time.  To schedule an appointment or for more information, residents should visit Senator Mattera’s website at mattera.nysenate.gov and click on the link on the home page or call the NYBC at 800-933-2566.

Donors with O-negative blood type, or “universal donors,” are especially encouraged to donate, as their blood is essential in emergency situations.  Any potential donor with questions concerning medical eligibility is asked to call 1-800-688-0900.  It is recommended that those donating eat well and drink plenty of fluids prior to their appointment.

“The ongoing crisis is causing a very real and extremely serious shortage of blood supply and it is my hope that all residents who are eligible to donate will join us on Valentine’s Day to show some heart for their fellow Long Islanders.  Each donation has potential to save three lives and all donors will be a Valentine’s Day hero to everyone in our community in need of life saving assistance,” stated Senator Mattera.

Residents are urged to visit Senator Mattera’s website at mattera.nysenate.gov for more information and to make an appointment.

Stony Brook University Hospital

Stony Brook University Hospital has once again been named one of America’s 100 Best Hospitals™ for 2021 by Healthgrades – the only hospital on Long Island to receive this distinction for the past three consecutive years. The distinction places Stony Brook University Hospital in the top two percent of nearly 4,500 hospitals assessed nationwide for its consistent, year-over-year superior clinical performance as measured by Healthgrades, the leading resource that connects consumers, physicians and health systems. Only five hospitals in New York State were named among America’s 100 Best Hospitals this year. 

Dr. Kenneth Kaushansky

“This is the equivalent of receiving another A+ on our annual report card for quality care,” said Kenneth Kaushansky, MD, Senior Vice President for Health Sciences, Stony Brook Medicine. “It places us among the top 2 percent of hospitals nationwide. More importantly, it measures results that make a significant difference in the lives of our patients every day.”

Healthgrades analyzes hospitals nationwide to examine in-hospital complication rates and mortality rates. From 2017 through 2019, patients treated in hospitals achieving the award had, on average, a 26.1 percent lower risk of dying than if they were treated in hospitals that did not receive the award, as measured across 19 rated conditions and procedures for which mortality is the outcome.* And during that same period, if all hospitals performed similarly to those achieving the Healthgrades America’s 100 Best Hospitals Award, 172,298 lives could potentially have been saved. 

“These outcomes are the direct result of the high-quality care provided by our staff every day,” said Carol A Gomes, MS, FACHE, CPHQ, Chief Executive Officer for Stony Brook University Hospital. “Their daily commitment to our patients drives these outstanding results, which literally save lives.”

Stony Brook University Hospital has been recognized as One of America’s 100 Best Hospitals for Cardiac Care™ for seven years in a row, One of America’s 100 Best Hospitals for Coronary Intervention and Stroke Care™ for six years in a row.

In fact, Stony Brook is the only hospital in the northeast** region of the U.S., and one of only five hospitals in the nation, to achieve 2021 America’s 100 Best Hospitals Award and America’s 100 Best in Cardiac Care, Coronary Intervention and Stroke Care.

“These types of consistent awards are not achieved by accident,” said Meadow P. Jaime, MA, Director of Quality Solutions for Healthgrades. “This recognition is validation of the ongoing effort and focus that Stony Brook’s dedicated teams have devoted to providing high-quality care and clinical excellence.”

During the 2021 study period (Medicare Fiscal Years 2017-2019), Healthgrades America’s 100 Best Hospitals Award recipients are recognized for overall clinical excellence and providing top quality care across multiple specialty lines and areas. These hospitals showed superior performance in clinical outcomes for patients in the Medicare population across at least 21 of 32 most common inpatient conditions and procedures — as measured by objective performance data (risk-adjusted mortality and in-hospital complications).

“Now more than ever, it is important to celebrate the physicians, nurses and extended care teams that are working around the clock to keep our nation safe. For the select hospitals that have been recognized with a Healthgrades America’s 100 Best Hospitals Award, we extend our heartfelt appreciation and commend them for their ongoing commitment to delivering the highest quality healthcare,” said Brad Bowman, MD, Chief Medical Officer, Healthgrades.

To learn more about how Healthgrades determines award recipients, and for more information on Healthgrades Quality Solutions, please visit www.healthgrades.com/quality.

About Stony Brook University Hospital:

Stony Brook University Hospital (SBUH) is Long Island’s premier academic medical center. With 624 beds, SBUH serves as the region’s only tertiary care center and Regional Trauma Center, and is home to the Stony Brook University Heart Institute, Stony Brook University Cancer Center, Stony Brook Children’s Hospital and Stony Brook University Neurosciences Institute. SBUH also encompasses Suffolk County’s only Level 4 Regional Perinatal Center, state-designated AIDS Center, state-designated Comprehensive Psychiatric Emergency Program, state-designated Burn Center, the Christopher Pendergast ALS Center of Excellence, and Kidney Transplant Center. It is home of the nation’s first Pediatric Multiple Sclerosis Center. To learn more, visit www.stonybrookmedicine.edu/sbuh.

*Statistics are based on Healthgrades analysis of MedPAR data for years 2017 through 2019 and represent 3-year estimates for Medicare patients only.

**Northeast region is defined by the Census Bureau as Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island, Vermont, New Jersey, New York & Pennsylvania.

What your microbiome really needs is fiber. Stock photo
Studies show significant short-term changes to the microbiome when eating fruits, vegetables and plant fiber

By David Dunaief, M.D.

Dr. David Dunaief

Considering our recent focus on cleansing germs from every surface, it’s a leap to acknowledge that we harbor a multitude of microorganisms, or microbes, in our bodies. We have so many, over one trillion microorganisms, that they outnumber our cells by a 10-to-1 ratio, even in healthy individuals.

These make up what we call the microbiome. It includes bacteria, viruses and single-cell eukaryotes. Our relationship to these organisms is complex, spanning from parasitic to commensalistic (one benefits and the other is not affected) to mutualistic (both benefit). While the microbiome is found throughout our bodies, including the skin, the eyes and the gut, we’re going to focus on the gut, where the majority of the microbiome resides.

Why do we care about the gut microbiome? 

The short answer is it may have a role in diseases — preventing and promoting them. These include obesity, diabetes, irritable bowel syndrome, autoimmune diseases, such as rheumatoid arthritis and Crohn’s, and infectious diseases, such as colitis. Like the Human Genome Project, which mapped our genes, there is a Human Microbiome Project, launched by the National Institutes of Health in 2007, to map out the composition and diversity of these gut organisms. We are still in the early stages of understanding this vast universe of microbes, yet there have been some preliminary studies.

What affects the microbiome? 

Drugs, such as antibiotics, can wipe out the diversity in the microbes, at least in the short term. Also, lifestyle modifications, such as diet, can have an impact. Microbiome diversity also may be significantly different in distinct geographic locations throughout the world. Let’s look at the evidence.

Using twins to study obesity

Obesity can be one of the most frustrating disorders; most obese patients continually struggle to lose weight. Obese and overweight patients now outnumber malnourished individuals worldwide (1). 

I know this will not come as a surprise, but we are a nation with a weight problem; about 70% of Americans are overweight or obese (2) (3). For the longest time, the paradigm for weight loss had been that if you ate fewer calories, you would lose weight. However, extreme low-caloric diets did not seem to have a long-term impact. It turns out that our guts, dominated by bacteria, may play important roles in obesity and weight loss, determining whether we gain or lose weight. Let’s look at the data on obesity.

The results from a study involving human twins and mice are fascinating (4). In each pair of human twins, one was obese and the other was lean. Gut bacteria from obese twins was transplanted into thin mice. The result: the thin mice became obese. However, when the lean human twins’ gut bacteria were transplanted to thin mice, the mice remained thin.

By pairing sets of human twins, one obese and one thin in each set, with mice that were identical to each other and raised in a sterile setting, researchers limited the confounding effects of environment and genetics on weight.

The most intriguing part of the study compared the effects of diet and gut bacteria. When the mice who had received gut transplants from obese twins were provided gut bacteria from thin twins and given fruit- and vegetable-rich, low-fat diet tablets, they lost significant weight. But they only lost weight when on a good diet; there was no impact if the diet was not low in fat. The authors believe this suggests that an effective diet may alter the microbiome of obese patients, helping them lose weight. These are exciting, but preliminary, results. It is not clear yet which bacteria may be contributing these effects.

This definitely suggests that the diversity of gut bacteria may be a crucial piece of the weight-loss puzzle.

Do gut bacteria influence rheumatoid arthritis development?

Rheumatoid arthritis (RA) is an autoimmune disease that can be disabling, with patients typically suffering from significant morning stiffness, joint soreness and joint breakdown. What if gut bacteria influenced RA risk? In a study, the gut bacteria in mice that were made susceptible to RA by deletion of certain genes (HLA-DR genes) were compared to those who were more resistant to developing RA (5). Researchers found that the RA-susceptible mice had a predominance of Clostridium bacteria and that those resistant to RA were dominated by bacteria such as bifidobacteria and Porphyromonadaceae species. The significance is that the bacteria in the RA-resistant mice are known for their anti-inflammatory effects.

Although nobody can say what the ideal gut bacteria should consist of, and the research is still evolving when it comes to the microbiome, there are potential ways of influencing this milieu, especially in our gut. Diet and other lifestyle considerations, such as eating and sleeping patterns or their disruptions, seem to be important to the composition and diversity of gut bacteria (6). Studies have already demonstrated prebiotic effects of fiber and significant short-term changes to the microbiome when eating fruits, vegetables and plant fiber. The research is continuing, but we’ve learned a lot already that may help us tackle obesity, inflammatory bowel syndrome and autoimmune disorders.

References:

(1) “The Evolution of Obesity”; Johns Hopkins University Press; 2009. (2) cdc.gov (3) nih.gov (4) Science. 2013;341:1241214. (5) PLoS One. 2012;7:e36095. (6) Nutrients. 2019 Dec;11(12):2862.

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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