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Focus on improving your health by making lifestyle modifications. METRO photo
The right motivators might be as important as dietary changes

By David Dunaief, M.D.

Excess weight has consequences, including chronic diseases such as cardiovascular disease, diabetes, osteoarthritis, autoimmune diseases and a host of others. Weight also has an impact on all-cause mortality and longevity.

In theory, losing weight should be simple: if we burn more kilocalories (energy) than we take in, we should lose weight. However, it is much more complicated.

Among factors that result in weight loss (or not) are stress levels. High stress levels can contribute to metabolic risk factors such as central obesity with the release of cortisol, the stress hormone (1). In this case, hormones contribute to weight gain.

It is hotly debated as to which approach is best for weight loss. Is it lifestyle changes with diet and exercise, medical management with weight loss drugs, surgical procedures or even supplements? The data show that, while medication and surgery may have their places, they are not replacements for lifestyle modifications; these modifications are needed no matter what route you follow.

But the debate continues as to which diet is best – for both weight loss and overall health. Let’s look at the evidence.

Low-carbohydrate vs. low-fat diets

Is a low-carbohydrate, high-fat diet a fad? In the publication of a 12-month randomized controlled trial (RCT), results showed that a low-carbohydrate diet was significantly better at reducing weight than low-fat diet, by a mean difference of 3.5 kg lost (7.7 lb), even though calories were similar and exercise did not change (2).

The authors also note that the low-carbohydrate diet reduced cardiovascular disease risk factors in the lipid (cholesterol) profile, such as decreasing triglycerides (mean difference 14.1 mg/dl) and increasing HDL (good cholesterol). Patients lost 1.5 percent more body fat on the low-carbohydrate diet, and there was a significant reduction in the inflammation biomarker C-reactive protein (CRP). There was also a reduction in the 10-year Framingham risk score, which estimates cardiovascular risk. However, there was no change in LDL (bad cholesterol) levels or in truncal obesity in either group.

There were 148 participants, predominantly women with a mean age of 47, none of whom had cardiovascular disease or diabetes, but all of whom were obese or morbidly obese (BMI 30-45 kg/m²). Although there were changes in biomarkers, there was a dearth of cardiovascular disease clinical end points, which were not investigated.

Digging deeper into the diets used, it’s interesting to note that the low-fat diet was remarkably similar to the standard American diet; it allowed 30 percent fat, only 5 percent less than the 35 percent baseline for the same group. In addition, it replaced the fat with mostly refined carbohydrates, including only 15 to 16 g/day of fiber.

The low-carbohydrate diet participants took in an average of 100 fewer calories per day than participants on the low-fat diet, so it’s no surprise that they lost a few more pounds over a year’s time.

As David Katz, M.D., founding director of Yale University’s Prevention Research Center, noted, this study was more of a comparison of low-carbohydrate diet to a high-carbohydrate diet than a comparison of a low-carbohydrate diet to a low-fat diet (3).

Diet comparisons

Interestingly, in a meta-analysis (group of 48 RCTs), results showed that whether a low-carbohydrate diet (including the Atkins diet) or a low-fat diet (including the Ornish plant-based diet) was followed, there was a similar amount of weight loss compared to no intervention at all (4). Both diet types resulted in about 8 kg (17.6 lb) of weight loss at six months versus no change in diet.

In an accompanying editorial, the author points out that it is unclear whether a low-carbohydrate/high-animal protein diet might result in adverse effects on the kidneys, loss of calcium from the bones, or other potential health risks. The author goes on to say that, for overall health and longevity and not just weight loss, micronutrients found in nutrient-dense foods may be the most important factor.

A Seventh-Day Adventist trial would attest to the benefits of emphasizing a micronutrient-rich, plant-based diet with limited animal protein. It resulted in significantly greater longevity compared to a macronutrient-rich animal protein diet (5).

Psyche

Finally, the type of motivator is important, whatever our endeavors. Weight loss goals are no exception. A published study followed West Point cadets from school to many years after graduation and noted who reached their goals (6). The researchers found that internal motivators and instrumental (external) motivators were very important.

The soldiers who had an internal motivator, such as wanting to be a good soldier, were more successful than those who focused on instrumental motivators, such as wanting to become a general. Those who had both internal and instrumental motivators were not as successful as those with internal motivators alone. In other words, having internal motivators led to an instrumental consequence of advancing their careers.

When it comes to health, focusing on an internal motivator, such as increasing energy or decreasing pain, could ultimately lead to an instrumental consequence of weight loss.

There is no question that dietary changes are most important to achieving sustained weight loss. However, we need to get our psyches in line for change. Hopefully, when we choose to improve our health, we don’t just focus on weight as a measure of success. Focus on improving your health by making lifestyle modifications. This tends to result in a successful instrumental consequence.

References:

(1) Psychoneuroendocrinol. online 2014 April 12. (2) Ann Intern Med. 2014;161(5):309-318. (3) Huffington Post. Sept 2, 2014. (4) JAMA. 2014;312(9):923-933. (5) JAMA Intern Med. 2013;173:1230-1238. (6) Proc Natl Acad Sci U S A. 2014;111(30):10990-10995.

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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The statue of St. Charles outside the hospital. Photo by Marilyn Fabbricante

At St. Charles Hospital in Port Jefferson and St. Catherine of Siena Medical Center in Smithtown, the use of face masks, regardless of the threat level from the virus that has claimed the lives of just over 2,000 people in Suffolk County and more than 144,000 in the United States, is likely to continue.

“I see [the use of] face masks moving forward.”

—Cecilia Hill

“I see [the use of] face masks moving forward,” said Cecilia Hill, director of Infection Prevention and Control at St. Charles.

Indeed, Hill and James O’Connor, president of St. Charles and St. Catherine’s hospitals, said they believe that masks were a critical part of protective equipment for staff.

Almost all of the antibody tests for staff at St. Charles came back negative, which Hill suggested “says a lot for what we were doing” to protect staff, including mask wearing and hand hygiene.

St. Charles recently restarted elective surgeries, which were on hold during the worst months of the pandemic on Long Island.

Anyone coming in for elective surgery needs a COVID-19 screening. The hospital also uses temperature screenings for staff and visitors. Medical personnel and visitors have to attest to the fact that they are feeling well and are showing no signs of the virus.

These procedures will “be in place for quite some time in the far future,” Hill said.

O’Connor said the two local hospitals didn’t meet Gov. Andrew Cuomo’s (D) target for 90 day’s worth of personal protective equipment for every hospital, which was his original goal in case of another viral surge.

“No one is able to get those kinds of supplies,” O’Connor said. Still, he said the hospitals would be in “far better shape, assuming there’s a surge in the fall,” because they are collecting as much PPE as they can. The hospitals are also not using as many N95 masks as they were, in part because they are testing so many patients.

O’Connor declined to give the exact amount of PPE the hospitals had on hand.

Following health and safety guidelines during the worst of the COVID-19 pandemic also helped lower the spread during the annual flu season.

A viral born respiratory illness like COVID, the flu typically threatens public health between December and the middle of May.

Suffolk County typically gets “slammed with the flu until the middle of May,” said Hill. This year, the last case was in March. While that could also be a product of people suffering through the flu without coming to a hospital during the pandemic, social distancing, face masks and sheltering in place likely reduced the spread of a disease that can also be fatal in some cases, though not nearly as much as COVID-19.

“My hope is that, because all of the testing, we are going to know earlier on that the wave is coming back.”

— James O’Connor

As the number of confirmed positive cases of people with COVID-19 has declined, O’Connor said the fear of going to the hospital for elective surgery is lower.

“Everybody is aware that the numbers are down on Long Island and in New York state,” he said. “My hope is that, because all of the testing, we are going to know earlier on that the wave is coming back.”

All elective surgeries have had testing done three days before the scheduled procedures. In cases where tests come back positive, the hospitals are postponing those procedures.

O’Connor said some of these tests have come back positive, even for people who are asymptomatic. The COVID-19 test is required for people who have fallen and fractured their hips.

“A number of positives are not because they are having symptoms,” O’Connor said. “They aren’t complaining of a fever or other respiratory problems. These are probably mild cases.”

O’Connor said it’s unclear from the literature that a mild case doesn’t spread as much as someone with full-blown COVID with a fever.

Indeed, some medical literature suggests that asymptomatic cases may shed even more of a viral load, he said.

Hill suggested there was a drastic contrast between patients who first came in with symptoms related to the virus and the people they are seeing now.

Part of the reason the prognosis has improved is that hospitals like St. Charles and St. Catherine’s have a much better idea of how to treat patients. Some drugs have helped relieve the symptoms associated with the virus.

As for the staff at the hospitals, O’Connor said he hopes they learned from the public health challenge during the worst of the first wave.

“You hope, and I would pretty much guess, that anybody who lived through it the first time will be very careful about potentially exposing themselves,” he said. “If you talk to people, what they are most concerned about is what’s coming back.”

Ultimately, O’Connor and Hill urged people to abide by the face mask guidelines, particularly when they are close to others. The decision not to wear a mask could have implications for the longevity of others who are following public health guidelines.

“Do the right thing,” O’Connor said. “Protect yourself and those around you.”

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John T. Mather Memorial Hospital in Port Jefferson. File photo from Mather Hospital

As the number of COVID-19 patients continue to decrease on Long Island, local hospitals say they are working to ensure that the public and patients feel safe walking through its front doors while keeping a safe and clean environment. 

Kenneth Roberts, president and CEO of Mather Hospital, stressed the importance of seeking out medical care.  

“It is safe to come back — whether it’s coming to the hospital or going to the doctor’s offices,” he said. “People shouldn’t neglect reaching out to their healthcare providers.” 

The hospital has been implementing the use of tele-medicine during the pandemic, but Roberts said there is only so much you can do remotely and that some things need to be done in person. 

“Being a part of the Northwell Healthcare system, we’ve put into place new processes and procedures at the hospital,” the president of Mather Hospital said. 

For hospital employees, they must attest that they are free of COVID-19 symptoms when coming into work, temperature checks are done before each person clocks in. 

Roberts said all employees and doctors are required to wear face masks. Those on the frontlines who may be in contact with potential COVID patients are required to wear face shield in addition to the n-95 masks. 

Another change at the hospital is the return of visitors. 

“We’re allowing two visitors per patient,” Roberts said. “Before they’re able to come in there will be required to answer a series of questions and their temperatures will be checked.”

As of now, those who need to go to the emergency room are being asked to remain in their cars until a hospital employee comes to them. 

Roberts said patients that come in on an emergency basis who may have COVID-19 symptoms will be tested immediately. The hospital will be administered a test and be able to get a result back in three days. 

In an effort to keep the facilities clean and safe, Mather Hospital will be utilizing PurpleSun devices, which use ultraviolet light to kill germs and provide rapid disinfection. 

Roberts said the patient feedback so far has been good and that a lot of them have confidence in the doctors and “have no fears.” 

With the restart of elective surgeries in May, the hospital has seen more people coming in to get important procedures done. 

“We’ve had over 1,000 operations that were scheduled, now we are playing catch up,” the president of the hospital said. 

Each patient scheduled for surgery will receive a phone call from a hospital employee and they will conduct a preprocedural interview gathering health history as well as a screening  for COVID symptoms or exposures. 

Once that evaluation has been completed, patients receive two separate in-person pre-surgical testing appointments. The first appointment may include lab tests, EKG and x-rays. The second appointment is for COVID testing and is scheduled 48 hours prior to the procedure. Patients are instructed to self-quarantine leading up to their surgery.  

“They’re going really well, a lot of the patients are grateful to get these procedures, but they also want to shorten their length of stay as much as possible,” Roberts said. “We want to continue to provide a safe place for our patients.”

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Deer ticks are widely known as the sole carrier of the bacteria that causes Lyme disease in humans. Stock photo
The lingering effects of Lyme can be debilitating

By David Dunaief, M.D.

Dr. David Dunaief

After a spring where we’ve spent more than our fair share of time indoors, summer’s heat is finally here. Many of us are taking advantage of the weather to enjoy day hikes and picnics along the shoreline or bike rides through wooded areas.

The summer’s heat also means that tick season is in full swing. This means we need to be aware of Borrelia burgdorferi, better known as the bacterium that causes Lyme disease. This bacterium is typically found in the deer tick, also known as the blacklegged tick.

What do deer ticks look like? They are small and can be as tiny as a pencil tip or the size of a period at the end of a sentence. The CDC.gov site is a great resource for tick images and other information related to Lyme disease.

If you have been bitten by a tick, you should remove it with forceps, tweezers or protected fingers (paper) as close to the skin as possible and pull slow and steady straight up. Do not crush or squeeze the tick; doing so may spread infectious disease (1). In a study, petroleum jelly, fingernail polish, a hot kitchen match and 70 percent isopropyl alcohol all failed to properly remove a tick. The National Institutes of Health recommend not removing a tick with oil (2).

When a tick is removed within 36 to 48 hours, the risk of infection is quite low (3). However, a patient can be given a prophylactic dose of the antibiotic doxycycline, one dose of 200 mg, if a bulls-eye rash — a red outer ring and red spot in the center — has not occurred, and it is within 72 hours of tick removal (4). Those who took doxycycline had significantly lower risk of developing the bulls-eye rash and thus Lyme disease; however, treatment with doxycycline did sometimes cause nausea.

Lyme Symptoms

Stock photo

There are three stages of Lyme disease: early stage, where the bacteria are localized; early disseminated disease, where the bacteria have spread throughout the body; and late stage disseminated disease. Symptoms for early localized stage and early disseminated disease include the bulls-eye rash, which occurs in about 80 percent of patients, with or without systemic symptoms of fatigue (54 percent), muscle pain and joint pain (44 percent), headache (42 percent), neck stiffness (35 percent), swollen glands (23 percent) and fever (16 percent) (5).

Early disseminated disease may cause neurological symptoms such as meningitis, cranial neuropathy (Bell’s palsy) and motor or sensory radiculoneuropathy (nerve roots of spinal cord). Late disseminated disease can cause Lyme arthritis (inflammation in the joints), heart problems, facial paralysis, impaired memory, numbness, pain and decreased concentration (2).

Lyme carditis is a rare complication affecting 1.1 percent of those with disseminated disease, but it can result in sudden cardiac death (6). If there are symptoms of chest pain, palpitations, light-headedness, shortness of breath or fainting, clinicians should suspect Lyme carditis.

Preventing Lyme

According to the Centers for Disease Control and Prevention, we should wear protective clothing, spray ourselves with insect repellent that includes at least 20 percent DEET and treat our yards (4). Always check your skin and hair for ticks after walking through a woody or tall grassy area. Many of us on Long Island have ticks in the yard, so remember to check your pets; even if treated, they can carry ticks into the house.

Diagnosing Lyme

Lyme disease often can be diagnosed within the clinical setting or with a blood test. When it comes to serologic or blood tests, the CDC recommends an ELISA test followed by a confirmatory Western blot test (3). However, testing immediately after being bitten by a tick is not useful, since the test will tend to be negative, regardless of infection or not (4). It takes about one to two weeks for IgM antibodies to appear and two to six weeks for IgG antibodies (5). These antibodies sometimes remain elevated even after successful treatment with antibiotics.

Does chronic Lyme disease exist?

There has been a debate about whether there is something called “chronic Lyme” disease. The research, unfortunately, has not shown consistent results that indicate that it exists. In one analysis, the authors note that the definition of chronic Lyme disease is obfuscated and that extended durations of antibiotics do not prevent or alleviate post-Lyme syndromes, according to several prospective trials (7).

The authors do recognize that there are prolonged neurologic symptoms in a subset population that may be debilitating even after the treatment of Lyme disease. These authors also suggest that there may be post-Lyme disease syndromes with joint pain, muscle pain, neck and back pain, fatigue and cognitive impairment.

Ultimately, the IDSA (Infectious Diseases Society of America) argues in favor of recognizing post-Lyme disease syndromes, while the ILADS (International Lyme and Associated Diseases Society) believes chronic Lyme exists.

Regardless, the lingering effects of Lyme can be debilitating. This may be as a result of systemic inflammation (8). Systemic inflammation and its symptoms can be improved significantly with dietary and other lifestyle modifications.

The CDC recommends that physicians look beyond Lyme for other possible diagnoses before diagnosing someone with chronic Lyme disease (9).

Prevention is key to helping stem Lyme disease. If this is not possible, treating prophylactically when pulling off a tick is an important step. Contact your physician as soon as you notice a tick. If you have a bulls-eye rash and it is early, then treatment of antibiotics for two to three weeks needs to be started right away. If it is prolonged and disseminated, then treatment should be for approximately three to four weeks with antibiotics. If it has affected the central nervous system, then IV antibiotics could be needed.

References:

(1) Pediatrics. 1985;75(6):997. (2) nlm.nih.gov. (3) cdc.gov. (4) Clin Infect Dis. 2008;47(2):188. (5) uptodate.com. (6) MMWR. 2014;63(43):982-983. (7) Expert Rev Anti Infect Ther. 2011;9(7):787-797. (8) J Infect Dis. 2009;199(9:1379-1388). (9) JAMA Intern Med. online Nov. 3, 2014.

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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Stock photo

On his daily update with reporters July 14, an exacerbated-sounding Suffolk County Executive Steve Bellone had a rather simple message: “Wear a mask, wear a face covering, there’s too much at stake for you not to.”

This comes on the heels of new virus data for Suffolk County, which says the positive test rate broke 2 percent today as the number of new positive tests rose by 102 to a total of 42,214 in Suffolk County. The number even beats the positive test rate for New York City, which is sitting at 1.4 percent as of reporting. The overall New York State positive rate is 1.5 percent.

“This is the first time the number of new positives has risen since May 31,” Bellone said. “The numbers are moving in the wrong direction.”

While the number of people in the hospital with COVID-19 remained relatively the same at 41, along with 14 people in ICU beds, the county executive said the number of increasing cases is due to young people, especially those 30 years or younger. Since June 24, 42 percent of positive cases have come from this age group, Bellone said. 

This news also comes on the heels of a release from Gov. Andrew Cuomo who cited a Fourth of July weekend party in Holtsville as an example of how new infections are being spread. While the governor’s office put the number at 35 percent testing positive, the county put the number at 4, meaning 22 percent of partygoers were confirmed with the virus. The county did not issue any citations for the party as the number of people was under the 25 required limit for gatherings. The county executive said police did not respond to this particular gathering in Holtsville, and he did not reveal

“It’s an example of why it’s critically important that we remain vigilant,” Bellone said. “If you attended a Fourth of July gathering, you should be extremely sensitive to how you’re feeling, and when in doubt go get tested.”

Bellone added they have been doing contract tracing for events tracing back to the Fourth of July weekend, but did not have other examples of other gatherings where people have tested positive. If the county has to, Bellone said police will step up enforcement about gatherings. 

“If that number climbs to 5 percent we’re not going to be able to reopen our schools, and that will be terrible for kids and parents,” he said.

The county executive said 10 lifeguards employed by Suffolk County have been confirmed with COVID-19, but officials said they were not confirmed with the virus from being on the beach during the holiday, and more likely were infected during gatherings with fellow lifeguards. All 10 are now in quarantine.

On the positive end, however, Tuesday also marked a third day in a row where no new people have died due to complications with COVID-19.

On the state side, Cuomo added another four states to the list of places people must quarantine after coming in to include Alabama, Arkansas, Arizona, California, Florida, Georgia, Iowa, Idaho, Kansas, Louisiana, Minnesota, Mississippi, New Mexico, North Carolina, Nevada, Ohio, Oklahoma, South Carolina, Tennessee, Texas, Utah and Wisconsin. 

 

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While Suffolk County remains well below the level of positive tests for the country as a whole and for states like Florida and Texas, the percentage of positive tests in the area has crept higher than it’s been in recent weeks.

Among 4,517 tests, 84 people tested positive for the coronavirus, which is a 1.9% positive test rate, The positive tests have been tracking closer to 1 percent for the last several days.

“If you attended a party last weekend on July 4 or a larger gathering, be sensitive to how you are feeling,” County Executive Steve Bellone (D) said on his almost daily conference call with reporters. “You may want to reconsider visiting friends and family who are vulnerable.”

Given the large number of tests throughout the country, the wait time to get results has increased to five to 10 days, Bellone said.

Additionally, Saheda Iftikhar, the Deputy Commissioner for Department of Health Services, said the time between exposure and a positive test is usually at least 48 hours. That means a person attending a gathering on a Sunday when he or she might have been exposed to someone with the virus should wait until Wednesday before taking a test, to avoid a likely false negative.

The 84 positive results from the July 12 data likely came from tests administered days or even a week earlier, which means that these tests could indicate any increase due to gatherings around Independence Day.

To be sure, Bellone said he doesn’t put too much stock in any one day’s numbers. Nonetheless, he said the county will remain vigilant about monitoring the infection rate over the next few days.

“Be smart,” Bellone urged. “If you attend a gathering in which social distancing or the guidelines may not be strictly adhered to, be very conscious of any symptoms you may have,” Bellone said.

Bellone also urged people to be responsive to calls from the Department of Health, as contact tracers gather confidential information designed to contain any possible spread of the virus.

The other numbers for residents were encouraging.

The number of residents in the hospital was 40, which is a decline from 54 on Friday. The number of people in Intensive Care Unit beds was 14, which is up from 10 from Friday.

Hospital bed occupancy was at 70 percent, while ICU occupancy was at 61 percent.

Hospitals discharged 13 people who had suffered with symptoms related to the virus.

For the last 48 hours, the number of fatalities has been zero. The total number of people who have died from complications related to the coronavirus is 1,993.

Bellone highlighted a financial report from New York State Comptroller Tom DiNapoli, titled “Under Pressure.” The report indicated that, statewide, local sales tax collections declined by 24 percent in April and 32 percent in May.

“Local governments are only beginning to feel the impacts of COVID-19 on their revenue,” Bellone said. Reductions in state aid are still possible, which puts counties cities and less wealthy school districts in an “especially tenuous position.”

Local governments will need to take drastic measures to fill enormous budget gaps. That includes Suffolk County, which may have a deficit as large as $839 million this year.

Separately, as school districts try to figure out how to balance between in-person and remote learning, Governor Andrew Cuomo (D) issued guidelines today designed to provide specific targets.

Schools in districts that have reached Phase 4 of the reopening, which includes Suffolk County and where the infection rate is below 5 percent, can reopen. When the positive testing percentage on a rolling 7-day basis exceeds 9 percent should close, Cuomo advised.

School districts will make their decisions about opening between Aug. 1 and Aug. 7.

The governor also announced a new requirement that people traveling into New York from 19 states with rising rates like Florida, California, Kansas, Louisiana and Texas will have to give the state contact information before leaving the airport. Those who fail to do this will receive a summons and face a $2,000 fine

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

By David Dunaief, M.D.

Dr. David Dunaief

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

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

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

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

Treat yourself – cocoa’s benefits

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

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

Increase your fiber intake

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

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

Legumes’ impact

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

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

A nutty solution

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

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

References:

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

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

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Generous Long Islanders have been finding ways to lend a helping hand to staff at Gurwin Jewish Nursing & Rehabilitation Center in Commack who have been on the frontlines of the COVID-19 battle, as well as Gurwin residents who are missing their loved ones due to the “No Visitation” mandate issued by the New York State Department of Health in March.

16-year-old Melville resident Emily Rind created 370 care packages filled with puzzles, word search books, activities and sundry items to help keep Gurwin’s residents entertained and engaged, as part of her “Put a Smile on a Senior Campaign.”

Rind, who was unable to visit her own grandmother due to New York State’s COVID-19 Stay-At-Home Order, said she could only imagine how seniors at Gurwin must feel not being able to see their loved ones. “I reached out to Gurwin to see which items were most needed, and then posted flyers around town to collect supplies,” said Emily. Affixed to the care packages was a note which read, “I know it must be hard not seeing your family and loved ones, so I hope this will brighten your day and put a SMILE on your face.”

Melville Girl Scout Troop 3650

In another show of support for Gurwin healthcare workers, fifth graders in Melville Girl Scout Troop 3650 dedicated their Bronze Award project to providing handmade personal protective equipment (PPE) for the staff. Troop members created face shields using 3D printers, as well as masks and ear guards, items that were in scarce supply during the onset of the pandemic.

“In these challenging times when our staff are working their hardest to protect the well-being of those in their care, and when are residents are missing their families, the thoughtfulness of people in our local community like Emily and the Scouts in Troop 3650 really make a difference in helping to keep morale and spirits high,” said Nicole Hopper, Director of Therapeutic Recreation at Gurwin.

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Susan V. Donelan, MD, FSHEA

Dr. Susan Donelan, medical director of Healthcare Epidemiology at Stony Brook University Hospital, spoke by phone with TBR News Media about reopening schools, the importance of face coverings and host of other issues related to COVID-19. Here are her thoughts on the pandemic and the virus.

TBR: At what point would the spread of the virus be contained?

Donelan: Let’s look at it this way: If you accept the concept that even if the virus doesn’t change or change so significantly that any exposure before will be useless going forward, if it remains static and doesn’t morph or mutate, you need 70 percent of persons to be infected in such a way that the vast majority don’t get repeatedly infected. That’s a whole different story. It takes time for the world population to reach that 70 percent.

TBR: How do you get to that level?

Donelan: You can get to that 70 percent, being a relatively typical cutoff [for herd immunity], by one of two ways: by natural infection, or you can get it from a successful vaccine. 

TBR: How does the process of distributing the vaccine work?

Donelan: Having enough is not the same as having it equitably distributed throughout the world. Ideally, [it would be] given to all of those who have reliably never been exposed. [There are a] lot of logistics: Having enough and having it distributed well and having it distributed equitably are different parameters. While this all gets figured out, the virus will hop along and continue to spread to the extent we give it the opportunity to spread. 

TBR: Are people who get the virus getting reinfected? Are some antibodies not providing resistance?

Donelan: That is not clear. There are different kinds of antibodies. With a neutralizing antibody, you get infected or you get vaccinated, the antibody you develop neutralizes the virus when it comes calling again, or when it comes calling for the first time. There are antibodies that are just kind of bumper stickers in your immune system. They show that you’ve been exposed. This is early in the pandemic, It’s really not clear at this point what types of antibodies most people are going to develop and how helpful they will be when the virus comes knocking at their door. 

TBR: Anecdotally, we’ve heard that some people may be less susceptible to the worst of the viral symptoms, if they have a certain blood type, for example. Do you know if any of that is true?

Donelan: I’ve seen tidbits here and there — you can be willy-nilly and not careful. I would caution anyone who picks up these reports to not assess their own individual risk in such a way that would make them less likely to follow the basics of trying to avoid getting sick or transmitting it.

TBR: Would a second wave be milder than the first because more people would have some resistance?

Donelan: I’m hesitant to declare if we had a milder second wave it’s the virus as opposed to other factors. In the 1918 [Spanish flu] versus the 1919 wave, the 1919 wave was bigger.

TBR: How did the protests affect infections?

Donelan: The protests are one of many, many instances of people with lacking social distancing, perhaps not wearing masks or wearing masks incorrectly. It’s maybe the most public one, not the only one. Every time I go out, I see people being noncompliant. As I understand from recent data, New York has an R0 [the average number of people who will get a disease from a single infected person] of under 1. We know that there’s going to be a slow creep in the infection. We’re right up against 1. That’s clearly less than the R0 of 2 or more that was early in the pandemic. By the time we see a bump in hospitalizations, a bump in positive cases, the protests are going to be muddled in with the graduations, the beach parties, the bars and the restaurants. 

TBR: What don’t people know about the disease?

Donelan: The biggest misconception about utilization of face coverings, is that the face covering is for me. I think it must be really be emphasized. I wear my face covering to protect you. You wear it to protect me. 

TBR: What do you think of the risks in youth sports, which are starting up again?

Donelan: There’s no uniform understanding of what’s right or wrong. There are other countries that have been ahead of us in terms of the pandemic and then are now easing themselves back into a more normal society. I think that those of us who are interested in what happens in sports, might keep a clear eye on what’s going on in those countries. Any time you interact, it’s not a zero-risk concept.

TBR: What do you think about schools?

Donelan: I’m working with the state and the campus and my own local school district on what school will look like. I have two kids that are heading to college, another one heading for a Ph.D. program. I have a particular interest in what’s going on. I think the schools have been working hard to optimize social distancing, with mouth and face coverings to the extent that each student at different levels is able to. I told them a couple of months ago, at the state and local level, I don’t see how schools cannot plan on having a hybrid learning platform [one that includes a mix of in-person and remote classes]. 

TBR: What advice would you give schools?

Donelan: The most important thing is to make sure however school looks like for the next two or three semesters, [that there is] a hybrid learning platform, with the ability to pivot quickly to a full-distance learning plan.

TBR: How do you think this will play out for colleges?

Donelan: [Many schools will] start in August. Come Thanksgiving, kids will go home and don’t come back [until the next year as influenza-like illness starts to circulate.] Thanksgiving is the first great cross-pollinator event in the winter season, with people traveling, coming back, picking up whatever is going on wherever they traveled to. I wouldn’t want students coming back to school after Thanksgiving recess, then cross-pollinating more. If there’s anything that people should be encouraged to do, it’s get a flu shot — and get it early.

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Police Set New Guidelines for Protests

Stock photo

With Suffolk County entering Phase 4 of a planned reopening, County Executive Steve Bellone (D) provided his final daily media update on the county’s response to the virus. The County Executive had conducted 122 such updates, as residents suffered personal and economic losses that extend far beyond the daily numbers and statistics.

“We reached the final stage of reopening” today, Bellone said. The county has gone “up the mountain and made it down the other side. In the process, we’ve seen terrible tragedy and acts of extraordinary heroism.”

Entering Phase 4 marks a “new stage” in this unprecedented event,” Bellone added.

Even as the county executive is pleased that the county has moved to Phase 4, in which people can gather outdoors in groups of 50 instead of 25 and some businesses that had remained closed can reopen, he is still aware of the additional work necessary to open other enterprises that remained closed, such as gyms, bowling alleys, catering facilities and movie theaters.

Gyms have presented plans for reducing risk, such as individual workout sessions and class-based reservations that would allow contact tracing to reduce risk, Bellone said.

Asked about reopening schools, which will affect so many families and teachers across the county, Bellone said he thinks schools “need to reopen. That needs to be done safely.”

He suggested that putting together those plans was complicated, but that it shouldn’t be a divisive or political issue.

“We know it is good for kids to be in school,” Bellone said. “We can not have a whole generation of kids that are falling behind. We know the devastating impact that would have.”

The county executive called on the federal government to provide relief to schools to prevent them from having to cut areas that he deemed critical, such as arts, music, sports and staff. Reopening schools will require additional expenses, as schools will not be able to operate normally.

“Right now, schools are worried about paying for the basics,” Bellone said. A federal government that didn’t provide disaster assistance would be “absolutely unconscionable.”

Viral Numbers

The number of people who tested positive for the coronavirus was 69, which represents a 1.7 percent positive rate for new tests. While that percentage is higher than the recent average, which is closer to 1.1 percent, Bellone said he doesn’t put too much stock in any one day’s data.

The total number of people who have tested positive for COVID-19 is 41,799.

The number of people who have tested positive for the antibody but who didn’t have symptoms of the disease is 20,104.

The number of people in the hospital declined by seven to 50, which is “an amazing number considering where we’ve been.”

The number in the Intensive Care Units is nine.

Overall hospital bed occupancy was at 68 percent, while ICU bed occupancy was at 59 percent.

Six people were discharged from the hospital in the last day.

The viral death toll held steady at a revised 1,984, as no residents died from complications related to the coronavirus.

To prepare for a possible second wave of the virus, the county developed a contact tracing program and has worked through procurement to stockpile some personal protective equipment.

Police Rules for Protests

The Suffolk County Police Department put several new rules in place in connection with any future protests.

For starters, demonstrators need to contact the SCPD at least 24 hours in advance to indicate the route they plan to take. They can call (631) 852-6110 between 8 a.m. and 11 p.m. from Monday through Friday.

Protests are prohibited from congregating in the street and disrupting the flow of traffic. Police said people who don’t comply with this rule are subject to enforcement action.

Demonstrators cannot block vehicular or pedestrian traffic and may not enter private property without consent.

Demonstrators may also not walk in the traffic lanes of a roadway when prohibited.

Finally, people who are older than two years old who can tolerate a face mask medically is required to wear one in situations where maintaining six feet of social distancing is not possible.

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