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Minimize serious medication risks with modest lifestyle change

By David Dunaief M.D.

Dr. David Dunaief

If you are planning to enjoy a large Thanksgiving dinner, you’ll probably experience reflux afterward. Here, your stomach contents flow back into your esophagus when the valve between your stomach and your esophagus, the lower esophageal sphincter, relaxes. This is normal, especially after a meal, and doesn’t require medical treatment (1).

Gastroesophageal reflux disease (GERD), however, is more serious and can have long-term health effects. Among them are erosion or scarring of the esophagus, ulcers, and increased cancer risk. Approximately 20 percent of the U.S. adult population has been diagnosed with GERD, although researchers estimate it affects as much as 28 percent (2). It’s no surprise that pharmaceutical firms have lined drug store shelves with all kinds of solutions.

GERD risk factors range from lifestyle — obesity, smoking and diet — to medications, like calcium channel blockers and antihistamines. Other medical conditions, such as hiatal hernia and pregnancy, also play a role (3). Dietary triggers, such as spicy, salty, or fried foods, peppermint, and chocolate, might also contribute.

Medication options

The most common and effective medications for treating GERD are H2 receptor blockers and proton pump inhibitors (PPIs). H2 receptor blockers, such as Zantac and Tagamet, partially block acid production. PPIs, which include Nexium and Prevacid, almost completely block acid production (4). Both have two levels: over-the-counter and prescription strength. Let’s focus on PPIs, for which over 92 million prescriptions are written each year in the U.S. (5).

The most frequently prescribed PPIs include omeprazole (Prilosec) and pantoprazole (Protonix). Studies show they are effective with short-term use in treating Helicobacter pylori-induced peptic ulcers, GERD symptoms, gastric ulcer prophylaxis associated with NSAID use, and upper gastrointestinal bleeds.

Most of the package insert data is from short-term studies lasting weeks, not years. The landmark study supporting long-term use FDA approval was only one year. However, maintenance therapy is usually prescribed for many years.

Concerns about long-term use effects and overprescribing have prompted pharmacists to take an active role in educating patients about their risks and about the need to take them before eating for them to work (6).

PPI risks

PPI side effects after years of use can include increased bone fracture risk; calcium malabsorption; Clostridium difficile (C. difficile), a serious intestinal bacterial infection; potential vitamin B12 deficiencies; and weight gain (7).

The FDA has amplified its warnings about the increased risk of C. difficile, which must be treated with antibiotics. Unfortunately, it only responds to a few, and that number is dwindling. Patients must contact their physicians if they develop diarrhea when taking PPIs and it doesn’t improve (8).

Suppressing stomach acid over long periods can also result in malabsorption issues. In a study where PPIs were associated with B12 malabsorption, it took at least three years’ duration to cause this effect. While B12 was not absorbed properly from food, PPIs did not affect B12 levels from supplementation (9). If you are taking a PPI chronically, have your B12 and methylmalonic acid (a metabolite of B12) levels checked and discuss supplementation with your physician.

Before you stop taking PPIs, consult your physician. Rebound hyperacidity can result from stopping abruptly.

Lifestyle options

A number of lifestyle modifications can improve GERD, such as raising the head of the bed about six inches, not eating prior to bedtime and obesity treatment (10). 

Increase fiber and exercise. A study that quantified the increased risks of smoking and salt also found that fiber and exercise both had the opposite effect, reducing GERD risk (11). An analysis by Journal Watch suggests that the fiber effect may be due to its ability to reduce nitric oxide production, a relaxant for the lower esophageal sphincter (12).

Lose weight. In one study, researchers showed that obesity increases pressure on the lower esophageal sphincter significantly (13). Intragastric (within the stomach) pressures were higher in both overweight and obese patients on inspiration and on expiration, compared to those with lower body mass indexes.

Eat long before bedtime. A study showed a 700 percent increased risk of GERD for those who ate within three hours of bedtime, compared to those who ate four hours or more before bedtime (14).

While drugs have their place in the arsenal of options to treat GERD, lifestyle changes are the first, safest, and most effective approach in many instances. 

References:

(1) Gastroenterol Clin North Am. 1996;25(1):75. (2) Gut. 2014; 63(6):871-80. (3) niddk.nih.gov. (4) Gastroenterology. 2008;135(4):1392. (5) Kane SP. Proton Pump Inhibitor, ClinCalc DrugStats Database, Version 2024.08. Updated August 7, 2024. (6) US Pharm. 2019:44(12):25-31. (7) World J Gastroenterol. 2009;15(38):4794–4798. (8) FDA.gov. (9) Linus Pauling Institute; lpi.oregonstate.edu. (10) Arch Intern Med. 2006;166:965-971. (11) Gut 2004 Dec; 53:1730-1735. (12) JWatch Gastro. Feb. 16, 2005. (13) Gastroenterology 2006 Mar; 130:639-649. (14) Am J Gastroenterol. 2005 Dec;100(12):2633-2636.

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 or consult your personal physician.

 

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Thoracic surgeon Dr. Andrea Carollo in front of the ION robot. Photo courtesy Lee Weissman

By Daniel Dunaief

Early and prompt detection of any cancer can and often does lead to better patient outcomes. With that in mind, Huntington Hospital recently added a new ION Robotic-Assisted Bronchoscopy to identify and perform biopsies on lung nodules. The robotic system, which the hospital has used on 25 patients, can trim the time for a diagnosis to as little as two to four weeks from as much as 70 days.

“We felt it would be an appropriate investment for the patient population so they wouldn’t have to travel to get a diagnosis in a timely manner,” said thoracic surgeon Dr. Andrea Carollo.

Lung cancer is the leading cause of cancer in Suffolk County, according to Dr. Nick Fitterman, Executive Director of Huntington Hospital. On top of that, two out of three lung cancers are in the outer third of the lungs, which the ION Robot specializes in sampling. Prior to the introduction of this system, patients either traveled to South Shore Hospital or would receive more extensive surgery to sample nodules.

For 90 percent of the patients, these nodules are benign. Not every nodule warrants a biopsy. Doctors use standard guidelines to monitor nodules and perform a procedure when these nodules require further investigation. With the ION Robotic-Assisted Bronchoscopy, these patients, who are under general anesthesia during the analysis, can go home the same day.

Get screened

Huntington Hospital. File photo

Doctors typically recommend further evaluation when nodules come up on a CAT scan. While many residents receive screenings for breast cancer, colorectal cancer, cervical cancer and prostate cancer, few take the time to receive a lung screen, even among those who would benefit from initial and ongoing surveillance. About 79 percent of people eligible for a mammography get one. Of the people eligible for lung cancer screening, however, only about 6 percent receive them, Fitterman added.

“We are woefully, woefully deficient in lung cancer screening,” Fitterman said. “There’s an effective screening tool out there that is widely under utilized.”

The US Preventive Services Task Force recommends that high risk patients between 50 and 80 receive lung cancer screening. High risk patients include those who have smoked a pack of cigarettes a day for 20 years and are either current smokers or have quit smoking within the last 15 years.

“If you are a smoker, you should definitely get involved in lung cancer screening,” said Carollo.

By screening more patients, the hospital can offer immediate services, including surgery and various treatment regimes such as chemotherapy.

Options

Once a CAT scan reveals a nodule that warrants further imaging, doctors have three potential surgical options.

They can use trans-thoracic biopsy if the nodule is of a good size, is in a favorable location and the interventional radiologist performing the procedure thinks it is technically possible.

The overall risk of a collapsed lung is about 10 percent with this approach, but much higher in patients with central lesions and  considerable emphysema. The risk is lower in patients with peripheral nodules and no emphysema. If a pneumothorax occurs, sometimes the patient requires a chest tube and hospital stay for as long as one to seven days.

With ION, the procedure is done through a breathing tube in the mouth and into the airways. The risk of a collapsed lung is less than one percent.

If there is a high suspicion of cancer, doctors can also go straight to surgery, which could be the case for a 50 year-old smoker with a 0.7 centimeter nodule that grew to one centimeter and shows activity on a PET scan.

In that case, the nodule and a portion of the lung are removed and sent to pathology, which evaluates it on site and, in about 20 minutes, can indicate whether it’s cancer. From there, doctors can take more lung tissue and lymph nodes for completion of a cancer operation. They review the tissue samples, which takes about 7 to 10 days to get a full answer of the type of cancer and stage if any mutations occurred.

The ION procedure, which has been available for over five years, decreases the risk of a collapsed lung and bleeding and provides an analysis of the nodule more rapidly. The complication rate is lower than with trans thoracic surgery.

At this point, Carollo is doing the majority of these ION-assisted biopsies, while pulmonologist, Dr. Nazir Lone, is doing some, as well.

In the ION procedure, doctors use a roller ball and a wheel that requires eye-hand coordination.

The company provides training to get certified and it takes about 10 to 15 of these procedures for a surgeon to feel comfortable doing them on his or her own, Carollo said.

Huntington Hospital ensures that doctors have sufficient training before allowing them to treat or diagnose patients. “Whenever we adopt any new technology or procedure, we have significant quality guardrails,” said Fitterman.

“We make sure that anyone operating on a machine first is proctored by someone else who is facile with it. They sign off and say, ‘Yes, you now met competencies. You can do it.’”

The speed of the analysis has important implications for patients. “If we can get this done in 30 days from the time we find something to treatment, that’s huge,” Carollo said. “Patients tend to have better outcomes. They live longer,” he continued. Delays over 50 days lead to decreased one and five year survival.

Other new developments

Huntington Hospital has several other new developments in the works.

The hospital is building a new cancer center in Greenlawn as well as expanding its labor and delivery capacity to provide services to more pregnant women.

Ever since St. Catherine of Siena closed its obstetrical unit on Feb. 1, Huntington Hospital has seen an increase in the number of pregnant patients.

The labor and delivery suites will add four beds and will refresh the space the hospital currently uses. The mother-baby units are “beautiful,” but the suites have to “catch up to that,” said Fitterman.

In the third quarter of next year, during the renovation, the labor and delivery areas will move to a place where the old emergency space had been. The improvements are expected to take about three months.

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Photo from Mather Hospital/Jim Lennon

Northwell’s Mather Hospital in Port Jefferson earned its 21st “A” Hospital Safety Grade from The Leapfrog Group, the most of any Suffolk Country Hospital. Leapfrog, an independent national nonprofit watchdog focused on patient safety, assigns an “A,” “B,” “C,” “D” or “F” grade to general hospitals across the country based on over 30 performance measures reflecting errors, accidents, injuries and infections, as well as the systems hospitals have in place to prevent them.

“Patient safety and raising health for everyone are the top priorities at Mather Hospital and the goal of every team member,” said Mather President Kevin McGeachy. “I applaud this continued recognition of our hospital’s achievements in patient safety by the Leapfrog Group. Mather Hospital is committed to continuous improvement in safety and patient satisfaction and exceeding expectations about the care we provide to our community.”

“Achieving an ‘A’ Hospital Safety Grade is a significant accomplishment for Mather Hospital,” said Leah Binder, president and CEO of The Leapfrog Group. “It reflects enormous dedication to your patients and their families, and your whole community should be proud. I extend my congratulations to Mather Hospital, its leadership, clinicians, staff and volunteers for their tireless efforts to put patients first.”

 The Leapfrog Hospital Safety Grade stands as the only hospital ratings program focused solely on preventable medical errors, infections and injuries that kill more than 500 patients a day in the United States. This program is peer-reviewed, fully transparent and free to the public. Grades are updated twice annually, in the fall and spring. 

 Full safety grade details and valuable tips for staying safe in the hospital are at  HospitalSafetyGrade.org.

 

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Immunosuppressives can help, but with serious side effects

By David Dunaief, M.D.

Dr. David Dunaief

Eczema is relatively common, affecting 20 percent of children and 10 percent of adults around the world (1). If you are one of the many who experiences eczema, you know the symptoms, which can include skin rashes, itching, pain and redness.

Eczema is a chronic inflammatory process, and it’s likely caused by a combination of genetics and environmental or lifestyle issues (2). Investigation into potential causes is a growing field.

The National Eczema Association details the seven different kinds of eczema on its website, nationaleczema.org. Atopic dermatitis is the most frequently occurring.

While there is no cure, some treatments can ease symptoms and reduce flare-ups. These range from over-the-counter creams and lotions, antihistamines for itchiness, prescription steroid creams, oral steroids, and injectable biologics. Some use phototherapy for severe cases, but there’s not a lot of research suggesting this is effective. Interestingly, diet may play an important role.

Two studies have shown an association between eczema and fracture risk, which we will look at more closely.

Eczema and diet

In a Japanese study involving over 700 pregnant women and their offspring, results showed that when the women ate either a diet high in green and yellow vegetables, beta carotene or citrus fruit there was a significant reduction in the risk of the child having eczema of 59 percent, 48 percent and 47 percent, respectively, when comparing highest to lowest consumption quartiles (3).

Elimination diets may also play a role in identifying allergic causes. One study’s results showed when eggs were removed from the diet of those who were allergic, according to IgE testing, eczema improved significantly (4).

In my practice, I have seen very good results when treating patients who have eczema with dietary changes. My practice has many patients who suffer from some level of eczema. For example, a young adult had eczema mostly on his extremities. When we first met, these were angry, excoriated, inflamed lesions. However, after several months of a vegetable-rich diet, the patient’s skin improved significantly. These results are not unique.

Do immunosuppressives provide a solution?

Injectable biologics are generally recommended for moderate to severe atopic dermatitis when other treatment options have failed (5). Three are approved by the FDA, dupilumab, tralokinumab-ldrm, and lebrikizumab-lbkz.

In trials, they showed good results when topical steroids alone were not effective. Like other monoclonal antibodies, they work by limiting your immune system response. 

Other oral immunosuppressives, such as those used to inhibit organ rejection in transplant patients, are options, as well.

Unfortunately, any suppression of the immune system’s response, whether oral or injectable, leaves the door open for side effects, including serious infections.

Can supplements help reduce symptoms?

Two well-known supplements are known to reduce inflammation, evening primrose oil and borage oil. Are they good replacements for – or additions to – medication? The research is mixed, leaning toward ineffective. There are also some important concerns about them.

In a meta-analysis of seven randomized controlled trials, evening primrose oil was no better than placebo in treating eczema (6). Researchers also looked at eight studies of borage oil and found there was no difference in symptom relief than placebo. 

While these supplements only had minor side effects in the study, they can interact with other medications. For example, evening primrose oil in combination with aspirin can cause clotting problems (7). If you do try them, be sure to consult with your physician first.

What’s the relationship between eczema and bone fractures?

Several studies have examined the relationship between eczema and bone fractures. One observational study of 34,500 patients showed that those with eczema had a 44 percent increased risk of injury causing limitation and a 67 percent risk of bone fracture and bone or joint injury for those over age 29 (8).

Those with both fatigue or insomnia in combination with eczema are at higher risk for bone or joint injury. The researchers postulated that corticosteroid treatments could contribute, in addition to chronic inflammation, which may also add to bone loss risk. Steroids can weaken bone, ligaments and tendons and can cause osteoporosis by decreasing bone mineral density.

A study of over 500,000 patients found that the association between major osteoporotic fractures and atopic dermatitis remained, even after adjusting for a range of histories with oral corticosteroids (9). Also, fracture rates were higher in those with severe atopic dermatitis.

If you have eczema, talk to your physician about having a DEXA (bone) scan to monitor your bone health.

There is an array of possibilities in development, from topical to oral to injectable treatments, which might provide future relief. Until then, partner with your physician to identify solutions that will work for you, but ensure you understand the side effects of what you’re taking. Diet adjustments appear to be very effective, at least at the anecdotal level.

References:

(1) naiad.nih.gov. (2) Acta Derm Venereol (Stockh) 1985;117 (Suppl.):1-59. (3) Allergy. 2010 Jun 1;65(6):758-765. (4) J Am Acad Dermatol. 2004;50(3):391-404. (5) JAMA Dermatol. 2015;151(1):33-41. (6) Cochrane Database Syst Rev. 2013;4:CD004416. (7) mayoclinic.org (8) J Allergy Clin Immunol Pract. 2021 Sep 24;S2213-2198(21)01018-7. (9) nationaleczema.org.

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 or consult your personal physician.

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Although presents garner most of the fanfare during the holiday season, there is no denying that food and entertaining also figure prominently this time of year. Delish magazine reports that Christmas food consumption ranks third, behind Thanksgiving and Super Bowl Sunday, among Americans, and that a single Christmas meal can weigh in at 3,000 calories, not factoring in any other food consumed that day.

No one wants to feel held back while having fun with family and friends, but smart food choices can mean healthier living during this season of festivities. Dish up these alternatives when holiday entertaining.

• Lean on leaner cuts of meat. A strong body is built on protein, and holiday hosts often make a meat or poultry dish the star of the holiday dinner table. When selecting holiday fare, choose leaner options such as “round” or “loin” roasts; otherwise, select white-fleshed fish and skinless poultry in lieu of other options.

• Use broths instead of creams. Soups and gravies are popular this time of year, and both can be made healthier by opting for stock or broth bases over more fattening milks or creams when creating these recipes.

• Create a one-crust pie. Pie is one of the more popular holiday desserts, and plenty of the calories come from a rich, buttery crust. Lighten up by serving a one-crust pie, such as pumpkin or sweet potato. Fruit-based pies like apple or blueberry also can be made with one crust. Simply top the fruit with a light crumb coating.

• Find ways to incorporate vegetables. Vegetables are low in calories and rich in vitamins and nutrients. Many also are high in fiber, so they can help people avoid overeating. According to dietary experts from the American Heart Association, people should aim for four to five servings of vegetables each day. When making a plate, fill half of the plate with vegetables. Enhance dishes like lasagna or other pastas with fresh vegetables as well. See recipe below.

3. Raise the heat to get rid of any liquid that remains. Drizzle in the lemon juice and serve hot. PC226038

• Skip the fried bird. Although deep-frying a turkey can reduce cooking time, frying historically is not the best cooking method for those who are making health-conscious choices. Rather than frying, consider spatchcocking (also known as butterflying) the turkey to enable it to cook faster. Use fresh herbs and seasonings instead of butter and oil to flavor your turkey as well.

• Skip the cocktails. The Center for Science in the Public Interest says that classic cocktails with little to no added sugar typically fall into the 150- to 200-calorie range, while others can be about 200 to 300 calories each. Many people will want to save those extra calories for dessert or another indulgent dish rather than drinking them away. If you want to simulate a cocktail, make a spritzer with sparkling water and unsweetened cranberry juice.

Broccoli with Five Spices

YIELD: Serves 4

INGREDIENTS:

2 tablespoons sunflower oil

1/2 teaspoon cumin seeds

1/2 teaspoon fennel seeds

1/2 teaspoon fenugreek seeds

1/2 teaspoon black mustard seeds

1/2 teaspoon black onion seeds (kalonji)

11/4 pounds broccoli, cut into florets

1 teaspoon turmeric

1 teaspoon chili powder

Salt to taste

1 teaspoon lemon juice

DIRECTIONS:

1. Heat the oil and add all the spice seeds.

2. As they pop and darken, add the broccoli, turmeric, and chili powder, and salt. Mix well and pour in a few tablespoons of water. Bring to a sizzle, then reduce the heat and cook until the broccoli is tender but still holds its shape.

Celebrants can make some smart choices in the foods and beverages they eat to enjoy a healthier holiday season this November and December.

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From left to right: Scientific and Pedagogic Director Professor Cesaltina Ferreira Lorenzon, Executive Vice President for Stony Brook Medicine Dr. William Wertheim and Dr. Washington. Photo courtesy Stony Brook University

By Daniel Dunaief

In the midst of the pandemic, a new health effort started at Stony Brook Medicine, the medical enterprise of Stony Brook University, that is saving lives and paying other important dividends.

Dr. Sierra Washington. Photo courtesy Stony Brook University

Led by the Director of the Stony Brook Center for Global Health Dr. Sierra Washington, the university’s initiative has improved the outcomes for many people in Mozambique, particularly pregnant mothers, over the last few years.

The maternal mortality rate at Hospital Central de Maputo was 544 per 100,000 births when Washington, who was trained at Harvard Medical School and is an obstetrician/ gynecologist, joined Stony Brook. That’s about 39 times the rate in Suffolk County, which is about 14 per 100,000 live births.

For a doctor in Mozambique, “you’re losing a mother every week,” Washington said.

When mothers die, the rates of infant and child mortality increases as well.

The rate of maternal mortality by 2023 dropped to 365 per 100,000 live births.

“That’s a testament to our sustained collaboration and the work we’ve done,” Washington said, but “it’s still way too high.”

She is aiming for a 50 percent reduction within the next five years.

The benefit for pregnant mothers extends beyond one area, as residents in obstetrics and gynecology train at Hospital Central de Maputo before they are posted to other hospitals across the nation. 

Stony Brook introduced numerous ways to improve outcomes for expectant mothers. Washington introduced education and skills building and created and stocked single use medication kits for quick evaluation and treatment of a hemorrhage or infection, built systems to perform emergency C sections in a timely way and built systems to resuscitate the mother.

In addition to obstetrics and gynecology, Stony Brook has brought expertise and equipment in emergency medicine and general surgery to Mozambique.

“It’s a bilateral exchange,” said Washington. “We send learners in both directions.”

Medical trainees travel to Stony Brook, where they return with ideas and implement them in Mozambique.

So far, 11 faculty and four residents, meanwhile, have traveled over 8,000 miles to the southeastern part of the African continent to Mozambique to teach.

Additionally, the Department of Obstetrics and Gynecology at Stony Brook gives resident lectures every Wednesday over zoom to residents in Mozambique. Washington would like to duplicate that in emergency medicine and surgery.

“Almost everyone who comes here once wants to come back,” said Washington.

Indeed, this type of program can help recruit and retain talented medical care professionals eager to contribute to the world as global citizens.

“We definitely feature the program on interview days in departments that are engaged” in this global health effort, said Washington.

Mission

Dr. Sierra Washington (left) teaching surgery to Edite Magumber (right) at the Hospital Central de Maputo. Photo courtesy Stony Brook University

Washington explained that the mission of the program is to advance global health equity, beginning in Mozambique, by building capacity for care, education and research.

Collaborators in the two countries are working on five ongoing research projects on women’s health.

The framework she has used to build the system comes from the late Dr. Paul Farmer, who was a medical anthropologist at Harvard University.

Farmer coined the five S’s of global health, which include stuff, staff, skills, space and systems.

The stuff includes critical equipment and supplies, essential medicines, sutures, gloves and other products.

“These are the things Americans take for granted when they walk through the door” at a hospital or a medical practice, Washington said.

The Global Health Equity program currently has one other full-time staff member besides Washington who is an administrator.

She would like to recruit and retain a field director in emergency medicine and surgery in the next calendar year.

Additionally, Stony Brook Health would like to add expertise in nursing, pediatrics and anesthesiology, which she considers part of phase two.

The third phase involves bringing in the kinds of systems that help make hospitals run effectively in areas such as biomedical engineering, computer science and environmental science.

These experts could help ensure that a blood pressure cuff is functioning, that the ultrasound works, the lights turn on, and outlets provide power.

Africa is where people “send second-hand medical equipment that goes to die,” Washington explained. “Without properly trained and equipped maintenance departments and without industry service contracts, there is no way to repair most equipment.”

Financial reality

The Mozambique effort has been operating on what Washington described as a “shoestring budget” of around $100,000 per year.

The system leans on grant money, the good will of the hospital center, and on private donors.

Washington would like to raise $1 million over the next year, which, she suggested, would pay dividends in the health of the population.

Additional funding would help Washington develop a tool kit to reduce maternal mortality for the country.

During their eight week visits, Stony Brook’s visiting residents have stayed with Washington when they travel to Mozambique because the university cannot afford faculty/ resident housing.

“We would love to have an eponymous donation to be able to have a Stony Brook campus here, which would include short term housing, flexible learning space and meeting space,” she explained in an email.

Since the program inception, Stony Brook has raised about $500,000 in cash or in kind. The program currently has a balance of $165,000 that will last for one more year.

Washington is passionate about and committed to the effort, which she describe as “her life’s work.”

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Relatively small amounts of exercise lead to big benefits

By David Dunaief, M.D.

Dr. David Dunaief

Last week, I had a conversation with a vibrant, independent 96-year-old, who was excited to share her thoughts about the current election cycle.

It’s becoming more common to live into your 90s: according to the National Institutes of Health, those who were more than 90 years old increased by 2.5 times over a 30-year period from 1980 to 2010 in the U.S. (1). Researchers refer to this group as the “oldest-old,” which includes those over age 84.

What do these “oldest-old” have in common? According to one study, they tend to have fewer chronic medical conditions or diseases. As a result, they typically have greater physical functioning and mental acuity, which allows them a better quality of life (2).

A study of centenarians found that they tended to be healthy and then die rapidly, without prolonged suffering (3). In other words, they stayed mobile and mentally alert.

While genetics are a factor that can predict your ability to reach this exclusive club, lifestyle choices also play an important role. Let’s look at the research.

Does exercise really help extend our lives?

We’re repeatedly nudged to exercise. This is not vanity; it can have a direct impact on our longevity and health.

One study of over 55,000 participants from ages 18 to 100 showed that five-to-ten minutes of daily running, regardless of the pace, can significantly impact our life span by decreasing cardiovascular mortality and all-cause mortality (4).

Amazingly, even if participants ran fewer than six miles a 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 limited amount of time and modest pace potentially added three years to their life span.

An editorial that accompanied this study shared that more than 50 percent of people in the U.S. do not achieve the current recommendation of at least 30 minutes of moderate exercise a day (5).

One study of over a quarter-million people found that walking just 3867 steps a day started to reduce the risk of dying from any cause, and every additional 1000 steps reduced risk of death from all causes another 15 percent (6). The researchers could not find an upper limit to the benefits.

For those 85 and older, all-cause mortality risk was reduced 40 percent by walking just 60 minutes a week at a pace that qualified as physical activity, not even exercise.

What is the best protein source?

Many are questioning the value of a long-standing dietary paradigm that suggests we need to eat sufficient animal protein to support us as we age.

In an observational study of 7,000 participants from ages 50 to 65, researchers found that those who ate a high-protein diet with greater than 20 percent of their calories from protein had a had a 75 percent increase in overall mortality, a four-times increased risk of cancer mortality, and a four-times increased risk of dying from diabetes during the following 18 years (7). 

However, this did not hold true if plants were the protein source. Interestingly, they found a high-protein plant diet may actually 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 of over 73,000 participants with a median age of 57 years reinforced these findings (8). 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 experienced a significantly reduced risk of dying over the next six years compared to those who were more frequent meat eaters. 

What does systemic inflammation tell us about longevity?

The Whitehall II study included 3,044 participants over the age of 35 who did not have a stroke, heart attack or cancer at the beginning of the study (9). Researchers measured a specific marker for inflammation, interleukin-6 (IL-6). They found that higher levels had negative impacts on participants’ healthy longevity. 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 bottom line is that lifestyle choices are important to healthy longevity. A small amount of exercise and consuming more plant protein than animal 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. Your doctor can test to see if you have an elevated IL-6. If you do, 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) Eur J Prev Cardiol. 2023 Dec 21;30(18):2045. (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 or consult your personal physician.

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From left, NYS Senator Mario Mattera, Supervisor Ed Wehrheim, Louis Necroto, Katie Necrotom, Susan Necroto, Assemblyman Michael Fitzpatrick. Photo from Town of Smithtown
From left, Councilman Tom Lohmann, NYS Senator Mario Mattera, Katie Necroto, Supervisor Ed Wehrheim, Dr. Kevin Simmons, Assemblyman Michael Fitzpatrick, Matt Gribbin (Smithtown Central School District School Board). Photo from Town Smithtown

The Town of Smithtown hosted its first annual Epilepsy Awareness Ceremony, declaring November as Epilepsy Awareness Month throughout the township. The ceremony was held on November 7 at Town Hall, honoring the bravery of community members living with epilepsy and their journey to end the stigma surrounding it.

Katie Necroto, a 14-year-old Nesconset Resident shared her very personal and inspiring story, in front of a captive audience of family, friends, and local community members. Ms. Necroto was presented with a Proclamation from the Town of Smithtown by Supervisor Edward R. Wehrheim, recognizing her journey and declaring November Epilepsy Awareness Month.

“Smithtown has been at the forefront of celebrating community members and observing Health Awareness Months. Each year, we expand our partnerships, deepen our understanding, and are inspired by incredible individuals in our community. This November, we are thrilled to add Epilepsy Awareness Month to our roster. All month long, we aim to inform families about available resources, educate the public on epilepsy, and break down the stigma here in Smithtown. We will also be distributing awareness bracelets to anyone who pledges to support this mission right here at Town Hall,” said Supervisor Wehrheim in a press release.

Katie Necroto spoke to the community at large, sharing her first memory and journey to the present day with hopes of educating and inspiring others to not be ashamed or afraid of an epilepsy diagnosis. NY State Senator Mario Mattera, alongside Assemblyman Michael Fitzpatrick presented Katie with a framed, State Certificate of Recognition for her courage in raising awareness. Smithtown Central School Districts Assistant Superintendent for Instruction & Administration Cabinet, Dr. Kevin Simmons shared remarks on behalf of Superintendent Dr. Mark Secaur, who shares a personal bond, in connection to those impacted by epilepsy.

“I realized I was on the path I was meant to be on, inspired by angels who have loved, supported, and guided me. Thank you to my family, friends, school nurses, doctors, and everyone who helped me through the hardest times. I’m especially grateful to Supervisor Wehrheim and the Town for listening to my story and encouraging me to share it. If I had one wish today, it would be that my story helps someone else find hope and strength. That the telling of this story might encourage any one of you experiencing difficult times to know there are angels all around you, ready to help you on your journey and shine their light through the darkness,” said Katie, who is an Epilepsy Awareness Advocate and 9th-grade student at Smithtown High School East.

The ceremony concluded with a purple ribbon cutting in front of the sign at Town Hall, which has been landscaped with Fall purple annuals and Epilepsy Awareness garden flags. All Month long the Town of Smithtown will seek to inform families about available resources, work to educate the public on the various types of Epilepsy and pledge to end the stigma. St. Catherine of Siena Hospital has delivered informational pamphlets, available at the entrance of Town Hall for anyone wishing to learn more about treatments and resources locally available. Additionally, the Town has made silicone Awareness Bracelets available at the main entrance of Town Hall for anyone who would like to take the pledge to be informed, compassionate and help spread a positive message with the community.

“Smithtown is proud to be at the forefront of honoring Health Awareness Months, expanding community partnerships, and celebrating remarkable individuals. All November long, Smithtown will educate the public on Epilepsy, promote available resources, and work collectively to end the stigma around the condition,” read the release.

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Sherri Shepherd. Photo from BrandPoint

Award-winning TV host, comedian, actress and author Sherri Shepherd is at increased risk for pneumococcal pneumonia and invasive pneumococcal disease (IPD) because she has diabetes. She doesn’t want to let it stop her from taking her shot on – or off – the stage. That’s why Sherri is partnering with Pfizer to share her diabetes story and help raise awareness about the importance of getting vaccinated.

Q: Sherri, there’s no doubt that you’re a superstar in more than one arena. What has helped contribute to your success over the years?

I learned early on that you need to run toward the thing that scares you because that’s where you can really thrive. And let me tell you, starting out in comedy and TV can be scary. But I put in the time practicing jokes on the bus, spending time on the road, working late hours behind the scenes, and it all led me to where I was supposed to be. And now, I get to take my shot at doing what I love every day.

Q: I’m sure you faced some challenges to get where you are today. What was one of the biggest you’ve faced?

I think the biggest one for me is more of a personal one. I have diabetes, so over the years I’ve had to learn how to keep my health in check. For me, I prioritize eating right, keeping active, talking with my doctor regularly, and getting vaccinated to help prevent pneumococcal pneumonia and IPD. It took a lot to get here so I don’t want to be held back from doing what I love.

Q: Tell me more about pneumococcal pneumonia and IPD. Are they serious?

Absolutely. Pneumococcal pneumonia is a potentially serious bacterial lung disease that can disrupt your life for weeks. In more severe cases, it can put you in the hospital and even be life-threatening. The same bacteria that cause pneumococcal pneumonia can also cause invasive pneumococcal disease, or IPD, which includes blood infection and meningitis.

Q: That does sound serious. Who is at greater risk?

People like me who are 19 or older with certain underlying medical conditions like diabetes, asthma or COPD. In fact, people 19-64 living with diabetes are at over 5x higher risk for pneumococcal pneumonia and up to 4.8x higher risk for IPD, compared with healthy adults the same age. People 65 or older are also at increased risk, even if they’re healthy.

Q: What advice would you give to people about protecting themselves against pneumococcal pneumonia and IPD?

Getting vaccinated is one of the best ways to help protect yourself. And vaccination is available all year round, so I encourage everyone to talk to their doctor or pharmacist to see if a pneumococcal vaccination is right for them. They can also visit VaxAssist.com to book an appointment online today.

Q: Thanks, Sherri. Is there anything else people should know about pneumococcal pneumonia and IPD?

People assume you can only get pneumococcal pneumonia and IPD during flu season or in the winter, but you can get it any time of year. And even if you’ve already been vaccinated against pneumococcal pneumonia before, your doctor may still recommend another vaccination for further protection. I love hosting my show and doing comedy, but I don’t joke around when it comes to pneumococcal pneumonia and IPD – and you shouldn’t either. Go talk to your doctor or pharmacist about getting vaccinated, so you can also keep taking your shot at whatever it is you love to do. (BPT)

Brought to you by Pfizer.

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Cold Spring Harbor Laboratory. Photo courtesy Cold Sping Harbor Laboratory website

By Daniel Dunaief

A stock fund is taking a page out of the Newman’s Own playbook.

The food company which was started by the late actor Paul Newman and author A.E. Hotchner donates its after tax profits to charity through the Newman’s Own Foundation, enabling consumers to feel that they aren’t just covering their salad with tasty dressing but are helping the world through their consumer choices.

Range Cancer Therapeutics, an exchange-traded fund that purchases a broad basket of cancer therapeutic stocks, created a new partnership with Cold Spring Harbor Laboratory to contribute to cancer research.

The fund, which was started in 2015, plans to contribute 23 percent of its revenues, reflecting the 23 pairs of chromosomes in the human genome, each quarter to Cold Spring Harbor Laboratory.

“The contribution from Range will directly benefit the research efforts at CSHL, underscoring our commitment to advancing scientific innovation in oncology therapeutics,” Range ETF’s founder and CSHL Association Board Member Tim Rotolo, said in a statement. The ETF provides “exposure to nearly the entire lifecycle of drug development and distribution, and this new collaboration with CSHL provides an opportunity for investors to also see their money go toward the earliest stages of cancer breakthroughs.”

Revenues collected by the fund are likely to vary by quarter, depending on the amount of money the fund manages. With an estimated $12.1 million in assets under management as of the end of September and an expense ratio of 0.79%, the fund could contribute about $21,850.

“Hopefully, people will feel when they’re buying the ETF that they are in some ways supporting cancer research,” said Charles Prizzi, Senior Vice President for Advancement & Special Advisor to CSHL President Bruce Stillman.

Prizzi anticipates that the funding could support the lab’s efforts to conduct a broad range of research as CSHL’s staff, who come to the site from all over the world, seek to address the kinds of questions that can lead to advancements in a basic understanding of processes as well as to translational breakthroughs that can help in the prevention, diagnosis and treatment of various diseases.

Prizzi hopes this partnership will attract attention and inspire other fund managers or businesses to contribute to the lab, particularly amid periods when the budgets for federal funding agencies that support research rise and fall.

Borrowing from the language of genetics, Prizzi hoped that this kind of arrangement will be “replicated” by others.

 NASDAQ event

The NASDAQ stock market, which is where the Range Cancer Therapeutics Fund trades under the ticker CNCR, will celebrate the partnership on November 14th in New York City.

The Nasdaq tower will feature a visual display, while Range ETFs and CSHL leadership and guests come together at the Nasdaq podium to mark the ongoing contribution.

Dave Tuveson, head of the Cancer Center, Professor Adrian Krainer, who developed an effective treatment for spinal muscular atrophy using antisense oligonucleotide to affect gene splicing, Vice Chair Howard Morgan, and Goldman Sachs’s Roy Zuckerberg, and others will attend the event.

d Spring Harbor Laboratory President Bruce Stillman. File photo

“Cold Spring Harbor Laboratory is one of only seven national basic biological research cancer centers designated by the National Cancer Institute in Washington, DC,” Bruce Stillman, CEO of the lab said in a statement. “The institution is investing heavily in the growth of our cancer program, specifically in multidisciplinary, collaborative ventures as part of our new brain-body physiology initiative.”

Prizzi is often searching for novel ways to support research and was pleased with the contribution and hopeful that it would spur other creative donations and support.

“I hope people will learn from it and copy it,” Prizzi said. “It will benefit the lab for many years to come.”

Rotolo joined the board at CSHL earlier this year and has supported the lab for about a decade.

Rotolo had approached the lab to establish this financial commitment.

The laboratory is a 501c3 nonprofit institution, which means that donations to the lab are tax deductible.

Prizzi suggested that interested donors often reach out to him towards the end of December.

“We would love to have more people support what we’re doing,” said Prizzi.

CSHL is home to eight Nobel Prize winners and employs 1,000 people, including 600 scientists, students and technicians.

The Meetings & Courses Program bring in more than 12,000 scientists from around the world each year, offering opportunities for researchers to meet and establish collaborations and to learn about the latest scientific breakthroughs.

CSHL is in the first phase of a Foundations for the Future project, which is a seven-acre expansion effort that will tackle research in neuroscience, neuro-AI and the brain-body. Scientists will pursue better patient outcomes by exploring cancer’s whole-body impacts.

In the second phase of the project, the lab will create a new conference center and collaborative research center.

As for the connection with Range, Prizzi added that CSHL is a “lab, we like experiments. This is like an experiment. I hope it goes well and other people build off of it.”

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