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EAT YOUR FRUITS AND VEGGIES: Studies have shown that eating five servings or more of fruits and vegetables daily can reduce your risk of cardiovascular disease. Stock photo
Cardiovascular disease is pervasive but preventable

By David Dunaief, M.D.

Dr. David Dunaief

Heart disease is so pervasive that men who are 40 years old have a lifetime risk of 49 percent. In other words, about half of men will be affected by heart disease. The statistics are better for women, but they still have a staggering 32 percent lifetime risk at age 40 (1).

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

Heart disease risk factors

Risk factors include obesity, high cholesterol, high blood pressure, smoking and diabetes. Unfortunately, both obesity and diabetes are on the rise. For patients with type 2 diabetes, 70 percent die of cardiovascular causes (2). However, high blood pressure, high cholesterol and smoking have declined (3).

Of course, family history also contributes to the risk of heart disease, especially with parents who experienced heart attacks before age 60, according to the Women’s Health Study and the Physician’s Health Study (4). Inactivity and the standard American diet, rich in saturated fat and calories, also contribute to heart disease risk (5). The underlying culprit is atherosclerosis (fatty streaks in the arteries).

The newest potential risk factor is a resting heart rate greater than 80 beats per minute (bpm). In one study, healthy men and women had 18 and 10 percent increased risks of dying from a heart attack, respectively, for every increase of 10 bpm over 80 (6). A normal resting heart rate is usually between 60 and 100 bpm. Thus, you don’t have to have a racing heart rate, just one that is high-normal. All of these risk factors can be overcome, even family history.

The role of medication

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

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

The downside of statins is their side effects. Statins have been shown to increase the risk of diabetes in intensive dosing, compared to moderate dosing (7).

Unfortunately, many on statins also suffer from myopathy (muscle pain). I have a number of patients who have complained of muscle pain and cramps. Their goal when they come to see me is to reduce and ultimately discontinue their statins by following a lifestyle modification plan involving diet and exercise. Now I will address the role of lifestyle modification as a powerful ally in this endeavor. There is an abundance of studies showing exciting effects.

Lifestyle effects

There was significant reduction in mortality from cardiovascular disease with participants who were followed for a very long mean duration of 18 years. The Baltimore Longitudinal Study of Aging, a prospective (forward-looking) study, investigated 501 healthy men and their risk of dying from cardiovascular disease. The authors concluded that those who consumed five servings or more of fruits and vegetables daily with <12 percent saturated fat had a 76 percent reduction in their risk of dying from heart disease compared to those who did not (8). The authors theorized that eating more fruits and vegetables helped to displace saturated fats from the diet. These results are impressive and, most importantly, to achieve them it only required a modest change in diet.

The Nurses’ Health Study shows that these results are also seen in women, with lifestyle modification reducing the risk of sudden cardiac death (SCD). Many times, this is the first manifestation of heart disease in women. The authors looked at four parameters of lifestyle modification, including a Mediterranean-type diet, exercise, smoking and body mass index. There was a decrease in SCD that was dose dependent, meaning the more factors incorporated, the greater the risk reduction. There was as much as a 92 percent decrease in SCD risk when all four parameters were followed (9). Thus, it is possible to almost eliminate the risk of SCD for women with lifestyle modifications.

Heart risk and decreased sexual function in men

A meta-analysis (group of studies) showed that with lifestyle modifications and medication therapies, the risk of cardiovascular disease was reduced significantly, which appeared to result in improvements in erectile dysfunction (10). The lifestyle modifications included dietary changes and increased physical activity. When statin medications were not included, the risk reduction remained relatively constant, demonstrating the strength of lifestyle changes. This research is important, since those with chronic erectile dysfunction are likely to have heart disease within two to five years, according to the authors.

How do you know that you are reducing your risk of heart disease and how long does it take?

These are good questions that I have been asked by a number of patients. We use cardiac biomarkers, including inflammatory markers like C-reactive protein, blood pressure, cholesterol and body mass index. A cohort (a certain group of people) study helped answer these questions. It studied both high-risk participants and patients with heart disease. The results showed an improvement in biomarkers, as well as in cognitive function and overall quality of life.

Participants followed extensive lifestyle modification: a plant-based, whole foods diet accompanied by exercise and stress management. The results were statistically significant with all parameters measured. The best part is the results occurred over a very short period to time — three months from the start of the trial (11). Many patients I have seen have had similar results.

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

References: (1) Lancet. 1999;353(9147):89. (2) Diabetes Care. 2010 Feb; 33(2):442-449. (3) JAMA. 2005;293(15):1868. (4) Circulation. 2001;104(4):393. (5) Lancet. 2004;364(9438):93. (6) J Epidemiol Community Health. 2010 Feb;64(2):175-181. (7) JAMA. 2011;305(24):2556-2564. (8) J Nutr. March 1, 2005;135(3):556-561. (9) JAMA. 2011 Jul 6;306(1):62-69. (10) Arch Intern Med. 2011;171(20):1797-1803. (11) Am J Cardiol. 2011;108(4):498-507.

Dr. 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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New law closes loophole to permanently ban replacement of old, primitive cesspool technology to reduce nitrogen levels in water

Suffolk County Executive Steve Bellone, center, displays the new county law banning the updating or instillation of primitive cesspools and the technology associated with them, as he’s surrounded by local leaders and environmental group organizers during a press conference. Photo from Suffolk County Executive Steve Bellone’s office

Repairing old cesspools is now a thing of the past in Suffolk County.

As part of an ongoing effort to improve water quality on Long Island, Suffolk County Executive Steve Bellone (D) signed into law a ban on installing new cesspools, ending the practice of grandfathering inadequate
sanitary system fixes with the now-primitive technology.

“It marks another historic step forward in our ongoing effort to reverse decades of nitrogen pollution that has degraded water quality in our lakes, bays and harbors, and it is a step that is long overdue,” Bellone said. “It is fairly unusual for the local governments, environmental groups and the region’s largest builders group to agree on the importance of tightening up outdated regulations to protect water quality, but that is exactly what happened in this instance. This inclusive, collaborative approach is making a huge difference in our efforts to reduce decades of nitrogen pollution.”

Cesspools have been identified as primary sources of nitrogen pollution that have degraded water quality throughout Suffolk County, contributing to harmful algae blooms, beach closures and fish kills. The use of cesspools in new construction has been banned in the county since 1973, when a requirement for the addition of a septic tank was added, but the county sanitary code did not require that homeowners add a septic tank when replacing an existing cesspool, making it legal to install a new cesspool to replace an existing one. By now closing this loophole, it will advance the water quality efforts undertaken by the county and set the stage for the evolution away from the use of nonperforming cesspools and septic systems to the use of new, state-of-the-art technologies that reduce nitrogen in residential wastewater by up to 70 percent, according to Bellone.

“With this action, I would like to say that we, as a county, have adopted the policies necessary to adequately address our region’s nitrogen pollution problems, but in reality, this gets us closer to where we should have been in the decades following 1973,” said county Legislator Kara Hahn (D-Setauket), a co-sponsor of the Article 6 revisions and chairwoman of the Suffolk County Legislature’s Environment, Planning and Agriculture Committee. “I look forward to continuing the process of finally bringing Suffolk County’s sanitary code into the 21st century.”

In addition to banning the installation of new cesspools, the law approved by the Suffolk County Legislature Dec. 5 requires the wastewater industry to provide data regarding system replacement and pumping activities to the Department of Health Services beginning July 1, 2018. It also mandates permits for replacement of existing systems effective July 1, 2019, and requires business properties with grandfathered nonconforming wastewater flows to install nitrogen-reducing advanced systems if making significant changes to the use of the property.

Adrienne Esposito, executive director of Citizens Campaign for the Environment, joined forces with other environmental group leaders in thanking the county for what was a necessary step in eliminating nitrogen from groundwater.

“We can no longer allow inadequately treated sewage to mix with our sole source of drinking water,” she said. “Modernizing our health codes is a commonsense action that is critically needed for water protection.”

Richard Amper, executive director of the Long Island Pine Barrens Society, said he was overjoyed by the “huge step,” ending pollution by what he called Suffolk’s No. 1 threat to clean water.

“Now, we’re not just complaining,” he said. “We’re doing something about it.”

For the past three years, Suffolk’s Legislature has instituted a pilot program to test the new technologies, using a lottery system to select homeowners willing to have a donated system installed to demonstrate system performance. Under the pilot program, a total of 14 different technologies have been installed at 39 homes throughout the county. Four have been provisionally approved for use after demonstrating six months of acceptable operating data. As part of continued efforts, a voluntary Septic Improvement Program, the first of its kind in the state, was launched in July 2017 to provide grants and low-interest financing to make the replacement of cesspools and septic systems with new innovative/alternative technologies affordable for homeowners who choose to upgrade their systems. Over the first five months, nearly 850 homeowners have registered for the program, 228 have completed applications and 160 have been awarded grants and are moving toward installation of the new systems.

Suffolk County was the first in the state to apply for funding from New York State’s newly created $75 million Septic System Replacement Fund and will use the funding to expand its efforts to see the new technologies installed throughout the county.

The changes are the first in what is expected to be a series of updates to the county sanitary code over the next several years as county officials consider whether to put in place policies that require new nitrogen-
reducing systems in new construction projects, require installation of the new systems when a cesspool or septic system fails and needs to be replaced, or upon sale of a property. For now, all parties involved are on the same page moving forward, including both a working group comprised of county legislators, town planners and engineers with members of environmental organizations, as well as the Long Island Builders Institute.

“There is more work to do,” said Kevin McDonald, conservation finance and policy director for The Nature Conservancy on Long Island. “But passage of this bill means less nitrogen pollution in our water, and more resilient, healthy bays and people for generations to come.”

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The path to improved health: Your body needs vitamins and minerals, known as micronutrients, to nourish and keep it healthy and to reduce risk for chronic diseases. Getting them through food ensures that your body can absorb them properly.
Increasing food quality makes a difference

By David Dunaief, M.D.

Dr. David Dunaief

Hunger is only one reason we eat. There are many psychological and physiological factors that influence our eating behavior, including addictions, lack of sleep, stress, environment, hormones and others. This can make weight management or weight loss for the majority who are overweight or obese — approximately 75 percent of the U.S. adult population — very difficult to achieve (1).

Since calorie counts have been required on some municipalities’ menus, we would expect that consumers would be making better choices. Unfortunately, studies of the results have been mostly abysmal. Nutrition labeling either doesn’t alter behavior or encourages higher calorie purchases, according to most studies (2, 3).

Does this mean we are doomed to acquiesce to temptation? Actually, no: It is not solely about will power. Changing diet composition is more important.

What can be done to improve the situation? In my clinical experience, increasing the quality of food has a tremendous impact. Foods that are the most micronutrient dense, such as plant-based foods, rather than those that are solely focused on macronutrient density, such as protein, carbohydrates and fats, tend to be the most satisfying. In a week to a few months, one of the first things patients notice is a significant reduction in their cravings. But don’t take my word for it. Let’s look at the evidence.

Effect of refined carbohydrates

By this point, many of us know that refined carbohydrates are not beneficial. Well, there is a randomized controlled trial (RCT), the gold standard of studies, with results that show refined carbohydrates may cause food addiction (4). There are certain sections of the brain involved in cravings and reward that are affected by high-glycemic (sugar) foods, as shown by MRI scans of participants.

The participants consumed a 500-calorie shake with either a high-glycemic index or with a low-glycemic index. The participants were blinded (unaware) as to which type they were drinking. The ones who drank the high-glycemic shake had higher levels of glucose in their blood initially, followed by a significant decline in glucose levels and increased hunger four hours later. In fact, the region of the brain that is related to addiction, the nucleus accumbens, showed a spike in activity with the high-glycemic intake.

According to the authors, this effect may occur regardless of the number or quantity of calories consumed. Granted, this was a very small study, but it was well designed. High-glycemic foods include carbohydrates, such as white flour, sugar and white potatoes. The conclusion: Everyone, but especially those trying to lose weight, should avoid refined carbohydrates. The composition of calories matters.

Comparing macronutrients

We tend to focus on macronutrients when looking at diets. These include protein, carbohydrates and fats, but are these the elements that have the most impact on weight loss? In a RCT, when comparing different macronutrient combinations, there was very little difference among groups, nor was there much success in helping obese patients reduce their weight (5, 6). In fact, only 15 percent of patients achieved a 10 percent reduction in weight after two years.

The four different macronutrient diet combinations involved an overall calorie restriction. In addition, each combination had either high protein, high fat; average protein, high fat; high protein, low fat; or low protein, low fat. Carbohydrates ranged from low to moderate (35 percent) in the first group to high (65 percent) in the last group. This was another relatively well-designed study, involving 811 participants with an average BMI of 33 kg/m², which is defined as obesity (at least 30 kg/m²). Again, focusing primarily on macronutrient levels and calorie counts did very little to improve results.

Impact of obesity

In an epidemiological study looking at National Health and Nutrition Examination Survey data, results demonstrate that those who are overweight and obese tend to be lacking in micronutrients (7). The authors surmise that it may have to do with the change in metabolic activity associated with more fat tissue. These micronutrients include carotenoids, such as lutein, zeaxanthin, beta-carotene, alpha-carotene and beta-cryptoxanthin, as well as vitamin B12, folate and vitamins C, E and D.

However, it does not mean this population should take supplements to make up for the lack of micronutrients. Quite the contrary, micronutrients from supplements are not the same as those from foods. Overweight and obese patients may need some supplements, but first find out if your levels are low, and then see if changing your diet might raise these levels. With a few exceptions, such as vitamin D and potentially B12, most micronutrient levels can be raised without supplementation. Please ask your doctor.

Steroid levels

It may seem like there are numerous factors influencing weight loss, but the good news is that once people lose weight, they may be able to continue to keep the weight off. In a prospective (forward-looking) study, results show that once obese patients lose the weight, the levels of cortisol metabolite excretion decreases significantly (8).

Why is this important? Cortisol is a glucocorticoid, which means it raises the level of glucose and is involved in mediating visceral or belly fat. This type of fat has been thought to coat internal organs, such as the liver, and result in nonalcoholic fatty liver disease. Decreasing the level of cortisol metabolite may also result in a lower propensity toward insulin resistance and may decrease the risk of cardiovascular mortality. This is an encouraging preliminary, yet small, study involving women.

Therefore, controlling or losing weight is not solely about willpower. Don’t use the calories on a menu as your sole criteria to determine what to eat; even if you choose lower calories, it may not get you to your goal. While calories may have an impact, the nutrient density of the food may be more important. Thus, those foods high in micronutrients may also play a significant role in reducing cravings, ultimately helping to manage weight.

References: (1) www.cdc.gov. (2) Am J Pub Health 2013 Sep 1;103(9):1604-1609. (3) Am J Prev Med.2011 Oct;41(4):434–438. (4) Am J Clin Nutr Online 2013;Jun 26. (5) N Engl J Med 2009 Feb 26;360:859. (6) N Engl J Med 2009 Feb 26;360:923. (7) Medscape General Medicine. 2006;8(4):59. (8) Clin Endocrinol.2013;78(5):700-705.

Dr. 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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Rivera is honored by members of Brookhaven Town Board for his advocacy and support work surrounding the disease. Photo from Councilwoman Cartright's office

By Jennifer Sloat

He has been called an angel, the personification of goodness and strength, a champion of the underrepresented and an inspiration. Frank Rivera is all of that and more.

Rivera is the founder and president of Sarcoidosis of Long Island, an awareness and advocacy group for sarcoidosis, a rare and often debilitating disease from which the Coram resident is suffering. In 2004 at the age of 36, he received an incorrect diagnosis of lung cancer for which he underwent treatment. The X-ray showed lumps in his lungs. It was after a hospital visit in 2011 for abdominal pain that he was correctly diagnosed with sarcoidosis.

Frank Rivera, at center, cuts a ribbon at Mount Sinai’s Heritage Park to signal the start of his Sarcoidosis Awareness 5K. Photo from Councilwoman Cartright’s office

Things got even tougher for Rivera as complications from the disease arose. It attacked his neurological system, eyes and gallbladder. In April 2012, he went back to the hospital with more stomach cramps and learned his colon had ruptured. He contracted sepsis and nearly died.

Through it all Rivera continues to fight, not only for his own health, but for the health of others affected by the disease. His organization raises awareness for sarcoidosis patients at local, state and federal levels, and helps them find doctors and treatment.

Suffolk County Legislator Sarah Anker (D-Mount Sinai) said Rivera came to her office a few years ago and told her his story and idea to start a not-for-profit organization.

Anker said his tireless work with elected officials and medical research experts have provided him the guidance and resources to help residents dealing with sarcoidosis.

“He has accomplished so much,” Anker said. “It was his goal, and it remains his goal.”

County Legislator William “Doc” Spencer (D-Centerport), a practicing ear, nose and throat physician, said when he heard Rivera was creating awareness, he reached out to lend support. Spencer, who lost his mother to the disease, said he was fascinated by the work Rivera does.

“It hit close to home,” the legislator said. “Many have not even heard of the disease.”

Spencer said that what Rivera has done also generated a lot of funding to aid sarcoidosis patients in seeking medical attention and emotional support.

“I hope to continue to support him,” he said. “I hope to see him do more great things for those who don’t have champions.”

Some of the organization’s efforts include a health fair and a 5K run/walk at Heritage Park in Mount Sinai.

“He gets folks together to share ideas and stories, and to support one another,” Anker said. “It is amazing what Frank has done considering he is dealing with his own challenges, both physical and mental.”

The Town of Brookhaven celebrates National Sarcoidosis Awareness Month in April, and it’s a direct result of Rivera’s work and dedication.

“The town board has learned an overwhelming amount about the misconceptions surrounding sarcoidosis and the hurdles patients face who are suffering from rare diseases,” said town Councilwoman Valerie Cartright (D-Port Jefferson Station). “This is due in large part to Frank’s efforts. Listening to Frank speak about his personal experiences is a testament to his strength of character.”

In an interview with RARE Daily, a Global Genes patient advocacy organization, Rivera said his focus is helping others with hardships before worrying about himself.

“There are 200,000 sarcoidosis patients,” he said. “I always consider myself a representative for those 200,000 patients. I always think about what they need.”

Anker said despite his own struggles he’s always being positive to inspire others to have the will to get through the tough times.

“He always has a smile on his face and goodness in his heart,” Anker said. “His mind is going 1,000 miles an hour to accomplish what he has set out to do. He has been able to accomplish so many of his goals.”

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As you become more active, Santa, you’ll find that you have more energy all year round, not just on Christmas Eve.

By David Dunaief, M.D.

Dr. David Dunaief

Dear Santa,

This time of year, people around the world are no doubt sending you lists of things they want through emails, blogs, tweets and old-fashioned letters. In the spirit of giving, I’d like to offer you — and maybe your reindeer — some advice.

Let’s face it: You aren’t exactly the model of good health. Think about the example you’re setting for all those people whose faces light up when they imagine you shimmying down their chimneys. You have what I’d describe as an abnormally high BMI (body mass index). To put it bluntly, you’re not just fat, you’re obese. Since you are a role model to millions, this sends the wrong message.

We already have an epidemic of overweight kids, leading to an ever increasing number of type 2 diabetics at younger and younger ages. According to the Centers for Disease Control and Prevention, as of 2015, more than 100 million U.S. adults are living with diabetes or prediabetes. It complicates the issue that approximately two-thirds of the U.S. population is overweight and/or obese. This is just one of many reasons we need you as a shining beacon of health.

Obesity has a much higher risk of shortening a person’s life span, not to mention quality of life and self-image. The most dangerous type of obesity is an increase in visceral adipose tissue, which means central belly fat. An easy way to tell if someone is too rotund is if a waistline, measured from the navel, is greater than or equal to 40 inches for a man, and is greater than or equal to 35 inches for a woman. The chances of diseases such as pancreatic cancer, breast cancer, liver cancer and heart disease increase dramatically with this increased fat.

Santa, here is a chance for you to lead by example (and, maybe, by summer, to fit into those skinny jeans you hide in the back of your closet). Think of the advantages to you of being slimmer and trimmer. For one thing, Santa, you would be so much more efficient if you were fit. Studies show that with a plant-based diet, focusing on fruits and vegetables, people can reverse atherosclerosis, clogging of the arteries.

The importance of a good diet not only helps you lose weight but avoid strokes, heart attacks, peripheral vascular diseases, etc. But you don’t have to be vegetarian; you just have to increase your fruits, vegetables and whole-grain foods significantly. With a simple change, like eating a handful of raw nuts a day, you can reduce your risk of heart disease by half. Santa, future generations need you. Losing weight will also change your center of gravity, so your belly doesn’t pull you forward. This will make it easier for you to keep your balance on those steep, icy rooftops.

Exercise will help, as well. Maybe for the first continent or so, you might want to consider walking or jogging alongside the sleigh. As you exercise, you’ll start to tighten your abs and slowly see fat disappear from your midsection, reducing risk and practicing preventive medicine. Your fans everywhere leave you cookies and milk when you deliver presents. It’s a tough cycle to break, but break it you must. You — and your fans — need to see a healthier Santa. You might let slip that the modern Santa enjoys fruits, especially berries, and veggies, with an emphasis on cruciferous veggies like broccoli florets dipped in humus, which have substantial antioxidant qualities and can help reverse disease.

As for your loyal fans, you could place fitness videos under the tree. In fact, you and your elves could make workout videos for those of us who need them, and we could follow along as you showed us “12 Days of Workouts with Santa and Friends.” Who knows, you might become a modern version of Jane Fonda or Richard Simmons or even the next Shaun T!

How about giving athletic equipment, such as baseball gloves, footballs and basketballs, instead of video games? You could even give wearable devices that track step counts and bike routes or stuff gift certificates for dance lessons into people’s stockings. These might influence the recipients to be more active.

By doing all this, you might also have the kind of energy that will make it easier for you to steal a base or two in this season’s North Pole Athletic League’s Softball Team. The elves don’t even bother holding you on base anymore, do they?

As you become more active, you’ll find that you have more energy all year round, not just on Christmas Eve. If you start soon, Santa, maybe by next year, you’ll find yourself parking the sleigh farther away and skipping from chimney to chimney.

The benefits of a healthier Santa will ripple across the world. Think about something much closer to home, even. Your reindeer won’t have to work so hard. You might also fit extra presents in your sleigh. And Santa, you will be sending kids and adults the world over the right message about taking control of their health through nutrition and exercise. That’s the best gift you could give!

Wishing you good health in the new year,

David

P.S. I could really use a new baseball bat, if you have a little extra room in your sleigh.

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

A historic change at a nearly 90-year-old Port Jefferson institution has been finalized.

John T. Mather Memorial Hospital will officially finalize an affiliation agreement with Northwell Health Dec. 21, according to a Mather board member, who asked not to be referred to by name. Leadership from Mather Hospital signed a letter of intent to join Northwell, New York’s largest health care provider, in August, though the sides had not yet finalized the terms of the agreement at that time. It is the first time in the hospital’s history it will be affiliating with a larger health system, and a signing ceremony is set to take place Thursday, Dec. 21, at 3 p.m. in a conference room at the hospital. The board member said he expects Northwell Health president and chief executive officer Michael Dowling as well as Mather board of directors chairman Ken Jacoppi to attend the signing.

Mather Hospital is set to join Northwell Healht. Photo from Huntington Hospital

“We’re very pleased Northwell has committed to making an investment in our community and bringing their extraordinary capabilities to our community,” the board member said. “They’ve committed to preserve our culture of patient safety.”

The board member said part of the agreement is that Mather’s board and CEO will remain in place through an initial period of five years, allowing the hospital to remain “largely self-governing” during that time with collaboration and cooperation from Northwell. The Mather board member did not specify the total length or any other specifics of the agreement. A spokesperson from Mather confirmed the ceremonial signing will take place Dec. 21 and that the agreement has been reached, but declined to confirm any details relating to the contract.

The board member summed up what the change might mean for hospital patients going forward.

“In the near term the experience should not change at all,” he said. “We happen to believe that’s a good experience, generally speaking. In the long term Northwell has greater capabilities than we do and we’ll gain those. They’re committed to supporting our residency program as well.”

In August, state Sen. Ken LaValle (R-Port Jefferson) voiced opposition to the agreement, saying he would have preferred Mather affiliate with Stony Brook University Hospital.

“I don’t think it’s a good decision,” LaValle said at the time. “For 50 years-plus there’s been a culture in place if people needed tertiary care they would go from Mather to Stony Brook. Stony Brook will still be in place, will still offer services and people if they choose can go to Stony Brook.”

Mather Hospital vice president of public affairs Nancy Uzo said in August Stony Brook was considered an option for affiliation and offered an explanation by email.

“Our goal through this process is to ensure that our communities continue to have access to advanced, high-quality care and superior satisfaction close to home, and to serve the best interests of our medical staff and employees,” she said.

Dowling commented similarly about Mather Hospital’s reputation around the letter of intent signing in August, and as to why Northwell would be a good fit for Mather.

“Mather Hospital is known for patient-centric care both in the community and throughout the industry,” he said. “That deeply embedded sense of purpose is the type of quality we want to represent Northwell Health, along with an excellent staff of medical professionals and physicians. Together, Mather and Northwell will play a crucial partnership role expanding world-class care and innovative patient services to Suffolk County residents.”

A public relations representative from Northwell did not immediately respond to requests for comment.

This story was updated Dec. 19 to include a Mather spokesperson’s confirmation of the signing ceremony.

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Are we over- or undertreating?

By David Dunaief, M.D.

Dr. David Dunaief

How do we protect one of our most valued assets, our infrastructure? Not roads and bridges, but our bones. When we think of bone fractures as a child or young adult, we think of short-term pain and inconvenience, but usually we recover without long-term consequences.

However, as we get older, fractures can be a lot more significant, with potentially life-altering or life-ending consequences. Osteoporosis is a silent disease that affects millions of patients, most commonly, but by no means exclusively, postmenopausal women. The trend is for low bone mass and osteoporosis diagnoses to increase by 29 percent from 2010 to 2030.

Osteoporosis is where there is bone loss, weakening of the bones and small deleterious changes in the architecture of the bone over time that may result in fractures with serious consequences (1).

One way to measure osteoporosis is with a dual-energy X-ray absorptiometry (DXA) scan for bone mineral density. Osteopenia is a slightly milder form that may be a precursor to osteoporosis. However, we should not rely on the DXA scan alone; risk factors are important, such as a family or personal history of fractures as we age. The Fracture Risk Assessment Tool (FRAX) is more thorough for determining the 10-year fracture risk. Those who have a risk of fracture that is 3 percent or more should consider treatment with medications. A link to the FRAX tool can be found at www.shef.ac.uk/FRAX.

Most of us have been told since we were young that we need more calcium to make sure we have strong bones. In fact, the National Osteoporosis Foundation recommends that we get 1,000 to 1,200 mg per day of calcium if we are over 50 years old (2). Recommendations vary by sex and age. This would be mostly from diet but also from supplements. However, the latest research suggests that calcium for osteoporosis prevention may not be as helpful as we thought.

The under/overmedication treatment paradox

Depending on the population, we could be overtreating or undertreating osteoporosis. In the elderly population that has been diagnosed with osteoporosis, there is undertreatment. One study showed that only 28 percent of patients who are candidates for osteoporosis drugs are taking the medication within the first year of diagnosis (3). The reason most were reluctant was that they had experienced a recent gastrointestinal event and did not want to induce another with osteoporosis medications, such as bisphosphonates. The data were taken from Medicare records of patients who were at least 66 years old.

On the other hand, as many as 66 percent of the women receiving osteoporosis medications may not have needed it, according to a retrospective study (4). This is the overtreatment population, with half these patients younger, between the ages of 40 and 64, and without any risk factors to indicate the need for a DXA scan. This younger population included many who had osteopenia, not osteoporosis.

Also, the DXA scan may have shown osteoporosis at what the researchers described as nonmain sites in one-third of patients diagnosed with the disease. Main sites, according to the International Society for Clinical Densitometry recommendations, would be the anterior-posterior spine, hip and femoral neck. A nonmain site in this review was the lateral lumbar spine. Before you get a DXA scan, make sure you have sufficient risk factors, such as family or personal history of fracture, age and smoking history. When the DXA scan is done, make sure it is interpreted at the main sites. If you are not sure, have another physician consult on the results.

We all need calcium to prevent osteoporosis, right?

Calcium has always been the forefront of prevention and treatment of osteoporosis. However, two studies would have us question this approach. Results of one meta-analysis of a group of 59 randomized controlled trials showed that dietary calcium and calcium supplements with or without vitamin D did increase the bone density significantly in most places in the body, including the femoral neck, spine and hip (5). Yet the changes were so small that they would not have much clinical benefit in terms of fracture prevention.

Another meta-analysis of a group of 44 observational dietary trials and 26 randomized controlled trials did not show a benefit with dietary or supplemental calcium with or without vitamin D (6). There was a slight reduction in nonsignificant vertebral fractures, but not in other places, such as the hip and forearm. Dietary calcium and supplements disappointed in these two trials.

Does this mean calcium is not useful? Not so fast!

In some individual studies that were part of the meta-analyses, the researchers mentioned that dairy, specifically milk, was the dietary source on record, and we know milk is not necessarily good for bones. But in many of the studies, the researcher did not differentiate between the sources of dietary calcium. This is a very important nuance. Calcium from animal products may increase inflammation and the acidity of the body and may actually leach calcium from the bone, while calcium from vegetable-rich, nutrient-dense sources may be better absorbed, providing more of an alkaline and anti-inflammatory approach. This would be a good follow-up study, comparing the effects of calcium from animal and plant-based dietary sources.

What can be done to improve the situation?

Studies have shown that yoga can help prevent osteoporosis by improving mobility, posture and strength.

Yoga used to be on the fringe of society. Now, it has become more prevalent and part of mainstream exercise. This is a good trend since this type of exercise may have a big impact on prevention and treatment of osteoporosis. In a small pilot study, the results showed that those who practiced yoga had an increase in their spine and hip bone density compared to those who did not (7). There were 18 participants in this trial.

The researchers were encouraged by these results, so they increased the number of participants in another study. The results showed that 12 minutes of yoga daily or every other day significantly increased the bone density from the start of the study in both the spine and femur, the thigh bone (8). There was also an increase in hip bone density, but this was not significant. The strength of the study includes its 10-year duration. However, one weakness was that this trial did not include a control group.

Another was that 741 participants started the trial, but only 227 finished, less than one-third. Of those, 202 were women. Significantly, prior to the study there were 109 fractures in the participants, most of whom had osteoporosis or osteopenia, but none had yoga-related fractures by the end of the trial. The “side effects” of yoga include improved mobility, posture, strength and a reduction in anxiety. The researchers gave a nice road map of specific beneficial poses. Before starting a program, consult your doctor.

The moral of the story is that exercise is beneficial. Yoga may be another simple addition to this exercise regimen. Calcium may be good or bad, depending on its dietary source. Be cautious with supplemental calcium; it does have side effects, including kidney stones, cardiovascular events and gastrointestinal symptoms, and consult with your doctor to assess whether you might be in an overtreatment or undertreatment group when it comes to medication.

References: (1) uptodate.com. (2) nof.org. (3) Clin Interv Aging. 2015;10:1813-1824. (4) JAMA Intern Med. online Jan. 4, 2016. (5) BMJ 2015; 351:h4183. (6) BMJ 2015; 351:h4580. (7) Top Geriatr Rehabil. 2009; 25(3); 244-250. (8) Top Geriatr Rehabil. 2016; 32(2); 81-87.

Dr. 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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Studies have shown that having a pet in your life significantly reduces the risk of cardiovascular disease.

By Matthew Kearns, DVM

I had a classmate in veterinary school who simply described his cat as “good for the head.” What he meant by that statement was when the stress of classes and studying became too much he could always count on his cat to ease the burden. Well, science is backing up this claim. Having a pet in your life can be good for the head and the body.

Let’s start with the head. How do we know that interacting with a pet reduces stress? Well, a recent study revealed that just the act of petting something reduces stress. This study put individuals in a stressed state and then offered them a rabbit, a turtle, a toy rabbit or a toy turtle. Those individuals who petted a real rabbit or turtle showed a significant reduction in stress compared to those that petted a toy rabbit or toy turtle.

Other studies have revealed that people with significant mental illness such as bipolar disease and schizophrenia benefit from pet ownership. Many people with significant mental illness live at home and do not reach out to the health care system and see their social circles shrink. Pet ownership decreases the loneliness and feelings of isolation that come with that.

One schizophrenic in an article I read stated that he was able to keep the voices in his head at bay by concentrating on the singing of his birds. Another study observed the act of walking or grooming a horse has been successful in reducing depression, anxiety and the symptoms of post-traumatic stress disorder in both survivors of childhood abuse and veterans.

A third study focused on comparing human social support and pet attachment support in combatting depression in geriatric patients. What they found was there was no relationship between human social support and depression, but there was a significant positive influence in pet attachment and depressed mood.

Now, we can move on to the body. Studies both in the United States and abroad have concluded that just sharing your life with a pet significantly reduces the risk of cardiovascular disease, such as a heart attack or stroke, reduces the risk of type 2 diabetes and lowers cholesterol. In addition, owning a pet motivates us to exercise more.

The national physical activity guidelines recommend 150 minutes of moderate exercise per week, but a Centers for Disease Control and Prevention analysis states only about 50 percent of Americans get that total.

In contrast to this data, research shows that dog owners walk an average of 22 minutes more per day. Not only do dog owners exercise more, but also the type of exercise is healthier. The type of exercise is described as at a moderate pace, which refers to getting the heart rate up.

This holiday season consider a pet as a gift for yourself. Consider it a New Year’s resolution, as well as a gift.

Thank you to all the readers who enjoy this column. I would like to also thank Heidi Sutton, editor of the Arts & Lifestyle section, as well as all the staff at the Times Beacon Record News Media for another great year.

Dr. Kearns practices veterinary medicine from his Port Jefferson office and is pictured with his son Matthew and his dog Jasmine.

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Added sugar increases risk of many diseases

By David Dunaief, M.D.

Dr. David Dunaief

We should all reduce the amount of added sugar we consume because of its negative effects on our health. It is recommended that we get no more than 10 percent of our diet from added sugars (1). However, approximately 14 percent of our diet is from added sugars alone (2).

Is all sugar bad for us? The answer is not straightforward. It really depends on the source, and when I mention source, my meaning may surprise you.

We know that white, processed sugar is bad. But I am constantly asked: Which sugar source is better — honey, agave, raw sugar, brown sugar or maple syrup? None are really good for us; they all raise the level of glucose (a type of sugar) in our blood. Forty-seven percent of our added sugar intake comes from processed food, while 39 percent comes from sweetened beverages, according to the most recent report from the Centers for Disease Control and Prevention (2). Sweetened beverages are defined as soft drinks, sports and energy drinks and fruit drinks. Even 100 percent fruit juice can raise our glucose levels. Don’t be deceived because it says it’s natural and doesn’t include “added” sugar.

These sugars increase the risk of, and may exacerbate, chronic diseases such as diabetes, heart disease, high blood pressure, cancer and obesity. This is such a significant problem that municipal legislatures have considered adding warning labels to sweetened drinks (3).

However, I did say that sugar’s source impacts its effect. Most fruits have beneficial effects in preventing disease, including diabetes, and do not raise sugar levels, even in patients with diabetes. It is a myth that whole fruit raises your sugar levels. However, dried fruits, fruit juice and fruit concentrate do raise your sugar levels. Note that sugar extracted from fruit has an effect similar to that of sugar added to foods and sweetened beverages.

Let’s look at the evidence.

Heart disease

When we think of sugar’s effects, heart disease is not usually the first disease that comes to mind. However, results from a 20-year study of 31,000 U.S. adults showed that, when comparing those who consumed the least amount of added sugar (less than 10 percent of calories daily) with those who consumed 10 to 25 percent and those who consumed more than 25 percent of daily calories from sugar, there were significant increases in risk of death from heart disease (4). The added sugar was from foods and sweetened beverages, not from fruit and fruit juices.

This was not just an increased risk of heart disease but an increased risk of cardiovascular death. This is a wake-up call to rein in our sugar consumption.

Obesity and weight gain

Does soda increase obesity risk? An assessment published in PLoS One, a highly respected, peer-reviewed journal, showed that it depends whether studies were funded by the beverage industry or had no ties to any lobbying groups (5). Study results were mirror images of each other: Studies not affiliated with the industry show that soda may increase obesity risk, while studies funded by the beverage industry show there may not be any association.

In studies without beverage industry funding, greater than 80 percent (10 of 12) showed associations between sugary drinks and increased weight or obesity, whereas with the beverage industry-funded studies, greater than 80 percent of them did not show this result (5 of 6). The moral of the story is that patients must be diligent in understanding studies’ funding and, if the results sound odd, they probably are. If this is the case, make sure to ask your doctor about the studies’ findings. Not all studies are equally well designed.

Diabetes and the benefits of fruit

Diabetes requires the patient to limit or avoid fruit altogether. Correct? This may not be true. Several studies may help change the long-standing, commonly held paradigm that fruit should be restricted in patients with diabetes and to prevent development of diabetes.

One study found that whole fruit may reduce the risk of diabetes by reducing inflammation and reducing insulin resistance (6). Specifically, results demonstrated a reduction in the inflammatory biomarker hsCRP. Ultimately, this may result in better glucose control. A potential reason for these impressive results may be the high levels of flavonoids, specifically anthocyanins and flavones. Flavonoids, as a class, are phytochemicals (plant nutrients) that provide pigment to fruits and vegetables and may have substantial antioxidant activities. Substances that are high in these two flavonoids include red grapes, berries, tea and wine.

Another study, a meta-analysis that looked at three large studies, including the Nurses’ Health Study, NHS II, and the Health Professionals Follow-up Study, showed that those who consumed the highest amount of anthocyanins were likely to experience a 15 percent reduction in the development of type 2 diabetes (7). Researchers compared those in the highest quintile of anthocyanin consumption with those in the lowest quintile.

Specifically, at least two servings of blueberries per week were shown to reduce the risk of diabetes by 23 percent, and at least five servings of apples and pears per week were also shown to reduce the risk by 23 percent. These were compared to those who consumed less than one serving per month. This is a small amount of fruit for a significant reduction.

From the same three studies, it was also shown that grapes, bananas and grapefruit reduce the risk of diabetes, while fruit juice and cantaloupe may increase risk (8).

In still another diabetes study, involving those who were newly diagnosed with type 2 diabetes, the risk of increasing glucose levels was no greater in those who consumed more than two servings of fruit per day compared to those who consumed fewer than two servings per day (9). The properties of flavonoids, for example, those found in whole fruit, may also result in anticancer and anticardiovascular disease properties, the opposite of added sugars (10).

Chronic disease incidence and complications from these diseases have skyrocketed in the last several decades. Therefore, any modifiable risk factor should be utilized to decrease our risk. By keeping added sugar to a minimum in our diets, we could make great strides in the fight to maintain our quality of life as we age.

We don’t have to avoid sugar completely; we still can satiate a sweet tooth by eating ripe fruits. Our access to fruit, even off-season, has expanded considerably. The most amazing thing is that fruit may actually reduce the risk of diabetes, something for years we thought might exacerbate it.

References: (1) 2015-2020 Dietary Guidelines for Americans. (2) cdc.gov. (3) reuters.com. (4) JAMA Intern Med. online Feb 03, 2014. (5) PLoS Med. 2013 Dec;10(12):e1001578. (6) J Nutr. 2014 Feb;144(2):202-208. (7) Am J Clin Nutr. 2012 Apr;95(4):925-933. (8) BMJ. online Aug 29, 2013. (9) Nutr J. published online March 5, 2013. (10) Plant Foods Hum Nutr. 2004 Summer;59(3):113-122.

Dr. 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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Above, Stony Brook Medicine’s Puerto Rico medical relief team. Photo from SBU

By Kenneth Kaushansky, M.D.

Dr. Kenneth Kaushansky

As the holidays arrive, our thoughts turn to giving — and giving back to those who need our help. Stony Brook Medicine’s Puerto Rico medical relief team did just that, spending two weeks on the devastated island to treat patients and give a much-needed break to health care workers there.

We got word, after Category 5 Hurricane Maria swept through, of the conditions in Puerto Rico. Pharmacies were in ruins. Patients with chronic illnesses who needed to see their primary care physicians could not get appointments. Health care professionals couldn’t tend to their own families, nor repair their damaged homes, because their services were needed around the clock.

Relief efforts for those in Puerto Rico took on many forms. In my role as chair of the Greater New York Hospital Association board of directors, I served as part of an organization that teamed up with the Healthcare Association of New York State to establish the New York Healthcare’s Puerto Rico Hurricane Relief Fund to assist hospitals, health care workers and their families in Puerto Rico. The fund is a vehicle for New York’s hospital community to show its support for frontline caregivers and their families who have suffered significant losses.

I’m proud how Stony Brook Medicine also responded to this human health crisis. As part of a 78-member relief team of personnel from hospitals around the region, Stony Brook organized a team of health care professionals that was deployed to Puerto Rico. They signed on to spend two weeks living and working 12-hour days in less-than-ideal conditions, with widespread shortages of food, water and electricity.

Our 23 care providers — three physicians, two nurse practitioners, nine nurses, four paramedics, four nursing assistants and one pharmacist — split up after arriving in Puerto Rico. Most were stationed in the city of Manatí, while the rest went to the city of Fajardo and then to the U.S. Navy hospital ship USNS Comfort. They worked closely with military personnel, federal agencies and the people of Puerto Rico. They saw more than 2,000 patients and helped local health care workers get some rest and get back on their feet.

Our team returned home in November to cheers and hugs from their co-workers and loved ones who met them at Stony Brook University Hospital. Despite the hardships and long hours, they spoke of the deeply fulfilling experiences they had in Puerto Rico. Their trip embodied the reasons why people choose a career in health care in the first place — to be of service and to provide excellent care.

Stony Brook Medicine’s mission is to deliver world-class, compassionate care to patients and families. And sometimes that mission extends well beyond our own four walls. We are making a difference, not only here at home but in communities around the world.

All of us at Stony Brook Medicine are so extremely proud of our Puerto Rico relief team. The work they did was heroic, generous in the extreme and so worthwhile. Our thanks also go to their families and to their Stony Brook colleagues who stepped up to cover extra shifts while the team was away.

Having heard many of their experiences, I cannot say enough about the team members and their devotion. I know they have returned much better for the experience and are now safely back to continue their efforts to improve the health of our patients.

Dr. Kenneth Kaushansky serves as dean of the School of Medicine and senior vice president of Health Sciences at State University of New York at Stony Brook.

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