Above, the staff of the Adult Day Health Program at Gurwin Jewish Center. Photo from Gurwin Jewish Center
Gurwin Jewish Nursing & Rehabilitation Center’s Adult Day Health Program was recently named Long Island’s Best in Adult Day Health for 2017 through Bethpage Federal Credit Union’s Best of Long Island competition. The full-day medical model program, which opened its doors in 1989, offers comprehensive medical and social services to frail, elderly and cognitively impaired residents of Nassau and Suffolk counties in a supervised, secure and enriching environment.
“We are honored that Gurwin’s Adult Day Health program has been recognized as the Best on Long Island,” said Herbert H. Friedman, Gurwin’s executive vice president/CEO. “At the core of the Adult Day Health program is our talented multidisciplinary staff whose compassion and dedication is evident in their person centered care and innovative programming. Their attentiveness to each participant’s individualized needs offers families respite from the demanding responsibilities of caregiving, and peace of mind knowing that their loved one is good hands. We are pleased that our staff and the program have been recognized for the outstanding care they provide for the residents of our local community.”
Up to 133 individuals with varying health and cognitive challenges attend the program daily, which is located on Gurwin’s 67-acre campus within the renowned Gurwin Jewish Nursing & Rehabilitation Center. Medical and nursing care, rehabilitation therapy and a wide range of engaging therapeutic activities are offered for those who attend up to six days per week, supporting the physical, social and emotional needs of each participant.
According to Jeraldine Fedoriw, LMSW and Gurwin Adult Day Health Program director, “Socialization and structure in a secure environment are key to helping those with physical and cognitive disabilities flourish. From the moment our buses pick them up in the morning, to the time they return home in the afternoon, our registrants are kept busy and engaged. Starting with a well-balanced breakfast, the day is fun-filled with hands-on activities such as painting, crafts, exercise, music and dancing. It is a stimulating day that gives our members a sense of belonging and oftentimes a renewed sense of purpose.”
In addition to a full calendar of events and assistance with activities of daily living, Gurwin’s program offers access to its in-house clinic which provides a full array of health services including dental, ophthalmology, audiology and other specialty services. Other on-site amenities include access to the facility’s professional barber and beauty parlor and well-stocked gift shop for light shopping needs.
“At the Gurwin Adult Day Health Program, our staff is proud to make a difference in the lives of those who attend our program each day,” Fedoriw adds. “I’m delighted for our staff that we’ve been named the Best on Long Island — it’s a well-deserved honor.”
Ryan Madden from the Long Island Progressive Coalition leads a march calling for renewable energy in the form of wind. Photo from Ryan Madden
Scientists and politicians are relied upon to do the bulk of the work to reduce the effects and pace of climate change, but local activist organizations on Long Island are taking on the burden as well.
“I think it’s really important for grassroots and local solutions to tackle this crisis — to be at the forefront of the solutions,” Ryan Madden, with the Long Island Progressive Coalition said. “A lot of the problems we see in this country, in New York State and on Long Island, whether it’s rampant income inequality, access to education, just issues of local pollution and ailments related to the combustion of fossil fuels, all of this connects into a larger system that informs why climate change is a problem in the first place.”
The LIPC, a community-based grassroots organization that works on a range of issues related to sustainable development as well as achieving social, racial and economic justice, has a program for improving energy efficiency. The group helps low- to moderate-income homeowners take advantage of free energy assessments and obtain financial resources to be able to go through energy-efficient retrofits and ultimately help reduce carbon footprints. The organization also recently entered the solar arena.
Members of Sustainable Long Island’s youth-staffed farmers market in New Cassel. Photo from Gabrielle Lindau
“It’s part of a larger push to democratize our energy system so that communities have a say in the build out of renewable energy and have ownership or control over the systems themselves,” Madden said. “We’re pushing for constructive and far-reaching changes, which is what we think is needed in this time.”
Madden added he has fears about the future because of comments President Donald Trump (R) has made in the past regarding climate change and his previously stated belief it is a hoax. Trump signed an executive order March 28 that served as a rollback of the Clean Power Plan, an initiative meant to reduce carbon pollution from power plants. The order infringes on commitments to the Paris Agreement, a universal, legally binding global climate deal.
“We’re trying to meet that with really bold, visionary climate policy that has a wide range of economic transformative impacts, while also remaining on the ground helping homeowners and institutions make that switch through energy efficiency and renewable energy,” Madden said.
Other organizations like the Sierra Club, a nonprofit, are also focused on renewable energy, but in the form of offshore wind.
“Offshore wind is the best way to meet our need for large-scale renewable energy that can help us fight climate change and provide good jobs for New Yorkers, but we aren’t used to getting our energy this way in the United States,” Sierra Club organizer Shay O’Reilly said. “Instead, we’re used to relying on dirty fossil fuels, and our energy markets and production systems are centered on these ways of producing electricity.”
Gordian Raacke, with Renewable Energy Long Island also works on this front. He and his group advocated for and eventually convinced the Long Island Power Authority to do a study on offshore wind power.
“January of this year, LIPA agreed to sign a contract for New York’s first, and the country’s largest, offshore wind project,” he said.
New York Renews hosted a town hall to get community members together to talk about climate change issues. Photo from Ryan Madden
Deepwater Wind will build and operate the 90-megawatt project 30 miles east of Montauk Point in the Atlantic Ocean. The project will generate enough electricity to power 50,000 homes.
In 2012, the group also commissioned a study to evaluate whether Long Island could generate 100 percent of its annual electricity consumption from renewable energy sources. The study, The Long Island Clean Electricity Vision, showed that it would not only be possible, but also economically feasible.
Currently, the LIPC has a campaign to pass the Climate and Community Protection Act in New York State, which would decarbonize all sectors of New York’s economy by 2050, redirect 40 percent of all state funding to disadvantaged communities — which would decrease pollution over decades — and ensure a transition away from fossil fuels.
These topics and others are taught in classes at Stony Brook University under its Sustainability Studies Program. Areas of study include environmental humanities, anthropology, geology, chemistry, economy, environmental policies and planning. Students do hands-on and collaborative work and take on internships in the field. They also clear trails and develop businesses to help increase sustainability among other hands-on initiatives.
“Our mission is to develop students who become leaders in sustainability and help to protect the Earth,” Heidi Hutner, director of the program said. “Climate change and pollution is the most important issue facing us today. We have to find a way to live on this planet and not totally destroy it and all of its creatures. Our students are skilled in many different ways, going into nongovernmental or not-for-profit organizations, becoming law professors, lawyers, journalists, scientists, educators, but all focused on the environment. A former student of ours is the sustainability director at Harvard Medical School.”
Students from the program organized to march in the People’s Climate March in 2014, and will be doing so again April 29. The purpose of the march is to stand up to the Trump administration’s proposed environmental policies.
Students and staff at East Islip High School work with Sustainable Long Island to build a rain garden. Photo from Gabrielle Lindau
Undergraduates in the program also work closely with environmentally active local legislators like state Assemblyman Steve Englebright (D-Setauket), and county Legislators Kara Hahn (D-Setauket) and William “Doc” Spencer (D-Centerport). There is also a Sierra Club on campus.
The LIPC regularly hosts round tables to show other environmental groups what it’s up to and town halls to let community members share their stories and even visit assembly members to lobby for support. Sustainable Long Island, a nonprofit founded in 1998 that specialized in advancing economic development, environmental health and social equality for Long Island, also focuses on low-income communities through its programs.
Food equality and environmental health are the group’s biggest areas of concentration because according to Gabrielle Lindau, the group’s director of communications, the issues are tied to each other.
“There is a polarization here on Long Island,” she said. “We have extremely rich communities, and then we have extremely poor communities.”
According to Lindau, 283,700 people receive emergency food each year, so Sustainable LI builds community gardens and hosts youth-staffed farmers markets to combat the problem.
“It’s a game-changer for low income communities,” she said. “These communities gardens are great because they give people access to fresh, healthy food, and it also puts the power in their hands to find food and also, the learning skills to be able to grow that food. It’s also a paid program, so it’s giving them an opportunity to earn what they’re working toward.”
The youth-staffed farmers markets, which began in 2010, have been a real catalyst for change in communities like Farmingdale, Roosevelt, Freeport, Flanders, New Castle and Wyandanch where access to fresh food is not a given.
Children help Sustainable Long Island build a community garden. Photo from Gabrielle Lindau
“We have so much farming going on out east here on Long Island and I don’t think people who live here ever step back to look at all the food we have here in our own backyard,” Lindau said. “These markets are an incredible program because they’re not only teaching kids in communities about agriculture where they wouldn’t have necessarily had the opportunity to do that, but they’re also teaching them financial literacy skills, and, at the same time, they’re bringing in healthy food items to their neighbors.”
Shameika Hanson a New York community organizer on Long Island for Mothers Out Front, an organization that works to give women a voice for change — empowering and providing them with skills and resources to get decision makers and elected officials to act on their behalf — does specific work with climate change, also calling for the transition from fossil fuels to renewable energy. As a national organization, the topics range depending on the needs of an area from getting methane gas leaks plugged, to stopping oil trains for moving through the area, to getting involved in carbon offsets. Specifically on Long Island, women are creating a task force to ensure the drinking water quality across the island is standardized.
“Democracy doesn’t work without civic engagement,” Hanson said. “There’s a need for a conversation to happen that is united. Even though the water authorities are separate, the water isn’t.”
Sustainable Long Island also works on building rain gardens to reduce stormwater runoff into local waters.
“We’re in a dire situation here on Long Island when it comes to our aquifers,” Lindau said. “We have an intense amount of nitrogen that’s already going into the ground.”
The nonprofit works with the Environmental Resource Management Foundation and PSEG Foundation and builds rain gardens like the one at the Cove Animal Rescue in Glen Cove and others in East Islip and Long Beach.
“It’s about educating communities on the importance of the rain garden and why green infrastructure practices are pivotal for environmental health on Long Island moving forward,” Lindau said. “If we don’t have clean drinking water, we’re going to be in trouble, if we don’t have usable soil to plant in, we’re not going to have farms growing the produce we need to survive and if we don’t have that produce, then we’re not going to be able to bring food into these low-income communities for people who can’t get it otherwise. They’re all connected in a number of different ways and a lot of them root back to health.”
Students in Stony Brook University’s Sustainability Studies Program participate in the 2014 People’s Climate March in NYC. Photo from Heidi Hutner
Sustainable Long Island has done work with local municipalities following superstorms like Hurricane Sandy. They helped communities rebuild, hosted peer-to-peer education meetings to better prepare locals and business owners for another devastating storm and provided job training to bring businesses back.
“A big part of this is going into communities and educating them and helping to advocate in order to facilitate change,” Lindau said. “Working with other groups is extremely important as well. We’re not a lone wolf in the nonprofit world — we not only find it important to work with governments and other municipalities — but to connect with other nonprofits who have something unique to offer as well.”
Melanie Cirillo, with the Peconic Land Trust, reiterated the need for local organizations to team up. The Peconic Land Trust conserves open space like wetlands, woodlands and farmland. It keeps an eye on water quality and infrastructure like Forge River in Mastic, which is a natural sea sponge that absorbs storm surge.
“Wetlands are key in so many of our waterfront properties,” she said. “We have a finite amount of drinking water that we need to protect for our own health. The protection of land is integral to the protection of the water.”
She said although every organization may have a bit of a different focus, they’re all working under the same umbrella and premise, with the same goal in mind: maintaining the health of Long Island.
“I think it’s important for groups to have the ability to bring people together, especially because the impact of climate change affects people in a lot of different ways, whether it’s high energy costs, the impact of superstorms like Hurricane Sandy, sea level rise or coastal erosion, or ocean acidification that impacts people’s fishery and economic way of life,” Madden said. “We have to meet the immediate visceral needs of people — of communities and workers — but we also need to be thinking decades ahead on what it will take to decarbonize our entire economic system. It’s really important for groups to be oriented toward that long term focus, because this is an all hands on deck situation.”
This version corrects the spelling of Stony Brook University’s Sustainability Studies Program Director Heidi Hutner’s last name.
Scientists, like those who work out of the Stony Brook University School of Marine and Atmospheric Sciences’ Marine Sciences Center, are constantly asking
questions, as the desire grows to find links between correlation and causation. File photo
Researchers often desire more data to help make the distinction between correlation — it rained the last three Tuesdays — and causation — dumping nitrogen into the lake caused the growth of algae that robbed the lake of oxygen.
Scientists don’t like to get ahead of their information, preferring to take the painstaking steps of going that extra mile to control for as many mitigating or confounding variables as they can.
Researchers are often “reluctant to say with certainty that they are correct,” Larry Swanson, the interim dean of the School of Marine and Atmospheric Sciences at Stony Brook University said.
This hesitation to indicate a certain conclusion can raise challenges for politicians, who would like to rely on scientific proof in developing plans for their constituents.
“Policy people want to create a law or regulation that is definitive and will have the desired outcome,” Swanson added.
File photo.
Since he began working in and around Long Island waters in 1960, he started his work collecting data at wetlands around New Haven, and has since studied hypoxia — the process through which oxygen levels are depleted in waterways.
Swanson urges a more extensive collection of data around Long Island.
“I believe we need to monitor the physical environment for changes not just for time series data, such as temperature, but in order to understand how ecological processes are being altered as a consequence of warming,” Swanson said.
Henry Bokuniewicz, a distinguished service professor of oceanography at Stony Brook, said there was a coastline monitoring program in place in 1995 after nor’easters and hurricanes in 1992, but that the effort petered out.
“This should be re-established if [New York State is] serious about coastal impact of shoreline changes,” he said.
Bokuniewicz also suggests measuring and recording waves that are close to shore, and water levels at the ocean coast and interior bays.
Stony Brook had an initiative for additional hires in a cluster for coastal engineering and management, but never completed the hires for budgetary reasons, Bokuniewicz said. “We could do much better with a new generation of scientists dedicated to the Long Island shore,” he said.
Scientists acknowledge that the study of climate change rarely involves establishing the kind of linear connection between action and reaction that turning up the thermostat in a house would provide.
Scientists distinguish between the weather — is it raining today, tomorrow or next week — and the climate — how does March in New York compare to March in North Carolina?
File photo
The climate, generally, remains consistent with a long-term outlook, even if Long Island might experience an unseasonably hot July, an unusually cool September and a heavier-than-normal snowfall in December.
With climate change, scientists collect as much data as they can to determine how the climate is shifting. That presents significant challenges: how do researchers pick data to feed into their models and the patterns to explore?
The broader trend in March could be that spring starts earlier, extending the growing season and creating opportunities for insects, plants or animals to affect the habitat. That could be slightly different this year, amid a cold snap that lasts more than a few days, or in the wake of an unexpected blizzard days before spring.
Indeed, until, and even after there is a scientific consensus, researchers debate long into the night about their interpretations, conclusions and simulation models.
More often than not, scientists crave more information to help them interpret evolving conditions.
“While we know in general why hypoxia will be bad, we can’t really predict it,” Swanson said. “When will it start? How long will it last? This is because we do not understand all the processes — things like the role of bacteria, phytoplankton and the blooming processes and water circulation.”
Science, as it turns out, is often more about collecting more information to ask better questions and developing more precise theories.
As researchers often point out, they can be wrong for the right reasons and right for the wrong ones, all of which, they hope, helps them understand more about the inevitable next set of questions. And, as scientists have offered, it’s a never-ending discussion, as the best answers lead to more questions.
In recent studies, whole fruit was shown to actually reduce the risk of type 2 diabetes.
Some surprising results about lifestyle
By David Dunaief, M.D.
Most of us know that type 2 diabetes is an epidemic in America and continues to grow. Type 2 diabetes was thought to be an adult-onset disease, but more and more children and adolescents are affected as well. The most recent statistics show that 50 percent of teens with diabetes between the ages of 15 and 19 have type 2 (1). Thus, this disease is pervasive throughout the population.
Let’s test our diabetes IQ. See if you can determine whether the following items are true or false.
•Whole fruit should be limited or avoided.
•Soy has detrimental effects with diabetes.
•Plant fiber provides too many carbohydrates.
•Coffee consumption contributes to diabetes.
•Bariatric surgery is an alternative to lifestyle changes.
My goal is to help debunk type 2 diabetes myths. All of these statements are false. Let’s look at the evidence.
Fruit
Fruit, whether whole fruit or fruit juice, has always been thought of as taboo for those with diabetes. This is only partially true. Yes, fruit juice should be avoided because it does raise or spike glucose (sugar) levels. The same does not hold true for whole fruit. Studies have demonstrated that patients with diabetes don’t experience a spike in sugar levels whether they limit the number of fruits consumed or have an abundance of fruit (2). In another study, whole fruit actually was shown to reduce the risk of type 2 diabetes (3).
In yet another study, researchers looked at different whole fruits to determine their impacts on glucose levels. They found that berries reduced glucose levels the most, but even bananas and grapes reduced these levels (4) — that’s right, bananas and grapes, two fruits people associate with spiking sugar levels and increasing carbohydrate load. The only fruit that seemed to have a mildly negative impact on sugars was cantaloupe. Fruit is not synonymous with sugar. One of the reasons for the beneficial effect is the flavonoids, or plant micronutrients, but another is the fiber.
Fiber
We know fiber is important in a host of diseases, and it is not any different in diabetes. In the Nurses’ Health Study and NHS II, two very large prospective (forward-looking) observational studies, plant fiber was shown to help reduce the risk of type 2 diabetes (5). Researchers looked at lignans, a type of plant fiber, specifically examining the metabolites enterodiol and enterolactone. They found that patients with type 2 diabetes have substantially lower levels of these metabolites in their urine, compared to the control group without diabetes. There was a linear, or direct, relationship between the amount of metabolites and the reduction in risk for diabetes. The authors therefore encourage patients to eat more of a plant-based diet to get this benefit.
Foods with lignans include: flaxseed; sesame seeds; cruciferous vegetables, such as broccoli and cauliflower; and an assortment of fruits and grains (6). The researchers could not determine which plants contributed the most benefit. They believe the effect is from antioxidant activity.
Soy and kidney function
Soy sometimes has a negative association. However, in diabetes patients with nephropathy (kidney damage or disease), soy consumption showed improvements in kidney function (7). There were significant reductions in urinary creatinine levels and reductions of proteinuria (protein in the urine), both signs that the kidneys are beginning to function better.
This was a small but randomized controlled trial, considered the gold standard of studies, over a four-year period with 41 participants. The control group’s diet consisted of 70 percent animal protein and 30 percent vegetable protein, while the treatment group’s consisted of 35 percent animal protein, 35 percent textured soy protein and 30 percent vegetable protein.
This is very important since diabetes patient are 20 to 40 times more likely to develop nephropathy than those without diabetes (8). It appears that soy protein may put substantially less stress on the kidneys than animal protein. This negative effect with animal protein may be due to higher levels of phosphorus. However, those who have hypothyroidism should be cautious or avoid soy since it may suppress thyroid functioning.
Coffee
Coffee is a staple in America and in my household. It is one thing my wife would never let me consider taking away. Well, she and the rest of the coffee-drinking portion of the country can breathe a big sigh of relief when it comes to diabetes.
There is a meta-analysis (involving 28 prospective studies) that shows coffee decreases the risk of developing diabetes (9). It was a dose-dependent effect; two cups decreased the risk more than one cup. Interestingly, it did not matter whether it contained caffeine or was decaffeinated. This suggests that caffeine is not necessarily the driving force behind the effect of coffee on diabetes.
The authors surmise that other compounds, including lignans, which have antioxidant effects, may play an important role. The duration of the studies ranged from 10 months to 20 years, and the database was searched from 1966 to 2013, with over one million participants.
Bariatric surgery
In recent years, bariatric surgery has grown in prevalence for treating severely obese (BMI>35 kg/m²) and obese (BMI >30 kg/m²) diabetes patients. In a meta-analysis of bariatric surgery (involving 16 RCTs and observational studies), the procedure illustrated better results than conventional medicines over a 17-month follow-up period in treating HbA1C (three-month blood glucose measure), fasting blood glucose and weight loss (10). During this time period, 72 percent of those patients treated with bariatric surgery went into diabetes remission and had significant weight loss.
However, after 10 years without proper management involving lifestyle changes, only 36 percent remained in remission with diabetes, and a significant number regained weight. Thus, whether one chooses bariatric surgery or not, altering diet and exercise are critical to maintain long-term benefits.
There is still a lot to be learned with diabetes, but our understanding of how to manage lifestyle modifications, specifically diet, is becoming clearer. The take-home messages are: Don’t avoid whole fruit; soy is potentially valuable; fiber from plants may play a very powerful role in preventing and treating diabetes; and coffee may help prevent diabetes.
Thus, the overarching theme is that you can’t necessarily go wrong with a plant-based diet focused on fruits, vegetables, beans and legumes. And if you choose a medical approach, bariatric surgery is a viable option, but don’t forget that you need to make significant lifestyle changes to increase the likely durability over 10 or more years.
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.
The Kaiser Family Foundation, a nonprofit organization that analyzes health policies, has created an interactive map so Americans can compare changes in their premiums and tax credits from the Affordable Care Act to the American Health Care Act. Image from the Kaiser Family Foundation Website
Republicans in Congress have vowed to repeal and replace the Affordable Care Act, commonly referred to as Obamacare, since its inception in 2010, and after much adieu, a bill has finally been introduced to take its place.
The American Health Care Act has been met with opposition from both parties, while elected officials and hospital administrators weighed in on what the changes might mean for North Shore residents.
The most notable changes in the new health care plan compared to the existing one include an elimination of the individual mandate, which required all Americans to purchase health insurance or be subject to a fine — a sticking point for many Republicans on Obamacare; a cut of federal Medicaid funding for Planned Parenthood for one year; adjusting tax credits based on age instead of income; and shifting Medicaid expansion set forth by Obamacare to the discretion of states instead of the federal government, among many others.
The Kaiser Family Foundation, a nonprofit organization established to deliver health policy analysis to the public, has created an interactive map on its website to illustrate the estimated changes in premiums paid and tax credits for several demographics from the ACA to the AHCA.
“This is bad news for New York. … We cannot support this legislation in its current form.”
—Kevin Dahill
Tax credits, or the amount a taxpayer can offset what is owed in federal income tax, are a component of both the current health care law and the proposed replacement, though their implementation is very different.
According to the map estimates, a 27-year-old living in Suffolk County making $30,000 per year would receive about 50 percent less in tax credits in 2020 if the new bill became law. A 27-year-old making $40,000 per year would see the tax credit slashed by only 14 percent, but a $10,000 raise would net that same 27-year-old an approximate additional 52 percent in tax credits under the AHCA compared to the ACA.
A 40-year-old Suffolk County resident making $30,000 annually would receive 24 percent less in tax credits, while a 40-year-old making $50,000 would see a 128 percent boost in tax credits. Additionally, a 40-year-old making $75,000 annually would receive $3,000 in tax credits — under Obamacare no tax credits would be received.
Similarly, a Suffolk County resident who is aged at least 60 and earns $75,000 per year would receive a $4,000 tax credit under the proposed bill, despite being ineligible for a tax credit under Obamacare. A 60-year-old making $30,000 annually would receive a 2 percent increase in tax credits.
U.S. Rep. Lee Zeldin (R-Shirley), who has said in the past he would like to maintain certain aspects of Obamacare, like allowing people aged 26 or younger to remain on their parents’ health plans and coverage for people with preexisting conditions, weighed in on the Republican plan in an emailed statement through spokeswoman Jennifer DiSiena.
DiSiena reiterated Zeldin’s stance on kids remaining on parents plans and coverage for individuals with preexisting conditions, though she added he believes a smooth transition from the ACA to the new plan is the most important thing.
“Obamacare has resulted in higher premiums, higher deductibles, lost doctors and canceled policies, among many other challenges,” she said. “Deductibles are so high, many people now feel like they don’t even have insurance anymore. One-third of the counties in our country only have one option left under the exchange. That’s not choice. That’s a monopoly.”
“Deductibles are so high, many people now feel like they don’t even have insurance anymore. One-third of the counties in our country only have one option left under the exchange.”
—Lee Zeldin
DiSiena also sought to dispel what she called misconceptions being perpetuated about the new bill and what the policy might do to people’s coverage. She said no one will be kicked off Medicaid under the new bill, premiums might rise in the short term but are expected to be 10 percent lower by 2026 than their current levels, and the claim by the Congressional Budget Office that 24 million Americans covered under Obamacare would lose coverage can be attributed to people who were forced to purchase health care opting to go without.
DiSiena added Zeldin is generally supportive of the bill as written but intends to monitor proposed amendments.
U.S. Rep. Tom Suozzi (D-Glen Cove) was far less supportive during an interview on MSNBC’s “Morning Joe” March 14.
“We have to continue to point out that 24 million people are going to be kicked off, that their premiums are going to go up, that there’s a transfer of cutting taxes on the wealthiest Americans, and raising premiums on senior citizens and others,” he said in the interview. “This is really a life and death thing.”
Suozzi’s office did not respond to a request for comment.
Kevin Dahill, president and CEO of Suburban Hospital Alliance, an organization that represents the advocacy interests of Long Island health systems including St. Catherine of Siena in Smithtown and St. Charles Hospital in Port Jefferson, issued a statement regarding the House bill March 13.
“The House bill neither truly repeals nor meaningfully replaces the Affordable Care Act,” Dahill said. “This is bad news for New York. … We cannot support this legislation in its current form.”
Chief Medical Officer at Huntington Hospital Michael Grosso said in an email his facility will continue to hold itself to the highest standards regardless of the federal health care law.
“That said, we must bear in mind as an informed citizenry that when effective, preventive health care is delayed or denied, society pays the price several times over,” Grosso said.
The House of Representatives is scheduled to vote on the bill today, March 23. House Republicans introduced several amendments to the original legislation earlier this week.
Third-place winners among the high schools, BHS Foodies prepare their Lentil Shepherd’s Pie. Photo by Kevin Redding
Banana French Toast with Fruit Syrup by The Original French Toasters. Photo by Kevin Redding
Above, fifth-grader Grace Zehil from Southhold Elementary School joined other elementary school kids in giving out free samples at various stations throughout Whole Foods. Photo by Kevin Redding
A team from Sewanhaka High School prepares a dish during the competition. Photo by Kevin Redding
Pancake Tacos by The Spice Girls (Center Moriches). Photo by Kevin Redding
The judges take some notes as they make their rounds in the cooking arena. Photo by Kevin Redding
Guacamole Sunrise Stack by the Super Fresh Breakfast Boyz. Photo by Kevin Redding
Third-place winners among the high schools, BHS Foodies prepare their Lentil Shepherd’s Pie. Photo by Kevin Redding
A Middle School student prepares his breakfast dish in hopes of getting the top spot at the Junior Iron Chef Competition. Photo by Kevin Redding
WEHM DJ Anthony Cafaro tastes one of the dishes. Photo by Kevin Redding
WEHM DJ Anthony Cafaro interviews a middle school team after the completion of their dish. Photo by Kevin Redding
Breakfast Burrito with Fresh Tomato Salsa by Trailblazers 4-H Club. Photo by Kevin Redding
WEHM DJ Anthony Cafaro tastes Team Wholly Guacamole's dish titled Avocado's dish. Photo by Kevin Redding
The winners each received a trophy. Photo by Kevin Redding
By Kevin Redding
Students from across Long Island donned their aprons and unleashed their inner Bobby Flay’s and Julia Child’s last Saturday for a chance to win big at the fifth annual Junior Iron Chef competition at Whole Foods in Lake Grove.
Set up like a high-stakes Food Network show, middle and high school students from various Suffolk and Nassau County school districts treated the cafeteria section of Whole Foods as their cooking arena, with each team of three to five young chefs chopping and sauteing their ingredients, divvying up their tasks in an assembly line of excitement and nerves in their attempt to beat the clock.
WEHM DJ Anthony Cafaro tastes Team Wholly Guacamole’s dish titled Avocado’s dish. Photo by Kevin Redding
As a group of judges surveyed each workstation and breakfast and lunch foods sizzled in the pans, a large crowd of supportive parents, grandparents, siblings and strangers cheered on their team of choice. All the while, DJ Anthony Cafaro, from WEHM, served as the event’s emcee, interviewing the chefs at work and taste-testing each team’s dish. “Oh my God, that’s really good,” Cafaro said as he took a bite of a middle school team’s Breakfast Sushi, a crepe packed with strawberry filling and bananas and served with chopsticks. “You know what, you can’t really tell from the first bite,” he winked as he ate some more.
Hosted by Cornell Cooperative Extension of Suffolk County, the one-day event, described as “part ‘Chopped,’ part ‘Iron Chef,’ and part ‘Food Network Challenge,’” gives middle and high school students the opportunity to work together to complete a recipe of their choosing in under an hour.
As per tradition, the friendly competition also encourages healthier food options by eliminating certain ingredients like meat, fish or nuts and challenging the young chefs to create new healthy vegetarian or vegan-based recipes, including United States Department of Agriculture commodity foods like beans, grains, fruits and vegetables, that use local ingredients provided by Whole Foods and could be easily implemented into school cafeteria menus.
A team from Sewanhaka High School prepares a dish during the competition. Photo by Kevin Redding
According to Cornell Cooperative Extension’s 4-H youth Development Director Vicki Fleming, who helped get the event off the ground seven years ago, “If you handed a salad to a kid they might not eat it, but if they make it, it might entice them to try it.” Fleming said she got the idea for the event from a similar junior chef competition that’s been taking place in Vermont for more than 10 years. When Gary Graybosch, prepared foods team leader at Whole Foods, took his department on an educational field trip to Cornell Cooperative Extension’s Suffolk County Farm in Yaphank, members of the organization said they expressed an interest in holding such an event but were unable to find the proper location. It didn’t take long before Graybosch volunteered the cafe section of the store.
“This is great for the community, the kids love it and the parents love it,” Graybosch said. “It teaches the kids how to work together and teaches them how to communicate because they’re not just texting each other, they actually have to speak [to each other] when they’re cooking, so it’s good.”
The 13 middle school teams that competed in the first competition round had to create a breakfast dish while the eight high school teams in the second round had to concoct a lunch dish and implement the event’s mystery ingredient — raspberries — revealed on the day of the event by Graybosch. Elementary school students set up their own tables of treats and smoothies around the store as well. Cafaro, who’s emceed the event since it started, said after the first year he told the organization he’d “do this forever.”
“It’s so great, the kids are unbelievable, they’re doing stuff I can’t even do, and the pro chefs they have as judges are even blown away by some of the skill and levels of talent they have,” he said. “When we started this, there was no real big kid competitions and now there are so many of them — it’s kind of blowing up.”
The judges take some notes as they make their rounds in the cooking arena. Photo by Kevin Redding
Among the 12 judges who graded the dishes based on flavor, health value, creativity and presentation was 14-year-old William Connor from Northport, a contestant on “Chopped Junior” this past fall, and 13-year-old Kayla Mitchell of Center Moriches who was a contestant on the third season of “MasterChef Junior.”
Seneca Middle School’s team Super Fresh Breakfast Boyz from Holbrook won first place for the middle schools for the second year in a row for their Guacamole Sunrise Stack. Students Andrew Battelli, John Durkin, Dom Strebel, Nick Strebel and Hunter Ziems and coach Mary Faller made up the team. Despite a griddle shutting off in the middle of the competition, Durkin said he and his team were able to persevere. “We had to work together to get through that and we managed to come together and cook it and it came out good,” he said. “[The experience] was very fun overall. We met up and practiced from 6 a.m. to 7 a.m. every morning before school for about a month and half.”
Wholly Guacamole from Sagamore Middle School took second place. Students Molly Grow, Sydney Harmon, Emily Mangan, Sara Ann Mauro, Abigail Weiss, guided by coach Lindsey Shelhorse, won the judges over as runners up with their Avocado’s Nest.
Cow Harbor 4-H Club’s Original French Toasters also grabbed third place with their Banana French Toast with Fruit Syrup. Coached by Kim Gulemi, students Emily Brunkard, Jolie Fay, Ally Gulemi, Alexa Meinen and Stephanie Stegner were awarded for their blend of blueberries, strawberries, syrup and whipped cream.
The Tiger Lilies of Little Flower in Wading River took first place for the high schools for the second year in a row. Coached by Jennifer Quinlan, students Gianna D’arcangelo, Russell Diener and Alex Mora won with their Lentil Quinoa Kale Broth Bowl. The dish featured a blend of onion, garlic, celery, carrots and tomatoes.
From H. Frank Carey High School in Franklin Square, the Red Hot Chili Peppers secured the second place spot with their Vegetarian Chili. Students Lynn Abby M. Bigord, Akira Jordan, Isabella Legovich and coach Alexandra Andrade made up the team.
Coming in third place were Babylon High School’s BHS Foodies, the ultimate competition underdogs, with their Lentil Shepherd’s Pie. Consisting of Sean Cosgro, Emilie Leibstein, Sophia Levine-Aquino, Hayley Swaine and coach Jenna Schwartz, the team showed up not realizing they had to bring their own equipment. So they approached Graybosch and asked if they could borrow “a pot, pan, chef knife, peeler, and pretty much everything,” according to Cosgro. “We felt so unprepared and so we were so surprised that we placed,” Cosgro said. “I made a lot of ‘Rocky’ references to my group the entire time, saying ‘I feel like we’re the complete underdogs, we’re sort of inexperienced, and this’ll be our ‘Rocky’ moment if we win.’”
From left, Sean Doyle, Planet Fitness contractor; Rob Trotta; Cara Pagan, regional manager; John Mahoney, Planet Fitness owner; Pat Vecchio; and Eric Apicella, club manager. Photo from Leg. Trotta’s office
RIBBON CUTTING Suffolk County Legislator Rob Trotta (R-Fort Salonga) and Smithtown Town Supervisor Pat Vecchio (R) joined Fort Salonga resident John Mahoney and his staff in officially opening his sixth Planet Fitness at 240 Motor Parkway in Hauppauge with a ribbon cutting ceremony on March 6, joining locations in Hampton Bays, Riverhead, Medford, Rocky Point and Port Jefferson. The gym offers state-of-the-art equipment, circuit training, free weights, abs/core, tanning, Hydromassage and massage chairs. It is open Monday to Friday 24 hours and from 7 a.m. to 7 p.m. on weekends. “I think that this Planet Fitness is an excellent fit for the Hauppauge Industrial Park,” said Trotta
Suffolk County Community College’s Ammerman campus, 533 College Road, Selden will hold its 29th annual Health Fair on Wednesday, March 29 in the Babylon Student Center from 10 a.m. to 1 p.m. Visit the many college resource tables including Nursing, Paramedic/EMT and Dietetic Technician, enjoy massage therapy and reiki, sample healthy snacks, take advantage of free screenings of body fat to muscle ratio, measure cholesterol, blood pressure and more. Free and open to the public. Call 631-451-4110 for additional information.
Chronic kidney disease (CKD) is much more common than you think. Those at highest risk for CKD include patients with diabetes, hypertension (high blood pressure) and those with first-degree relatives who have advanced disease. But those are only the ones at highest risk. This brings me to my first question.
Why is chronic kidney disease (CKD) a tricky disease?
Unfortunately, similar to high blood pressure and dyslipidemia (high cholesterol), the disease tends to be asymptomatic, at least initially. Only in the advanced stages do symptoms become distinct, though there can be vague symptoms such as fatigue, malaise and loss of appetite in moderate stages.
What are the stages?
CKD is classified into five stages based on the estimated glomerular filtration rate (eGFR), a way to determine kidney function. Stages 1 and 2 are the early stages, while stages 3a and 3b are the moderate stages, and finally stages 4 and 5 are the advanced stages. This demarcation is based on an eGFR of >60 ml/min for early, 30-59 ml/min for moderate and <30 ml/min for advanced. Stage 5 is end-stage kidney disease or failure.
March is National Kidney Month
Why is CKD important?
The prevalence of the disease is predicted to grow by leaps and bounds in the next 15 years. Presently, approximately 13 percent of those over age 30 in the U.S. population are affected by CKD. In a simulation model, it is expected to reach 16.7 percent prevalence in the year 2030. Currently, those who are ages 30 to 49 have a 54 percent chance of having CKD in their lifetimes; those 50 to 64 years of age, a slightly lower risk of 52 percent; and those 65 years and older, a 42 percent risk (1). Thus, a broad spectrum of people are affected. Another study’s results corroborate these numbers, suggesting almost a 60 percent lifetime risk of at least moderate stage 3a to advanced stage 5 CKD (2). If these numbers are correct, they are impressive, and the disease needs to be addressed. We need to take precautions to prevent the disease and its progression.
Who should be screened?
According to the U.S. Preventive Services Task Force, screening for CKD may not be warranted in the asymptomatic “healthy” population (3). This means people without chronic diseases. The studies are inconclusive in terms of benefits and harms. In order to qualify as CKD, there has to be a minimum of three months of decreased kidney function. This appears to be a paradox: Remember, CKD is asymptomatic generally until the advanced stages. However, there are a number of caveats in the report.
Those who are at highest risk should be screened, including, as I mentioned above, patients with diabetes or hypertension. In an interview on www.Medscape.com entitled “Proteinuria: A Cheaper and Better Cholesterol?” two high-ranking nephrologists suggest that first-degree relatives of advanced CKD patients should also be screened and that those with vague symptoms of fatigue, malaise and/or decreased appetite may also be potential candidates (4). This broadens the asymptomatic population that may benefit from screening.
The fix!
Fortunately, there are several options available, ranging from preventing CKD with specific exercise to slowing the progression with lifestyle changes and medications.
Why exercise?
Here we go again, preaching the benefits of exercise. But what if you don’t really like exercise? It turns out that the results of a study show that walking reduces the risk of death and the need for dialysis by 33 percent and 21 percent, respectively (5). And although some don’t like formal exercise programs, most people agree that walking is enticing.
The most prevalent form of exercise in this study was walking. The results are even more intriguing; they are based on a dose-response curve. In other words, those who walk more often see greater results. So, the participants who walked one to two times per week had a significant 17 percent reduction in death and a 19 percent reduction in kidney replacement therapy, whereas those who walked at least seven times per week experienced a more impressive 59 percent reduction in death and a 44 percent reduction in the risk of dialysis. Those who were in between saw a graded response. There were 6,363 participants for an average duration of 1.3 years.
Protein is important, right?
Yes, protein is important for tissue and muscle health. But when it comes to CKD, more is not necessarily better, and may even be harmful. In a meta-analysis (a group of 10 randomized controlled trials, the gold standard of studies), results showed that the risk of death or treatment with dialysis or kidney transplant was reduced by 32 percent in those who consumed less protein compared to unrestricted protein (6). This meta-analysis used the Cochrane database to search for studies. According to the authors, as few as two patients would need to be treated for a year in order to prevent one from either dying or reaching the need for dialysis or transplant. Unfortunately, the specific quantity of protein consumption that is ideal in CKD patients could not be ascertained since the study was a meta-analysis.
Sodium: How much?
The debate roils on: How much do we need to reduce sodium in order to see an effect? Well, the good news is that in a study, results showed that a modest sodium reduction in our diet may be sufficient to help prevent proteinuria (protein in the urine) (7). Different guidelines recommend sodium intake ranging from fewer than 1500 mg to 2300 mg daily. This particular study says that less than 2000 mg is beneficial, something all of us can achieve.
Of course medications have a place
We routinely give certain medications, ACE inhibitors or ARBs, to patients who have diabetes to protect their kidneys. What about patients who do not have diabetes? ACEs and ARBs are two classes of anti-hypertensives — high blood pressure medications — that work on the RAAS system of the kidneys, responsible for blood pressure and water balance (8).
Results of a study show that these medications reduced the risk of death significantly in patients with moderate CKD. Most of the patients were considered hypertensive. However, there was a high discontinuation rate among those taking the medication. If you include the discontinuations and regard them as failures, then all who participated showed a 19 percent reduction in risk of death, which was significant. However, if you exclude discontinuations, the results are much more robust with a 63 percent reduction. To get a more realistic picture, the intention-to-treat result (those that include both participants and dropouts) is probably the response that will occur in clinical practice unless the physician is a really good motivator or has very highly motivated patients.
While these two classes of medications, ACE inhibitors and ARBs, are good potential options for protecting the kidneys, they are not the only options. You don’t necessarily have to rely on drug therapies, and there is no downside to lifestyle modifications. Lowering sodium modestly, walking frequently, and lowering your protein consumption may all be viable options, with or without medication, since medication compliance was woeful. Screening for asymptomatic, moderate CKD may lack conclusive studies, but screening should occur in high-risk patients and possibly be on the radar for those with vague symptoms of lethargy as well as aches and pains. Of course, this is a discussion to have with your physician.
References: (1) Am J Kidney Dis. 2015;65(3):403-411. (2) Am J Kidney Dis. 2013;62(2):245-252. (3) Ann Int. Med. 2012;157(8):567-570. (4) www.Medscape.com. (5) Clin J Am Soc Nephrol. 2014;9(7):1183-1189. (6) Cochrane Database Syst Rev. 2009;(3):CD001892. (7) Curr Opin Nephrol Hypertens. 2014;23(6):533-540. (8) J Am Coll Cardiol. 2014;63(7):650-658.
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.
In Europe, lipoic acid is classified as a drug, unlike in the United States, where it is a supplement.
Lipoic acid may have a significant effect on multiple chronic diseases
By David Dunaief, M.D.
Lipoic acid, also known as alpha lipoic acid and thioctic acid, is a noteworthy supplement. I am not a big believer in lots of supplements for several reasons: Diet contributes thousands more nutrients that work symbiotically; in the United States, supplements are not regulated by the FDA, thus there is no official oversight; and research tends to be scant and not well-controlled.
Dr. David Dunaief
So why would I write about lipoic acid? It is a supplement that has scientific data available from randomized controlled trials, which are the gold standard of studies. In Europe, lipoic acid is classified as a drug, unlike the United States, where it is a supplement (1).
Lipoic acid is an antioxidant, helping to prevent free radical damage to cells and tissues, but also is a chelating agent, potentially removing heavy metals from the body. Lipoic acid is involved in generating energy for cells; it is an important cofactor for the mitochondria, the cell’s powerhouse. It may also boost glutathione production, a powerful antioxidant in the liver (1). We produce small amounts of lipoic acid in our bodies naturally. Lipoic acid may be important in chronic diseases, including Alzheimer’s, multiple sclerosis and diabetic peripheral neuropathy. Let’s look at the evidence.
Diabetic peripheral neuropathy
Diabetic peripheral neuropathy, or diabetic neuropathy, involves oxidative stress and occurs in up to half the population with diabetes. One in five patients, when diagnosed, will already have peripheral neuropathy. The most common type is distal symmetric polyneuropathy — damage to nerves on both sides of the body in similar locations. It causes burning pain, numbness, weakness and pins and needles in the extremities (2).
The best studies with lipoic acid focus on peripheral neuropathy with diabetes. In a double-blinded, randomized controlled trial (SYDNEY I), results showed that the total treatment score had improved significantly more for those receiving 600 mg lipoic acid by intravenous therapy compared to the placebo group (3). Also, individual symptoms of numbness, burning pain and prickling significantly improved in the group treated with lipoic acid compared to placebo.
The study involved 120 diabetes patients with stage 2 neuropathy. Its weakness was its duration; it was a very short trial, about three weeks. The author concluded that this therapy would be a good adjunct for those suffering diabetic neuropathy.
In a follow-up to this study (SYDNEY II), the design and the results were the same (4). In other words, in a second double-blinded, placebo-controlled trial, the lipoic acid treatment group showed significantly better results than the placebo group. There were 180 patients with a similarly short duration of five weeks.
Why include this study? There were several important differences. One was that lipoic acid was given in oral supplements, rather than intravenously. Thus, this is a more practical approach. Another difference is that there were three doses tested for lipoic acid: 600, 1,200 and 1,800 mg. Interestingly, all of them had similar efficacy. However, the higher doses had more side effects of nausea, vomiting and vertigo, again without increased effectiveness. This suggests that an oral dose of 600 mg lipoic acid may help treat diabetic peripheral neuropathy.
Dementia and Alzheimer’s
In a recent randomized, placebo-controlled trial involving Alzheimer’s patients, results were significantly better for lipoic acid (600-mg oral dose) in combination with fish oil, compared to fish oil alone or to placebo (5). The amount of fish oil used was 3 grams daily containing 675 mg docosahexaenoic acid and 975 mg eicosapentaenoic acid of the triglyceride formulation.
The duration of this pilot study was 12 months with 39 patients, and the primary end point was a change in an oxidative stress biomarker, which did not show statistical significance. However, and very importantly, the secondary end point was significant: slowing the progression of cognitive and functional decline with the combination of fish oil and lipoic acid. Minimental status and instrumental activities of daily living declined less in the combination treatment group. This was encouraging, although we need larger trials.
However, another study showed 900 mg lipoic acid in combination with 800 IU daily of vitamin E (alpha tocopherol strain) and 500 mg vitamin C actually mildly reduced an oxidative stress biomarker but had a negative impact on Alzheimer’s disease by increasing cognitive decline on a minimental status exam (6). What we don’t know is whether the combination of supplements in this study produced the disappointing effects or if an individual supplement was the cause. It is unclear since the supplements were tested in combination. The study duration was 16 weeks and involved 78 moderate to severe Alzheimer’s patients.
Multiple sclerosis
In a study involving rats, giving them high doses of lipoic acid resulted in slowing of the progression of multiple sclerosis-type disease (7). The mechanism by which this may have occurred involved blocking the number of inflammatory white blood cells allowed to enter the cerebrospinal fluid in the brain and spinal cord by reducing the enzymatic activity of factors such as matrix metalloproteinases.
I know this sounds confusing, but the important point is that this may relate to a human trial with 30 patients that showed reduction in the enzyme MMP (8). Thus, it could potentially slow the progression of multiple sclerosis. This is purely connecting the dots. We need a large-scale trial that looks at clinical outcomes of progression in MS, not just enzyme levels. The oral dose used in this study was 1,200 to 2,400 mg lipoic acid per day.
Interestingly, the 1,200-mg dose used in the human trial was comparable to the high dose that showed slowed progression in the rat study (9). This only whets the appetite and suggests potential. So, we have lots of data. What do we know? In diabetic neuropathy, 600 mg oral lipoic acid may be beneficial. However, in Alzheimer’s the jury is still out, although 600 mg lipoic acid in combination with fish oil has potential to slow the cognitive decline in Alzheimer’s disease. It also may have a role in multiple sclerosis with an oral dose of 1,200 mg, though this is early data.
Always discuss the options with your physician before taking a supplement; in the wrong combinations and doses, supplements potentially may be harmful. The good news is that it has a relatively clean safety profile. If you do take lipoic acid, know that food interferes with its absorption, so it should be taken on an empty stomach (1).
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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