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.
CoQ10 is the first new ‘drug’ in over a decade to show survival benefits in heart failure.
A supplement reduces the risk of cardiovascular events
By David Dunaief, M.D.
Heart attacks and heart disease get a lot of attention, but chronic heart failure is something that tends to be overlooked by the press. The reason may be that heart failure is not acute like a heart attack.
Dr. David Dunaief
To clarify by using an analogy, a heart attack is like a tidal wave whereas heart failure is like a tsunami. You don’t know it is coming until it may be too late. Heart failure is an insidious (slowly developing) disease and thus may take years before it becomes symptomatic. It also increases the risk of heart attack and death.
Heart failure occurs in about 20 percent of the population over the age of 40 (1). There are about 5.8 million Americans with heart failure (2). Not surprisingly, incidence of heart failure increases with age (3).
Heart failure (HF) occurs when the heart’s pumping is not able to keep up with the body’s demands and may decompensate. It is a complicated topic, for there are two types — systolic heart failure and diastolic heart failure. The basic difference is that the ejection fraction, the output of blood with each contraction of the left ventricle of the heart, is more or less preserved in diastolic HF, while it can be significantly reduced in systolic HF.
We have more evidence-based medicine, or medical research, on systolic heart failure. Fortunately, both types can be diagnosed with the help of an echocardiogram, an ultrasound of the heart. The signs and symptoms may be similar, as well, and include shortness of breath on exertion or when lying down; edema or swelling; reduced exercise tolerance; weakness and fatigue. The risk factors for heart failure include diabetes, coronary artery disease, high blood pressure, obesity, smoking, heart attacks and valvular disease.
Typically, heart failure is treated with blood pressure medications, such as beta blockers, ACE inhibitors and angiotensin receptor blockers. We are going to look at how diet, iron and the supplement CoQ10 impact heart failure.
Effect of diet
If we look beyond the usual risk factors mentioned above, oxidative stress may play an important role as a contributor to HF. Oxidative stress is thought to potentially result in damage to the inner lining of the blood vessels, or endothelium, oxidation of cholesterol molecules and a decrease in nitric oxide, which helps vasodilate blood vessels.
In a population-based, prospective (forward-looking) study, called the Swedish Mammography Cohort, results show that a diet rich in antioxidants reduces the risk of developing HF (4). In the group that consumed the most nutrient-dense foods, there was a significant 42 percent (p<0.001) reduction in the development of HF, compared to the group that consumed the least. According to the authors, the antioxidants were derived mainly from fruits, vegetables, whole grains, coffee and chocolate. Fruits and vegetables were responsible for the majority of the effect.
This nutrient-dense approach to diet increased oxygen radical absorption capacity. Oxygen radicals have been implicated in cellular damage and DNA damage, potentially as a result of increasing chronic inflammation. What makes this study so impressive is that it is the first of its kind to investigate antioxidants from the diet and their impacts on heart failure prevention.
This was a large study, involving 33,713 women, with good duration — follow-up was 11.3 years. There are limitations to this study, since it is an observational study, and the population involved only women. Still, the results are very exciting, and it is unlikely there is a downside to applying this approach to the population at large.
CoQ10 supplementation
Coenzyme Q10 is a substance produced by the body that helps the mitochondria (the powerhouse of the cell) produce energy. It is thought of as an antioxidant. In a meta-analysis (group of 13 studies), the results showed that supplementation with CoQ10 may help improve functioning in patients with heart failure (5). This may occur because of a modest rise in ejection fraction functioning. It seems to be important in systolic heart failure. Supplementation with CoQ10 may help to reduce its severity.
The doses used in the meta-analysis ranged from 60 mg to 300 mg. Interestingly, those that were less than or equal to 100 mg showed statistical significance, while higher doses did not reach statistical significance. This CoQ10 meta-analysis was small. It covered 13 studies and fewer than 300 patients.
Like some other supplements, CoQ10 has potential benefits, but more study is needed. Because there are no studies showing significant deleterious effects, which doesn’t mean there won’t be, it is worth starting HF patients with comprised ejection fractions on 100 mg CoQ10 and titrating up, as long as patients can tolerate it, although the next study would suggest 300 mg was the appropriate dose.
CoQ10 — a well-run study
Results of the Q-SYMBIO study, a randomized controlled trial, the gold standard of studies, showed an almost 50 percent reduction in the risk of all-cause mortality and 50 percent fewer cardiac events with CoQ10 supplementation (6). This one randomized controlled trial followed 420 patients for two years who had severe heart failure. This involved using 100 mg of CoQ10 three times a day compared to placebo.
The lead author goes as far as to suggest that CoQ10 should be part of the paradigm of treatment. This the first new “drug” in over a decade to show survival benefits in heart failure. Thus, if you have heart failure, you may want to discuss CoQ10 with your doctor.
Iron deficiency
Anemia and iron deficiency are not synonymous, since iron deficiency can occur without anemia. A recent observational study that followed 753 heart failure patients for almost two years showed that iron deficiency without anemia increased the risk of mortality in heart failure patients by 42 percent (7).
In this study, iron deficiency was defined as a ferritin level less than 100 ug/L (the storage of iron) or, alternately, transferrin saturation less than 20 percent (the transport of iron) with a ferritin level in the range 100-299 ug/L.
The authors conclude that iron deficiency is potentially more predictive of clinical outcomes than anemia, contributes to the severity of HF, and is common in these patients. Thus, it behooves us to try to prevent heart failure through dietary changes, including high levels of antioxidants, because it is not easy to reverse the disease. Those with HF should have their ferritin and iron levels checked, for these are correctable. I am not typically a supplement advocate; however, based on the latest results, CoQ10 seems like a compelling therapy to reduce risk of further complications and potentially death. Consult with your doctor before taking CoQ10 or any other supplements, especially if you have heart failure.
References: (1) Circulation. 2002;106(24):3068. (2) Circulation. 2010;121(7):e46. (3) J Am Coll Cardiol. 2003;41(2):21. (4) Am J Med. 2013 Jun:126(6):494-500. (5) Am J Clin Nutr. 2013 Feb;97(2):268-275. (6) JACC Heart Fail. 2014 Dec;2(6):641-649. (7) Am Heart J. 2013;165(4):575-582.
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.
A nutrient-dense, plant-based diet that intensively controls blood sugar is likely to decrease the risk of diabetic retinopathy complication. Stock photo
Diabetic retinopathy is a leading cause of blindness.
By David Dunaief, M.D.
Dr. David Dunaief
With diabetes, we tend to concentrate on stabilization of the disease as a whole. This is a good thing. However, there is not enough attention spent on microvascular (small vessel disease) complications of diabetes, specifically diabetic retinopathy (negativity affecting blood vessels in the back of the eye), which is an umbrella term.
This disease, a complication of diabetes that is related to sugar control, can lead to blurred vision and blindness. There are at least three different disorders that make up diabetic retinopathy. These are dot and blot hemorrhages, proliferative diabetic retinopathy and diabetic macular edema. The latter two are the most likely disorders to cause vision loss. Our focus for this article will be on diabetic retinopathy as a whole and on diabetic macular edema.
Diabetic retinopathy is the No. 1 cause of vision loss in those who are of working age, 25 to 74 years old (1). Risk factors include duration of diabetes, glucose (sugars) that is not well-controlled, smoking, high blood pressure, kidney disease, pregnancy and high cholesterol (2).
What is diabetic macula edema, also referred to as DME? This disorder is edema, or swelling, due to extracellular fluid accumulating in the macula (3). The macula is a yellowish oval spot in the central portion of the retina — in the inner segment of the back of the eye — and it is sensitive to light. The macula is the region with greatest visual acuity. Hence, when fluid builds up from blood vessels leaking, there is potential loss of vision.
Whew! Did you get all that? If not, to summarize: Diabetic macula edema is fluid in the back of the eye that may cause vision loss. The highest risk factor for DME was for those with the longest duration of diabetes (4). Ironically, an oral class of drugs, thiazolidinediones, which includes rosiglitazone (Avandia) and pioglitazone (Actos), used to treat type 2 diabetes may actually increase the risk of DME. However, the results on this are conflicting.
DME is traditionally treated with lasers. But intravitreal (intraocular — within the eye) injections of a medication known as ranibizumab (Lucentis) may be as effective as laser. Studies suggest that injections alone may be as effective as injections plus laser treatments, though the studies are in no way definitive. Unfortunately, many patients are diagnosed with DME after it has already caused vision loss. If not treated after having DME for a year or more, patients can experience permanent loss of vision (5).
In a cross-sectional study (a type of observational study) using NHANES data from 2005-2008, among patients with DME, only 45 percent were told by a physician that the diabetes had affected their eyes (6). Approximately 46 percent of patients reported that they had not been to a diabetic nurse educator, nutritionist or dietician in more than a year — or never.
The problem is that the symptoms of vision loss don’t necessarily occur until the latter stages of the disorder. According to the authors, there needs to be an awareness campaign about the importance of getting your eyes examined on an annual basis if you have diabetes. Many patients are unaware of the association between vision loss and diabetes.
According to a study, there is good news in that the percentage of patients reporting visual impairment from 1997 to 2010 decreased (7). However, the absolute number of patients with vision loss has actually continued to grow, but at a lesser rate than diabetes as a disease has grown.
Treatment options: lasers and injections
There seems to be a potential paradigm shift in the making for the treatment of DME. Traditionally, patients had been treated with lasers. The results from a randomized controlled trial, the gold standard of studies, showed that intravitreal (delivery directly into the eye) injections with ranibizumab, whether given prompt laser treatments or treatments delayed for at least 24 weeks, were equally effective in treating DME (8).
In fact, some in the delayed group, 56 patients or about half, never even required laser treatments at all. Unfortunately, intravitreal injections may be used as frequently as every four weeks. Though in practice, ophthalmologists generally are able to inject patients with the drug less frequently. However, the advantage of receiving prompt laser treatments along with the injections was a reduction in the median number of injections.
Increased risk with diabetes drugs
You would think that drugs to treat type 2 diabetes would prevent DME from occurring as well. However, in the THIN trial, a retrospective (backward-looking) study, a class of diabetes drugs, thiazolidinediones, which includes Avandia and Actos, actually increased the occurrence of DME compared to those who did not use these oral medications (9). Those receiving these drugs had a 1.3 percent incidence of DME at year 1, whereas those who did not had a 0.2 percent incidence. This incidence was persistent through the 10 years of follow-up.
To make matters worse, those who received both thiazolidinediones and insulin had an even greater incidence of DME. There were 103,000 diabetes patients reviewed in this trial. It was unclear whether the drugs, because they were second-line treatments, or the severity of the diabetes itself may have caused these findings.
This is in contrast to a previous ACCORD eye substudy, a cross-sectional analysis, which did not show an association between thiazolidinediones and DME (10). This study involved review of 3,473 participants who had photographs taken of the fundus (the back of the eye).
What does this ultimately mean? Both of these studies were not without weaknesses. It was not clear how long the patients had been using the thiazolidinediones in either study or whether their sugars were controlled and to what degree. The researchers were also unable to control for all other possible confounding factors (11). Thus, there needs to be a prospective (forward-looking) trial done to sort out these results.
Diet
The risk of progression of diabetic retinopathy was significantly lower with intensive blood sugar controls using medications, one of the few positive highlights of the ACCORD trial (12). Medication-induced intensive blood sugar control also resulted in more increased mortality and no significant change in cardiovascular events. But an inference can be made: A nutrient-dense, plant-based diet that intensively controls blood sugar is likely to decrease the risk of diabetic retinopathy complications (13, 14).
The best way to avoid diabetic retinopathy is obviously to prevent diabetes. Barring that, it’s to have sugars well controlled. If you or someone you know has diabetes, it is imperative that they get a yearly eye exam from an ophthalmologist so that DME and diabetic retinopathy, in general, is detected as early as possible, before permanent vision loss can occur. It is especially important for those diabetes patients who are taking the oral diabetes class thiazolidinediones, which include rosiglitazone (Avandia) and pioglitazone (Actos).
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.
7-year-old uses Disney award, projects to continue to brighten lives of pediatric patients
Kayla Harte poses by character Band-Aid boxes she collected from students at W.S. Mount Elementary School for pediatric patients at Stony Brook Children’s Hospital. Photo from Three Village school district
She may only be a 7-year-old, but Kayla Harte already has a huge heart. For the last two years, with the hopes of cheering up young patients, the second-grader has been a frequent visitor to Stony Brook Children’s Hospital’s pediatric oncology department.
Kayla’s mother, Robyn Harte, said when the W.S. Mount Elementary School student started visiting the patients, she would bring homemade get well cards and care packages. She began drawing cards with Minion characters from the film “Despicable Me” on them after she heard they were some of the children’s favorite characters, and she would always be looking for new things to bring them.
Kayla Harte with other donations she received as part of her Band-Aid and toy drives. Photo from Robyn Harte
“Every time we would go and deliver the items she would see that they would be so well received,” her mother said. “The coordinators would tell her how much the children would appreciate it and enjoy it, and it really motivated her to do more.”
During the summer while watching television, Kayla saw a commercial for the Disney Summer of Service grant through Youth Service America and asked her mother if she could apply for it. In November Kayla was one of 340 young leaders in the country awarded a $500 grant.
The money was given to Stony Brook Children’s Child Life Services Department, and Kayla and Director Joan Alpers decided it would be used to buy character bandages and musical toys for the patients. The young volunteer planned to match the grant by starting a project called Friends for Child Life, and she felt that boxes of Band-Aids as well as toys would be easy for people to bring to her, especially her fellow students.
“It makes me feel like she has this gift that she wants to give to other children, and she’s so genuine about it,” her mother said. “She really wants to help other children. She wants to make them feel better. It’s just such a lovely thing for me. It makes me feel really proud and very inspired.”
To kick off her character Band-Aid and musical toy drives, Kayla first asked friends and family members by emailing or texting them a video she and her mother created. Before she knew it, she received approximately 70 boxes of bandages and six musical toys. Her Girl Scout Troop 337 also donated items, and during Random Acts of Kindness Week at her school, fellow students joined the cause and she received close to 100 Band-Aid boxes that week, according to her mother.
“It makes me feel like she has this gift that she wants to give to other children, and she’s so genuine about it.”
— Robyn Harte
Kayla said she was excited when she heard she received the grant, and she’s happy with the amount of donations she has been receiving, especially since she is three-quarters of the way to her goal of 200 character Band-Aid boxes and 40 musical toys.
“I can’t wait to see the happy people at the hospital,” she said.
Even though her project for the Disney grant ends March 31, she plans to continue the drives on a smaller scale. The second-grader, who wants to play for the Mets one day, said once you start volunteering your time it feels so good that, “you can’t even stop doing it.”
Her mother said she and Kayla’s father, Dennis, are proud of how she ran with the project.
“I’m really proud of her,” she said. “I think she’s setting a really good example for other children her age to let them know that you don’t have to be a teenager or a grown-up to make a difference.”
Rally participants listen to a speech Saturday in Huntington. Photo from Ron Widelec
With changes in health care looming thanks to the election of President Donald Trump (R), the issue took center stage in Huntington this past weekend, as more than 350 Long Island residents participated in a rally Feb. 25 to support the Affordable Care Act and advocate for a single-payer plan bill in Albany.
Organized by the group Long Island Activists with help from Our Revolution and the New York Progressive Action Network, the rally joined together residents from all nine New York State Senate districts.
Ron Widelec, a member of the LIA steering committee, said the event was intended to help educate more New Yorkers about the strengths of a Medicare for all system, as he said many misconceptions about the plan have been spread.
A single-payer or Medicare for all plan “is the only plan that actually brings us to a place where health care is a human right,” Widelec said in a phone interview. “We would see better results and it would [cost] less per person. We can cover everyone for less.”
A single-payer system requires a single-payer fund which all New Yorkers would pay into to cover health care costs of an individual, instead of through private insurers. In a single-payer system every citizen is covered, patients have the freedom to choose their own doctors and hospitals, and employers would no longer be responsible for health care costs.
The ACA established standards for health care in America when enacted in 2010, though it does not supersede state laws relating to health care.
Congressman Tom Suozzi speaks at the event. Photo from Ron Widelec
Martha Livingston, professor and chair of the Department of Public Health at SUNY Old Westbury said a Medicare for all system would be an improvement to the current system.
“We know from experience looking everywhere else it works better and costs less,” she said in a phone interview. The World Health Organization conducted a study on American health care in 2014, and cited one of the reasons the U.S. health system has high costs and poor outcomes includes a lack of universal health care.
“No one would have to make the tough choice between the cost of an EpiPen and feeding their family,” Widelec said, referring to the increase in cost of pharmaceutical products patients can’t opt to go without. Mylan Pharmaceuticals, the drug’s maker, drove the price of EpiPen up about $500 in recent years — some six times. Turing Pharmaceuticals did the same with Daraprim, a drug used by cancer and AIDS patients — although that price tag increased to $750 a pill from $13.50.
The Journal of the American Medical Association has confirmed the U.S. faces this trend of large increases in drug prices, more so than any other countries.
“Per capita prescription drug spending in the United States exceeds that in all other countries, largely driven by brand-name drug prices that have been increasing in recent years at rates far beyond the consumer price index,” the study said.
Livingston agreed the current system is flawed.
“Really what we want is fairness,” she said. “We’re the only country that doesn’t negotiate with insurance companies. We need to get rid of the profiteers standing between us and [health care].”
Aside from informing Long Islanders about the benefits of a Medicare for all system, the rally also focused on creating a game plan to help grow support for the New York Health Act, a bill passed in the 2015-16 New York State Assembly session but not in the New York State Senate.
The Assembly bill for the 2017-18 session, which is currently in committee, establishes the New York Health program, a single-payer health care system.
“The Legislature finds … all residents of the state have the right to health care,” the bill states. It acknowledges ACA helped bring improvements in health care and coverage to New Yorkers, however there are still many left without coverage. The legislation explicitly labels itself as a universal health plan with the intention to improve and create coverage for residents who are currently unable to afford the care they need.
“No one would have to make the tough choice between the cost of an EpiPen and feeding their family.” — Ron Widelec
If New York passed the law, residents would no longer have to pay premiums or co-pays, employers would not have to be responsible to provide health care — which currently costs business more than $1 billion annually, and all patients would be covered and could chose whatever doctor or hospital they wanted.
According to a new study by Gerald Friedman, chair of the University of Massachusetts at Amherst Economics Department, the cost of New York Health Act would be $45 billion less than what New York currently spends.
“Individuals often find that they are deprived of affordable care and choice because of decisions by health plans guided by the plan’s economic needs rather than their health care needs,” the bill states.
The New York Health Act is also in committee in the state Senate, where it has significantly less support.
“We want to flip some state Senate seats,” Widelec said. Participants also broke up into their state Senate districts to discuss plans of action to garner support for the bill in each area and put pressure on their elected leader at the end of the rally.
Steve Cecchini, a rally participant, saidmany people are clearly in support of the bill.
“The only thing I learned was a lot of people were excited to hear about the New York Health Act,” he said in a phone interview. “One of the goals was to get people the tools they need to understand the act and talk about it. It’s really about getting enough support from the constituents. It’s ridiculous what we’re not getting and what we’re overpaying for right now.”
Widelec said there is a lot of misinformation about what a single-payer plan is, as many approach it as a socialist concept. But he affirmed the current system in not working and needs to be improved. According to the World Health Organization, the U.S. trailed more than 30 countries in life expectancy in 2015, and in a 2000 report by WHO, America was ranked 37 out of 191 countries for health care performance.
“It’s really exciting to see people inspired and activated,” Livingston said. “It’s looking to me like Long Islanders are eager to make a difference.”
The 3rd Congressional District U.S. Rep. Tom Suozzi (D-Glen Cove) spoke at the rally, after meeting with the Long Island Activists group in January and signing a pledge to sponsor a single-payer bill if the Democratic Party retakes control of the Congress. He has said until that time he will continue to defend the ACA.
Stony Brook has the only regional Trauma Center in Suffolk County. File photo from SBU
By L. Reuven Pasternak, M.D.
Injury is the leading cause of death for all Americans under age 45. When an injury or trauma occurs, having fast access to comprehensive care can be the difference between life and death. Stony Brook Trauma Center was officially verified by the American College of Surgeons (ACS) and designated by the New York State Department of Health as Suffolk County’s only Adult and Pediatric Level 1 Trauma Center earlier this month.
Level 1 Trauma Centers are the highest level centers, capable of providing a full range of services to the most severely injured patients. Stony Brook Trauma Center is also designated by New York State as the Regional Trauma Center (the highest level) for adults and children and serves as Suffolk’s only regional burn center through the Suffolk County Volunteer Firefighters Burn Center at Stony Brook Medicine.
Meeting the strict quality and safety requirements established by the ACS further proves Stony Brook’s standing in the community as a center of excellence, able to offer a full range of medical services and world-class patient care. Patients who are seriously injured by major trauma require immediate attention from a team of medical professionals who are specially trained to recognize and treat immediate threats to life.
Led by Dr. James Vosswinkel, trauma medical director, and Dr. Richard Scriven, pediatric medical director, Stony Brook Trauma Center cares for close to 2,000 patients annually — adults and children, who have sustained blunt, penetrating or thermal traumatic injury. Ninety-five percent of these patients have sustained blunt injuries — the majority from falls or from motor vehicle crashes. Twenty-five percent of the center’s patients are transferred in from one of the county’s 10 other hospitals and every day Stony Brook flight paramedics are on board Suffolk County Police Department helicopters, providing timely and advanced care directly at the scene of an injury.
As a Level I Trauma Center, Stony Brook participates in a national quality program called TQIP (Trauma Quality Improvement Program). In the most recent TQIP report, it was found that patients who were seriously injured and then treated at Stony Brook Trauma Center were much less likely to die or to develop a major complication than patients treated at other TQIP trauma centers.
Stony Brook Trauma Center is committed to not only treating injury but to preventing injury from occurring. The trauma center regularly conducts many community prevention programs in partnership with other local agencies. They include:
Teddy Bear Clinics: These school-based safety programs target the use of booster seats, rear-facing car seats and use of helmets for sports.
Senior Fall Prevention: These community-based programs educate older adults and their families on how to remain independent and safe. Evidenced-based programs, such as Tai Chi, that are designed to build core strength and prevent fall injury are taught.
Traffic Violators: A bimonthly program with the Suffolk County Traffic Court teaches the consequences of risky driving and offers techniques for behavior change.
Bleeding Control for the Injured (B-Con): To help community members cope with public emergency situations, this important program, which is provided at no charge to universities, community groups and schools, teaches key lifesaving skills, including hands-only CPR, tourniquet making and wound treatment.
To learn more about Stony Brook Trauma Center, visit www.trauma.stonybrookmedicine.edu.
L. Reuven Pasternak, M.D., is the chief executive officer at Stony Brook University Hospital and the vice president for health systems at Stony Brook Medicine.
Deaths due to heroin and other opiates are increasing exponentially on Long Island, especially on the North Shore. Join the Port Jefferson Free Library, 100 Thompson St., Port Jefferson for a Narcan Training workshop on Sunday, Feb. 26 at 2 p.m. and help save a life.
Learn about the signs and symptoms of opiate overdose and what to do from health and safety education expert, Erik Zalewski. This 45-minute class also includes a free naloxone (Narcan) emergency kit. A 20-minute “hands-only” CPR class will follow. All are welcome. Questions? Call 631-473-0022.
Deaths due to heroin and other opiates are increasing exponentially on Long Island, especially on the North Shore. Join the Port Jefferson Free Library, 100 Thompson St., Port Jefferson for a Narcan Training workshop on Sunday, Feb. 26 at 2 p.m. and help save a life.
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