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A diet rich in fruits, vegetables, beans, nuts and oily fish may prevent breast cancer. Stock photo

By David Dunaief, M.D.

NFL players are wearing pink shoes and other sportswear this month, making a fashion statement to highlight Breast Cancer Awareness Month. This awareness is critical since annual invasive breast cancer incidence in the U.S. is 246,000 new cases, with approximately 40,000 patients dying from this disease each year (1). The good news is that from 1997 to 2008 there was a trend toward decreased incidence by 1.8 percent (2).

We can all agree that screening has merit. The commercials during NFL games tout that women in their 30s and early 40s have discovered breast cancer with a mammogram, usually after a lump was detected. Does this mean we should be screening earlier? Screening guidelines are based on the general population that is considered “healthy,” meaning no lumps were found, nor is there a personal or family history of breast cancer.

All guidelines hinge on the belief that mammograms are important, but at what age? Here is where divergence occurs; experts can’t agree on age and frequency. The U.S. Preventive Services Task Force recommends mammograms starting at 50 years old, after which time they should be done every other year (3). The American College of Obstetricians and Gynecologists recommends mammograms start at 40 years old and be done annually (4). Your decision should be based on a discussion with your physician.

The best way to treat breast cancer — and just as important as screening — is prevention, whether it is primary, preventing the disease from occurring, or secondary, preventing recurrence. We are always looking for ways to minimize risk. What are some potential ways of doing this? These may include lifestyle modifications, such as diet, exercise, obesity treatment and normalizing cholesterol levels. Additionally, although results are mixed, it seems that bisphosphonates do not reduce the risk of breast cancer nor its recurrence. Let’s look at the evidence.

Bisphosphonates

Bisphosphonates include Fosamax (alendronate), Zometa (zoledronic acid) and Boniva (ibandronate) used to treat osteoporosis. Do they have a role in breast cancer prevention? It depends on the population, and it depends on study quality.

In a meta-analysis involving two randomized controlled trials, results showed there was no benefit from the use of bisphosphonates in reducing breast cancer risk (5). The population used in this study involved postmenopausal women who had osteoporosis, but who did not have a personal history of breast cancer. In other words, the bisphosphonates were being used for primary prevention.

The study was prompted by previous studies that have shown antitumor effects with this class of drugs. This analysis involved over 14,000 women ranging in age from 55 to 89. The two trials were FIT and HORIZON-PFT, with durations of 3.8 and 2.8 years, respectively. The FIT study involved alendronate and the HORIZON-PFT study involved zoledronic acid, with these drugs compared to placebo. The researchers concluded that the data were not evident for the use of bisphosphonates in primary prevention of invasive breast cancer.

In a previous meta-analysis of two observational studies from the Women’s Health Initiative, results showed that bisphosphonates did indeed reduce the risk of invasive breast cancer in patients by as much as 32 percent (6). These results were statistically significant. However, there was an increase in risk of ductal carcinoma in situ (precancer cases) that was not explainable. These studies included over 150,000 patients with no breast cancer history. The patient type was similar to that used in the more current trial mentioned above. According to the authors, this suggested that bisphosphonates may have an antitumor effect. But not so fast!

The disparity in the above two bisphosphonate studies has to do with trial type. Randomized controlled trials are better designed than observational trials. Therefore, it is more likely that bisphosphonates do not work in reducing breast cancer risk in patients without a history of breast cancer or, in other words, in primary prevention.

In a third study, a meta-analysis (group of 36 post-hoc analyses — after trials were previously concluded) using bisphosphonates, results showed that zoledronic acid significantly reduced mortality risk, by as much as 17 percent, in those patients with early breast cancer (7). This benefit was seen in postmenopausal women but not in premenopausal women. The difference between this study and the previous study was the population. This was a trial for secondary prevention, where patients had a personal history of cancer.

However, in a RCT, the results showed that those with early breast cancer did not benefit overall from zoledronic acid in conjunction with standard treatments for this disease (8). The moral of the story: RCTs are needed to confirm results, and they don’t always coincide with other studies.

Exercise

We know exercise is important in diseases and breast cancer is no exception. In an observational trial, exercise reduced breast cancer risk in postmenopausal women significantly (9). These women exercised moderately; they walked four hours a week. The researchers stressed that it is never too late to exercise, since the effect was seen over four years. If they exercised previously, but not recently, for instance, five to nine years ago, no benefit was seen.

To make matters worse, only about one-third of women get the recommended level of exercise every week: 30 minutes for five days a week. Once diagnosed with breast cancer, women tend to exercise less, not more. The NFL, which does an admirable job of highlighting Breast Cancer Awareness Month, should go a step further and focus on the importance of exercise to prevent breast cancer or its recurrence, much as it has done to help motivate kids to exercise with it Play 60 campaign.

Soy intake

Contrary to popular belief, soy may be beneficial in reducing breast cancer risk. In a meta-analysis (a group of eight observational studies), those who consumed more soy saw a significant reduction in breast cancer compared to those who consumed less (10). There was a dose-response curve among three groups: high intake of >20 mg per day, moderate intake of 10 mg and low intake of <5 mg.

Those in the highest group had a 29 percent reduced risk, and those in the moderate group had a 12 percent reduced risk, when compared to those who consumed the least. Why have we not seen this in U.S. trials? The level of soy used in U.S. trials is a fraction of what is used in Asian trials. The benefit from soy is thought to come from isoflavones, plant-rich nutrients.

Western vs. Mediterranean diets

A Mediterranean diet may decrease the risk of breast cancer significantly.
A Mediterranean diet may decrease the risk of breast cancer significantly.

In an observational study, results showed that, while the Western diet increases breast cancer risk by 46 percent, the Spanish Mediterranean diet has the inverse effect, decreasing risk by 44 percent (11). The effect of the Mediterranean diet was even more powerful in triple-negative tumors, which tend to be difficult to treat. The authors concluded that diets rich in fruits, vegetables, beans, nuts and oily fish were potentially beneficial.

Hooray for Breast Cancer Awareness Month stressing the importance of mammographies and breast self-exams. However, we need to give significantly more attention to prevention of breast cancer and its recurrence. Through potentially more soy intake, as well as a Mediterranean diet and modest exercise, we may be able to accelerate the trend toward a lower breast cancer incidence.

References: (1) breastcancer.org. (2) J Natl Cancer Inst. 2011;103:714-736. (3) Ann Intern Med. 2009;151:716-726. (4) Obstet Gynecol. 2011;118:372-382. (5) JAMA Inter Med online. 2014 Aug. 11. (6) J Clin Oncol. 2010;28:3582-3590. (7) 2013 SABCS: Abstract S4-07. (8) Lancet Oncol. 2014;15:997-1006. (9) Cancer Epidemiol Biomarkers Prev online. 2014 Aug. 11. (10) Br J Cancer. 2008;98:9-14. (11) Br J Cancer. 2014;111:1454-1462.

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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Brookhaven Town Councilwoman Jane Bonner speaks at the Organ Donor Enrollment Day kickoff event at Stony Brook University Hospital Oct. 6. Photo from Bonner’s office

By Rebecca Anzel

Registered organ donors are hard to come by in New York state compared to the rest of the United States, and for one elected official in Brookhaven, that’s not going to cut it.

Brookhaven Councilwoman Jane Bonner (C-Rocky Point) did not hesitate when her friend Tom D’Antonio said he needed a kidney. She decided right then, at the Huntington Lighthouse Music Festival in Huntington Harbor in September 2015, that she would share her spare.

She underwent comprehensive medical testing at the end of the next month to determine if she would be a viable donor — a blood test, chest X-ray, electrocardiogram, CT scan, MRI, psychological evaluation and cancer screening, to name a few.

“It’s the ultimate physical you’re ever going to have, and by the blood test alone several people were disqualified,” Bonner said. “For once in my life, it turned out that I was No. 1. And it worked out really, really well.”

Brookhaven Town Councilwoman Jane Bonner and her friend Tom D’Antonio after their surgeries to transplant her kidney into his body in April. Photo from Jane Bonner
Brookhaven Town Councilwoman Jane Bonner and her friend Tom D’Antonio after their surgeries to transplant her kidney into his body in April. Photo from Jane Bonner

The surgery was April 26, a Tuesday, at New York Presbyterian Hospital. Bonnor was home that Friday and missed only eight days of work. She said she just had her six-month checkup and she is in good health.

“Jane didn’t just save my life, she saved my family’s life,” D’Antonio said. “Donating an organ doesn’t just affect the person getting the organ — although certainly it affects them the most — it affects everyone’s life.”

Bonner said she takes every opportunity to share her story to bring awareness about the importance of being an organ donor.

“I want to be a living example to show that it can be done because it’s life changing for the recipient and only a little inconvenient for the donor,” she said.

There is a large need for organs in New York. More than 9,700 people are on the organ waiting list, and someone dies every 18 hours waiting for one, according to LiveOnNY, a federally designated organ procurement organization.

New York ranks last among the 50 states in percent of residents registered as organ donors, despite surveys showing 92 percent of New Yorkers support organ donation. Only 27 percent of New Yorkers are enrolled in the state registry, versus the average of 50 percent registered across the rest of the country.

Stony Brook Medicine and Stony Brook University hosted the Organ Donor Enrollment Day event Oct. 6, including Bonner, in a statewide effort to boost the number of registered organ donors.

“Our residents need to be reminded about the importance of organ donation,” Suffolk County Executive Steve Bellone (D) said in a statement. “Along with stressing how one organ and tissue donor can save multiple lives, understanding and debunking the social and religious myths about organ donation are also critical to turning the tides in New York as we currently rank last in registered organ donors in the nation.”

Dawn Francisquini, transplant senior specialist for the hospital, said volunteers enrolled 571 people.

“New York has a very large population, so it’s going to take a lot to get us up to where the other states are,” she said. “But we’re making progress.”

There are two ways to become an organ donor. One is to be a living donor, like Bonner. A potential donor does not have to know someone in need of an organ to donate a kidney, lobe of liver, lung or part of a lung, part of the pancreas or part of an intestine.

“I’ve been able to accomplish really amazing things, but this is a step above that. Satisfying is not even the word to describe it.”

— Jane Bonner

“Living donation is so important because not only are you giving an organ to someone, so you’ve saved that life, but you’ve also made room on the list,” Francisquini said. “So you’ve saved two lives by donating one organ.”

The most common way is by registering when filling out a driver’s license registration or renewal form to be considered as a candidate upon death. According to the U.S. Department of Health & Human Services, though, only about three in 1,000 deceased people are suitable for organ donations.

Doctors determine whether organs like kidneys, livers, bones, skin and intestines are medically viable for a waiting recipient and they typically go to patients in the same state as the donor.

Gov. Andrew Cuomo (D) signed legislation Aug. 18 allowing 16 and 17-year-olds to register as organ donors. If they die before turning 18, parents or guardians are able to reverse the decision.

“By authorizing 16 and 17-year-olds to make the selfless decision to become an organ donor, we take another significant step to grow the state’s Donate Life registry and create opportunities to save lives,” Cuomo said in a statement.

Francisquini said she thinks this new law will make a big difference. Previously, because those under-18 were not allowed to express their wishes when filling out a driver’s license form, many would not register as donors until years later when renewing their license.

Since her surgery, Bonner has shared her story in speeches, panel discussions and on social media using the hashtag #ShareTheSpare.

“I really feel like this is much better than anything I could accomplish in my professional career,” she said. “Through the support of the people that keep electing me, I’ve been able to accomplish really amazing things, but this is a step above that. Satisfying is not even the word to describe it.”

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Full-fat and low-fat cheeses are no better for you than refined grains. Stock photo

By David Dunaief, M.D.

We are constantly redefining or at least tweaking our diets. We were told that fats were the culprit for cardiovascular disease (CVD). That the root cause was saturated fats, specifically. However, a recent study showed the sugar industry had a strong influence on the medical and scientific communities in the 1960s and 1970s, influencing this perception (1).

Why is this all important? Well, for one thing, about one out every two “healthy” 30-year-olds in the United States will most likely develop CVD in their lifetime (2). This is a sobering statistic. For another, CVD is still the reigning notorious champion when it comes to the top spot for deaths in this country. Except, this disease is preventable, for the most part.

What can prevent CVD? You guessed it, lifestyle modifications, including changes in our diet, exercise and smoking cessation. There is no better demonstration of this than what I refer to as the “new” China Study, which was done through the Harvard T.H. Chan School of Public Health. I call it “new,” because T. Colin Campbell published a book in 2013 with the same name pertaining to the benefits of the Chinese diet in certain provinces. However, the wealthier China has become in the last few decades by opening its borders, the more it has adopted a Western hemisphere-type lifestyle, and the worse its health has become overall. In a recent study published in the Journal of the American College of Cardiology, results show that over 20 years the rate of CVD has increased dramatically in China, and it is likely to continue worsening over time (3). High blood pressure, elevated “bad” cholesterol LDL levels, blood glucose (sugars), sedentary lifestyle and obesity were the most significant contributors to this rise. In 1979 about 8 percent of the population had high blood pressure, but by 2010, more than one-third of the population did.

Does this sound familiar? It should, since this is due to adopting a Western-type diet. The researchers highlighted increased consumption of red meat and soda, an increasingly sedentary lifestyle and, unlike us, half the population still smokes. But you can see just how powerful the effects of lifestyle are on the world’s largest population. There were 26,000 people and nine provinces involved.

Cardiologist embraces fat

We are going to focus on one area, diet. What is the most productive diet for preventing cardiovascular disease? In a recent New York Times article, entitled “An Unconventional Cardiologist Promotes a High-Fat Diet,” published on Aug. 23, 2016, the British cardiologist suggests that we should embrace fats, including saturated fats (4). He has bulletproof coffee for breakfast, with one tablespoon of butter and one tablespoon of coconut oil added to his coffee. He also promotes full-fat cheese as opposed to low-fat cheese. These are foods that contain 100 percent saturated fats. He believes dairy can protect against heart disease. Before you get yourself in a lather, either in agreement or in disgust, let’s look at the evidence.

The Cheesy Study

Alert! Before you read any further, know that this study was sponsored by the dairy industry in Denmark. Having said this, this study would presumably agree with the unconventional cardiologist. The results showed that full-fat cheese was equivalent to low-fat cheese and to carbohydrates when it came to blood chemistries for cardiovascular disease, as well as to waist circumference (5). These markers included cholesterol, LDL “bad” cholesterol levels, fasting glucose levels and insulin. There were three groups in this study: those who consumed three ounces of full-fat cheese, low-fat cheese or refined bread and jam. The authors suggested that full-fat cheese may be part of a healthy diet. This means we can eat full-fat cheese, right? NOT SO FAST.

The study was faulty. The control arm was refined carbohydrates. And since both cheeses had similar results to the refined carbohydrates, the more appropriate conclusion is that full-fat and low-fat cheeses are no better for you than refined grains.

What about dairy fat?

In a meta-analysis (involving three studies — the Professional Follow-Up Study and the Nurses’ Health Studies 1 and 2), the results refute the claim that dairy fat is beneficial for preventing CVD (6). The results show that substituting a small portion of energy intake from dairy fat with polyunsaturated fats results in a 24 percent reduction in CVD risk. And doing the same with vegetable fats in replacement of dairy fat resulted in a 10 percent reduction in risk. Dairy fat was slightly better when compared to other animal fat.

This meta-analysis involved observational studies with a duration of at least 20 years and involving more than 200,000 men and women. There needs to be a large randomized controlled trial. But, I would not rush to eat cheese, whether it was the full-fat or low-fat variety. Nor would I drink bulletproof coffee anytime soon.

Saturated fat: not so good

In a recent meta-analysis (involving three studies run by the Harvard School of Public Health), replacing just 5 percent of saturated fats with both mono- and polyunsaturated fats resulted in a substantial reduction in the risk of mortality, 27 and 13 percent, respectively (7). This is a blow to the theory that saturated fats are not harmful to your health. Also, the highest quintile of poly- and monounsaturated fat intake, compared to lowest, showed reductions in mortality that were significant, 19 and 11 percent, respectively. Again, this is an observational conglomeration of studies, using the same studies as with the dairy results above. This analysis suggests that the unconventional cardiologist’s approach is not the one you want to take.

The good news diet!

Here is the good news diet. In a recent randomized controlled trial (RCT), the gold standard of studies, results showed that high levels of polyphenols reduce the risk of cardiovascular disease (8). Polyphenols are from foods such as vegetables, fruits, berries especially and, yes, chocolate. The researchers divided the study population into two groups, high and low polyphenol intake. The biomarkers used for this study were endothelial (inner lining of the blood vessel) dependent and independent vasodilators. The more dilated the blood vessel, the lower the hypertension and the lower the CVD risk. These patients had hypertension, a risk factor for CVD. Those who consumed high levels of polyphenols had higher levels of nutrients such as carotenoids and vitamin C in their blood.

Is fish useful?

In a study, results show that eating a modest amount of fish decreases the risk of death from CVD by more than one-third (9). What is a modest amount? Consume fish once or twice a week. You want to focus on fish that are rich in omega 3s — docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA). These are fatty fish with plenty of unsaturated fats, such as salmon. Thus, more of a Mediterranean-style diet, involving fruits and vegetables, as well as mono- and polyunsaturated fats in the forms of olive oil, nuts, avocado and fish may reduce the risk of CVD, while a more traditional American diet, with lots of pure saturated fats and refined carbohydrates may have the opposite effect. The reason we can’t say for sure that pure saturated fat should be avoided is that there has not been a large randomized controlled trial. However, many studies continually point in this direction.

References: (1) JAMA Intern Med. online Sept. 12, 2016. (2) Lancet. 2014;383(9932):1899-1911. (3) J Am Coll Cardiol. 2016;68(8):818-833. (4) NYTimes.com. (5) Am J Clin Nutr. 2016;104(4):973-981. (6) Am J Clin Nutr. Online Aug. 24, 2016. (7) JAMA Intern Med. 2016;176(8):1134-1145. (8) Heart. 2016;102(17):1371-1379. (9) JAMA. 2007;297(6):590.

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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Suffolk County Sheriff Vincent DeMarco signs $10,000 check presented with Legislator Sarah Anker, on right, to the North Shore Youth Council for a new family counseling initiative to combat substance abuse. Photo from sheriff's office

A strong support system is vital in a fight against drug abuse, and now North Shore families will have more options to help struggling loved ones manage their addiction.

Legislator Sarah Anker (D-Mount Sinai) and Suffolk County Sheriff Vincent DeMarco delivered a check for $10,000 to the North Shore Youth Council in Rocky Point this week, which will be designated for its new family counseling initiative to combat substance abuse. The grant, which is funded from the sheriff’s office asset forfeiture monies, will engage whole families in therapy designed to help them cope, understand the root causes of addiction and support their loved one’s recovery.

Anker proposed the pilot initiative following a conversation with Father Frank Pizzarelli from Hope House Ministries in Port Jefferson.

Suffolk County Legislator Sarah Anker and Suffolk County Sheriff Vincent DeMarco with members of the North Shore Youth Council after presenting the check for it's new substance abuse program. Photo from sheriff's office
Suffolk County Legislator Sarah Anker and Suffolk County Sheriff Vincent DeMarco with members of the North Shore Youth Council after presenting the check for it’s new substance abuse program. Photo from sheriff’s office“Father Frank is on the frontlines in our battle against addiction in Suffolk County,” she said. “He impressed upon me the importance of the family unit in successfully treating addiction.”

When Anker approached the sheriff about the possibility of using asset forfeiture funds dedicated for this purpose, DeMarco was all in favor of the project.

“Family therapy can lower relapse rates, help parents with addicted children find effective ways to support their loved one’s recovery and even help children with addicted parents deal with their struggles,” he said. “ I am hoping this initiative will serve as a model and get more families involved in recovery.”

The North Shore Youth Council serves communities across the North Shore, including Port Jefferson, Wading River, Middle Island, Ridge and Coram. The agency helps hundreds of families each day through their school-based prevention and before and after care programs. According to the youth council’s Executive Director Janene Gentile, many people within the community can’t afford family counseling, because money is tight due to lost wages and the cost of treatment.

“Treatment is the first step, but ongoing family therapy is often essential to getting to the root of the problems that led someone to use drugs in the first place,” she said. “This grant will defer the cost of family counseling, which will eliminate the most common barrier to families engaging in therapy.

North Shore Youth Council’s Board President Laurel Sutton joined with Gentile in thanking the County sheriff and legislator for their support.

“I want to thank Sheriff DeMarco and Legislator Anker for giving us this opportunity to enhance our counseling services to struggling families impacted by the opioid [problem],” she said.

For more information about the family counseling initiative, or to schedule an appointment with a counselor, call the North Shore Youth Council at 631-744-0207.

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Nurses and their supporters picket outside St. Charles Hospital on April 8, calling for higher staffing levels and encouraging passing drivers to honk in solidarity. Photo by Giselle Barkley

By Alex Petroski

Registered nurses at St. Catherine of Siena Medical Center in Smithtown and St. Charles Hospital in Port Jefferson have been working without a contract since March 2015, but they may be nearing a tipping point.

Nurses from both hospitals voted overwhelmingly to authorize a strike this week, according to a statement dated Oct. 17 from the New York State Nurses Association, a union that represents about 40,000 registered nurses in the state.

Nurses and their supporters picket outside St. Charles Hospital on April 8, calling for higher staffing levels and encouraging passing drivers to honk in solidarity. Photo by Giselle Barkley
Nurses and their supporters picket outside St. Charles Hospital on April 8, calling for higher staffing levels and encouraging passing drivers to honk in solidarity. Photo by Giselle Barkley

“We are very frustrated with management,” Tracy Kosciuk, a St. Charles nurse in the maternal child unit who has been with the hospital for nearly three decades, said in a statement. Kosciuk is also the president of the union’s executive committee for St. Charles. “We feel a total lack of respect. Our community appreciates our dedication and management should too.”

Spokespersons from both hospitals responded to the union’s actions in emailed statements.

“We are working diligently to resolve all issues and have made great progress toward that goal,” separate statements from St. Charles executive director for public and external affairs, Marilyn Fabbricante, and St. Catherine’s executive vice president and chief administrative officer, Paul Rowland, each said. “We look forward to a mutually satisfactory collective bargaining agreement which rewards our nurses and meets the needs of our hospitals.”

Fabbricante added that St. Charles has not yet been informed by the union of plans to go on strike. Carl Ginsburg, a spokesman for the union, said they have strike authorizations from members at both hospitals, though negotiations are ongoing and no dates have been determined for the strikes. Unions are required to give health care institutions at least 10 days notice prior to a strike, according to the National Labor Relations Board — and Ginsburg said that had not yet occurred.

According to the release from the union, its members are frustrated by inadequate staffing and are seeking better health benefits and a pay increase in their next contract. In 1995, performance of nurses and other health care professionals became subject to ratings based on patient surveys conducted by the Agency for Healthcare Research and Quality, according to its website.

“You can’t have two people lifting a patient all the time…When people are going out with back injuries, then [hospital administration members] wonder why.”

—Dawn Bailey

“All of these issues affect retention and recruitment,” Tammy Miller, a nurse at St. Catherine of Siena, said in a statement. “Keeping and attracting experienced nurses are essential to quality care.”

Dawn Bailey, a registered nurse and labor bargaining unit executive committee member of the NYS Nurses Association, said during a picket outside the Smithtown medical center in April that working a shift without adequate staff can be dangerous not only for patients, but for nurses as well, on top of the potential damage it can do to ratings.

“You can’t have two people lifting a patient all the time because there’s not that other person available,” Bailey said. “When people are going out with back injuries, then [members of hospital administration] wonder why.”

Kosciuk expressed a similar sentiment during a picket in April.

“Unfortunately the mentality … nowadays in the industry is [that] all hospitals are short staffed,” she said. “That’s not acceptable to have that mind-set.”

Victoria Espinoza contributed reporting for this story.

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Exercise and diet are key to losing weight.

By David Dunaief, M.D.

The more we seem to know about obesity as a chronic disease, classified this way first by the American Medical Association, the worse we in the medical community seem to have done to prevent and treat it and its complications. There are more obese people now than those who are overweight (1). Why would it be so difficult to treat a disease that has a simple solution, lose weight? How hard could that be, right?

If it were so simple to lose weight, we would not have an epidemic on our hands. We compete with internal and external forces, including forces from the food industry working to influence us every day. What is the problem with being obese? The issue with weight is not about vanity. The issue is that obesity creates medical complications and is second only to smoking in causing premature deaths (2). The research implies that weight loss in obese patients reduces the risk of death (3).

Life-threatening complications from obesity include multiple cancers, heart disease, stroke, diabetes, and nonalcoholic fatty liver disease. Is there something we can do about it? Simply, yes. Weight loss may have to do, at least in part, with the timing of when we eat. Also, exercise may help us increase lean muscle mass while decreasing body fat. Diet, of course, is important. A Mediterranean diet has only been shown to help with weight loss, not contribute to weight gain. There is too much doom and gloom about obesity. We need to focus on possible solutions first! Let’s look at the research.

Timing! Timing! Timing!

We have always been told not to eat late at night. Is there some truth to this, or is it an old wives’ tale? Well, it may be partially true; however, it may have more to do with how many hours we have access to food during a 24-hour period. Let me explain. In a recent study involving mice, results showed that those mice restricted to a 12-hour food consumption period in a 24-hour day were thinner than those allowed to eat anytime during the 24 hours. They may also have had reversal of metabolic disease, such as type 2 diabetes, in those mice who had pre-existing disease (4). Those that had access 24/7 became more obese and chronically ill. It did not matter which diet the mice ate.

Timing/access to food was the most important factor over the 38-week study. In fact, those that were initially given 24-hour access and then switched to the 12-hour limited access actually lost weight! Surprisingly, those that were limited to 12-hour food access could even cheat occasionally on the weekends, and it did not have a negative impact on their results. There were four diet groups — high fat and sucrose (a type of sugar), high fat, high fructose and typical diet. Of course, we are not mice. However, these are encouraging results.

Restricting eating to 12 consecutive hours during the day doesn’t seem like too much of a hardship. Now we need a randomized controlled trial in humans. In the meantime, I would suggest implementing these findings, even though we are not mice. There is no downside. In a previous study by the same research group, results showed that mice who had eight hours of access to food during a 24-hour period also showed considerably better results than those that had 24-hour access (5). Both mice groups were fed high-fat diets. The only difference was that one group was time restricted to eight hours of food exposure. The food-restricted mice saw an increase in prevention of metabolic parameters including diabetes, obesity and liver disease. The results also showed that restricting time to food decreased inflammation and improved energy expenditure. However, eight hours is more difficult to manage than 12 hours of access to food in a 24-hour cycle.

Mediterranean-type diet to the rescue

The Mediterranean diet has been valuable for a number of different chronic diseases, and obesity is no exception. In a meta-analysis (involving 16 randomized controlled trials, the gold standard of studies), the results showed that the Mediterranean-type diet was significantly better at helping patients lose weight when compared to a control diet (6). The longer the participants were on a Mediterranean-type diet, the greater the weight loss. Thus, this type of diet seems to get better with time. The meta-analysis involved over 3,000 participants. In none of the studies did any group on the Mediterranean diet gain weight.

Cancer is a weighty topic

We are always looking for cures for cancer. It is one of the more prevalent conglomerations of diseases. What might exacerbate cancer risk? If you guessed obesity, you would be right. Interestingly, it may have to do with duration of obesity that increases risk for cancer. This applies to multiple types of cancer. In a recent study, results showed that eight more cancers are associated with being overweight and obese, according to the International Agency for Research on Cancer (IARC), including mostly gastrointestinal cancers (liver, gallbladder, stomach and pancreas), as well as meningioma, thyroid, multiple myeloma and ovarian cancers (7). As we know, ovarian and pancreatic cancers tend to present with symptoms in the later stages and so are more lethal. This is added to the five cancers already known to be associated with obesity: esophageal, colorectal, uterine and post-menopausal breast cancers, plus renal cell carcinoma (kidney cancer).

The reasons for this association may have to do with the dysregulation of sex hormone breakdown and increased inflammation associated with body fat. According to the IARC, losing weight may be a way to reduce cancer risk, although studies that have shown this effect have been animal studies. However, this is pretty good motivation to lose weight. In another study, the results show the longer the duration of obesity, the greater the risk of developing cancer (8). According to the study results, for every 10 years of being overweight/obese, there was an additional 7 percent increase in the risk for several different cancers. The study involved over 70,000 postmenopausal women for a mean duration of 12.6 years.

Finally, the beverage industry’s black eye

A recent scientific review found that Coca-Cola and PepsiCo have spent millions and millions of dollars trying to influence medical organizations and public health institutions. They have put these groups in precarious situations by offering them money to help fund their organizations’ work, while asking them to back down on pressing issues such as a soda tax (9). The American Academy of Nutrition and Dietetics is, unfortunately, an example. However, the Institute of Medicine (IOM) has said that research shows soda has a strong association with the obesity epidemic (10). The moral of the story: We can and need to do a better job treating obese patients. One possible way to lose weight may be to restrict our access to food to the same 12-hour period each 24-hour cycle. Also, a Mediterranean diet has only been shown to cause weight loss, not weight gain.

References: (1) cdc.gov. (2) Lancet. online July 13, 2016. (3) Obes Rev. 2007;8(6):503-513. (4) Cell Metab. 2014;20(6): 991–1005. (5) Cell Metab. 2012;15(6):848-860. (6) Metab Syndr Relat Disord. 2011 Feb;9(1):1-12. (7) N Engl J Med. 2016;375:794-798. (8) PLoS Med. online August 16, 2016. (9) Am J Prev Med. online October 10, 2016. (10) hsph.harvard.edu/nutritionsource/sugary-drinks-fact-sheet.

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

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New standards will require school districts in New York state to test for lead in water. File photo

By Rebecca Anzel

Drinking water in public schools across the state will soon conclude testing for lead contamination. Legislation signed by Gov. Andrew Cuomo (D) in September makes New York the first state to mandate such testing.

The law established a level of lead allowed in drinking water, initial and future testing requirements for schools and deadlines for notifying parents and staff of results.

“These rigorous new protections for New York’s children include the toughest lead contamination testing standards in the nation and provide clear guidance to schools on when and how they should test their water,” Cuomo said in a press release.

Schools are more likely to have raised lead levels because intermittent use of water causes extended water contact with plumbing fixtures. Those installed before 1986, when federal laws were passed to restrict the amount of lead allowed in materials, might have a higher amount of lead.

“We know how harmful lead can be to the health and well-being of young children, and that’s why the Senate insisted on testing school water for lead,” state Senate Majority Leader John Flanagan (R-East Northport) said in a statement. “As a result, New York becomes the first state in the nation to perform this testing and protect millions of its students from potential health risks.”

Lead consumption by children is especially harmful because behavioral and physical effects, such as brain damage and reduced IQ, happen at lower levels of exposure, according to the federal Environmental Protection Agency. Even low levels of lead exposure can cause hearing loss, nervous system damage and learning disabilities.

“We know how harmful lead can be to the health and well-being of young children, and that’s why the Senate insisted on testing school water for lead.”

—John Flanagan

In adults, lead can cause damage to the reproductive system, kidneys and cardiovascular system.

The new law required schools teaching children in prekindergarten through fifth grade to test drinking water by Sept. 30 and schools with children from grades six through 12 to complete testing by the end of October.

This affects in excess of 700 school districts and 37 BOCES locations in the state, consisting of more than 5,000 school buildings, according to the state. Private schools are exempt from this testing.

Any lead level exceeding 15 micrograms per liter must be reported by the school to the local health department within one business day. Schools are also mandated to share the test results with parents and staff in writing and to publish a list of lead-free buildings on their websites.

Glenn Neuschwender, president of Enviroscience Consultants, a Ronkonkoma-based environmental consulting firm, said to a certain extent, these deadlines are a challenge, especially those pertaining to the test results.

“I’ve been speaking to the county health department — they’re currently not prepared to receive that data,” Neuschwender said in a phone interview. “The same would go for the state Department of Health. They’re not currently prepared to start receiving data yet, but they’ve told me that they will be within the coming weeks.”

The cost of a lead analysis ranges from $20 to $75 per sample and must be conducted by a laboratory approved by the Environmental Laboratory Approval Program. Long Island Analytical Laboratories in Holbrook and Pace Analytical Services in Melville are two approved labs, according to the state Department of Health.

If the level of lead in a sample exceeds what the law allows, the school is required to prohibit the use of that faucet until further testing shows the issue is rectified. The law also requires schools to conduct testing every five years.

“The law is certainly, I would say, a work in progress,” Neuschwender said. “The law is very short in discussing remediation — it’s more specific to sampling and action-level objectives — so we expect to see some clarification on the remediation side of things as the law is revised.”

Port Jefferson school district conducted voluntary testing of fixtures throughout the district this summer before Cuomo signed the law, and found small amounts of lead in nine locations. All nine fixtures have been replaced, according to Fred Koelbel, district plant facilities administrator.

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Debbie Carpinone and her son Anthony Forte. Photo from Debbie Carpinone

By Kevin Redding

On what would have been Anthony Michael Forte’s 25th birthday Oct. 8, Debbie Carpinone stood over a cake decorated with a photo of her son and icing that spelled out “Happy Birthday In Heaven Anthony There’s A Light That Will Never Go Out” and led family and friends in singing to him before taking a brief moment to reflect and pray to herself.

All were gathered at VFW Post 6249 in Rocky Point to honor and celebrate her son’s memory with live music, catered treats, a Chinese auction and raffle prizes for the 2nd annual Anthony’s Angels fundraiser.

For Carpinone — who lost Forte to a heroin overdose on May 2, 2015 — getting through this particular day without him is still a new challenge, but one that’s led her down a path of keeping active, doing good things for others and providing hope and charity to her community.

Local band Remedy plays old hits like ‘Fame’ by David Bowie during the second annual Anthony’s Angels fundraiser. Photo by Kevin Redding
Local band Remedy plays old hits like ‘Fame’ by David Bowie during the second annual Anthony’s Angels fundraiser. Photo by Kevin Redding

Last year, in the wake of Anthony’s death, she set up Anthony’s Angels to help raise money for Hope House Ministries in Port Jefferson, various treatment programs, as well as establish a scholarship in his name at Mount Sinai High School, which is geared toward someone who has overcome a personal obstacle. Carpinone, who works as a teaching assistant for the Mount Sinai Elementary School, was able to give $1,000 to Matthew Kirby this past June and help him pay for college in Rhode Island.

“Anthony always wanted to go to school, but due to his addiction, he never got the chance to go,” Carpinone said. “He just was always in and out of rehabs, and sober houses.”

Now, she continues to keep herself busy in different ways, by striving to do something good in his memory, like the scholarship.

“Matthew [Kirby] was pretty much one of the only kids who really wrote from the heart, about losing his grandparents, and he has suffered a lot of loss as far as family members … and I felt connected to his family just by reading his essay,” she said. “I’m glad I went with my gut and chose him, because he’s just a wonderful kid.”

She wanted this year’s fundraiser to benefit the next scholarship and hopes that she’ll be able to give it out to two students in 2017. Because the event happened to fall on his birthday this year, she also wanted to throw a party he would’ve appreciated.

“Debbie is channeling her grief in such a positive way, and I just find everything she’s doing to be so good for her body, mind and soul. Her situation touched my heart.”

—Kelly Amantea

“He loved all the old Hollywood legends,” said Carpinone, who filled the room with huge cutout standees of Elvis Presley and Audrey Hepburn, and stocked the tables with photos of icons like James Dean, Marilyn Monroe and Frank Sinatra. She said that caterer Crazy Crepe Café even provided an Elvis-themed peanut butter and banana crepe.

“Everybody just came together, and it’s so nice to know that there’s still good people out there, and people that still want to do good things,” the mother said.

Long tables were covered with over 100 prizes from local businesses and attendees, including a $25 gift card to Setauket Pastaria, a glam girl Marilyn basket, a Mercedes Benz donation and a kid’s pedal car.

As local band Remedy played high-energy covers of David Bowie, The Knack and Weezer, pictures of Forte in what appeared to be his happiest days adorned the tables and walls, and had many reminiscing about him.

“He was a very special person,” said Dolores Franklin, Forte’s aunt. “He was very charismatic, talented. I can’t say enough. He loved to act, liked to do skits … he brought us a lot of laughter. And no matter how awful you looked, he’d always tell you you were beautiful. He made you feel good.”

She said that there was certainly a big hole in the family’s hearts, having lost such a huge presence.

“I just wish that one of us could’ve gotten through to him, and could’ve let him know how special he really was,” she said, “because I don’t think he knew how great he was.”

Debbie Carpinone reads off raffle winners at the Anthony’s Angels fundraiser. Photo by Kevin Redding
Debbie Carpinone reads off raffle winners at the Anthony’s Angels fundraiser. Photo by Kevin Redding

Carpinone wants to get rid of the stigma around heroin and those who get hooked on it, because her son didn’t look like a drug addict, didn’t come from a terrible family and wasn’t a bad person. As overdoses become more and more common across Long Island, it’s become very clear that drugs don’t know who you are, and addiction can latch itself onto anybody — a fact that more and more people are becoming aware of.

“Debbie’s son’s death was my first eye-opening experience to heroin,” said Kelly Amantea, Carpinone’s friend. “It never touched my life, my family, or my heart prior to that. It just never affected me. I knew nothing about it. I lived in my own little drug-free bubble.”

She said for her, a lot of awareness came out of the tragic event.

“I do find that the community as a whole is starting to wrap its arms around this,” she said. “I’m hoping that there’s more attention paid to this because it’s affecting more and more families — more and more lives — and I want the cure and the remedy to catch up with the epidemic … they’re so far apart right now.”

Amantea added she’d never been to a funeral like Forte’s before and believes every middle school kid should be dragged to a funeral of someone who died this way, to open children’s eyes to the harsh reality.

“It rocked me to my core and I don’t think these kids really understand what it’s like for the families that have to carry this,” she said. “That drug is Russian roulette. Debbie is channeling her grief in such a positive way, and I just find everything she’s doing to be so good for her body, mind and soul. Her situation touched my heart.”

The fundraiser raised $220 for Hope House Ministries and $1,500 for the scholarship.

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Not all carbs are created equal. Photo by Heidi Sutton

By David Dunaief

It’s a persistent question: Should we minimize our carbohydrate consumption? Unfortunately, it depends on a number of factors including the type of carbohydrate and your family and personal history of chronic disease such as diabetes, cardiovascular disease, obesity, high triglycerides and hypertension. If this seems complicated and confusing to you, you are not alone. We have been bamboozled, railroaded or whatever term you like about carbohydrates for decades.

The body is like a chemistry set in that it turns many different types of carbohydrates into sugar. In other words, most of the sugar we consume is not what we add to food, but rather the food that our bodies turn into sugar. This is what’s so dangerous because it raises our blood sugar level.

The FDA has recently tried to quantify the amount of sugar we should consume on a daily basis (1). The agency recommends that we get no more than 50 grams of ADDED sugar a day. This seems like an easy task, for who would add 14.5 teaspoons of sugar to their food or drink in a day? Ah, but there is a catch: It includes processed foods such as refined carbohydrates and beverages. In fact, one can of soda may be enough to reach the upper limits of this recommendation.

We have been told for years that fats, especially saturated fats, were the enemy. Remember the food pyramid? The USDA had grains as its foundation for the longest time. Why would this be? Well, as it turns out, this is not a conspiracy theory but an actual scheme by the sugar industry to influence what we ate. They blamed fats as the cause for chronic diseases. However, they were very tricky in their approach, influencing scientists in the 1960s and 1970s with a small amount money, as was recently disclosed in a medical journal. We will discuss this in more detail.

Not all carbs are created equal

Carbohydrates come in many different forms. It depends on how much fiber they contain and whether they’re in liquid or solid form (2). Don’t focus on whether the carbohydrates are soluble or insoluble, complex or simple.

What is important is that some carbs don’t raise our blood sugar levels, while others have a much higher propensity to raise them. The carbs that don’t, or are less likely to, include fruits, nonstarchy vegetables, beans, legumes, pasta made from beans and tofu. With these, for the most part, you can eat a plentiful amount and may help prevent and even reverse chronic diseases such as diabetes, cardiovascular disease and obesity. However, carbs that raise our blood sugar are grains, especially refined grains, starchy vegetables like potatoes, fruit juice, sweets, bread, grain pasta, dried fruit, alcohol, soda, condiments and sauces. Let’s look at the evidence.

Sugar industry manipulation

You wouldn’t think we could be fooled by the sugar industry or distracted into thinking that saturated fats are what’s detrimental, not carbohydrates, and in their simplest form, sugars. This is just what the sugar industry did. A recent article in JAMA flushes this out (3).

The Sugar Research Foundation, the predecessor to the Sugar Association, paid three Harvard scientists to focus on fat and cholesterol as contributing factors to the rise in heart disease, not sugar. The resulting low-fat diet craze led to products loaded with sugar, like Snackwell cookies.

How much did they pay the researchers? A paltry $50,000 total in current monetary value. One of the scientists involved became the director of nutrition at the USDA. While the sugar industry and Harvard scientists in the 1960s may have conspired to downplay the dangers of sugar, strong evidence has now come to light that sugar, especially refined sugar, plays a role in heart disease and many other chronic diseases. However, this does not exonerate foods with high levels of saturated fat such as animal products.

We could never fall for this again, right? Well, that is what Coca-Cola was hoping to repeat recently by paying scientists millions of dollars to blame exercise, not diet, for the increase in heart disease, diabetes and obesity (4). This was recently revealed in a New York Times article entitled, “Coca-Cola Funds Scientists Who Shift Blame for Obesity Away From Bad Diets.” The Global Energy Balance Network, a nonprofit advocacy group, was influenced by the funding from Coke. In fact, a 2013 peer-reviewed journal article argued similar ridiculous assertions (5). It was subsequently amended to note the funding by Coca-Cola. The difference is that scientists now have to disclose any paid industry associations when published in a peer-reviewed journal, unlike in the 1960s and 1970s.

Starchy vegetables — be leery!

It is not only refined grains that are a problem. Another is starchy vegetables, in this case potatoes. In a recent study, results showed that potatoes increased the risk of diabetes, while replacing them with whole grains may decrease this risk (6). Those who ate less than two to four servings of starchy vegetables per week had a 7 percent increased diabetes risk, and those who ate at least seven servings per week had a 33 percent increased risk. Those who consumed french fries had even higher risks for diabetes. This was a meta-analysis including data from three prestigious sources, the Health Professional Follow-up Study and The Nurses’ Health Study I and II, involving almost 200,000 men and women across the three studies with a minimum duration of 20 years.

Here is the corker: It did not matter what type of potato they were eating! Although I could not find data that delineated the different types of potato, this may imply sweet potato.

Whole fruit vs. nonstarchy veggies vs. starchy veggies

Many people who want to lose weight find the task to be downright daunting. The following may provide motivation. In a study, results showed that eating whole fruit helped people lose weight. Nonstarchy vegetables also had similar results; however, starchy vegetables caused people to put on the pounds (7). The fruits included berries, pears and apples. The vegetables with the most positive weight-loss impact were cauliflower and soy/tofu. Starchy vegetables included corn and potatoes. This was a meta-analysis involving three studies and over 130,000 men and women.

Clinical example — what a surprise!

In my practice, I had been encouraging patients to eat starchy vegetables that were high in a class of nutrients known as carotenoids. These starchy vegetables include sweet potato, acorn squash, butternut squash, spaghetti squash, pumpkin and corn. Well, it turns out that a number of my patients indeed had higher nutrient levels in their blood, but unfortunately had no decrease in the inflammatory marker, C-reactive protein (CRP), that usually accompanies this effect. Even worse, their triglycerides, insulin levels and HbA1C, a measure of three-month sugars, were actually elevated and they could not lose weight.

The moral of the story is that we don’t have to be on a low-carb diet. Instead, we should focus on consuming carbohydrates that may prevent and reverse disease, such as fruits, nonstarchy vegetables and beans, while trying to minimize those that would potentially have the opposite effect, including starchy vegetables, disappointingly. The response to carbohydrates tends to depend on individuality when it comes to whole grains and starchy vegetables, though those with diabetes, heart disease, obesity and hyperinsulinemia would be advised to minimize their intake. Of course, all of us should minimize our intake of refined grains, sugars and processed foods.

References: (1) FDA.gov. (2) Uptodate.com. (3) JAMA Intern Med. online Sept. 12, 2016. (4) NYTimes.com. (5) PLoS One. 2013 Oct 9;8(10):e76632. (6) Diabetes Care. 2016;39(3):376-384. (7) PLoS Med. 2015;12(9):e1001878.

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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Suffolk County leads New York State in deaths related to heroin and opioid overdoses. Graphic by TBR News Media
Suffolk County leads New York State in deaths related to heroin and opioid overdoses. Graphic by TBR News Media

Suffolk County has a drug problem. And while it may be broken news, this is not breaking news.

Heroin and prescription opioid-related overdoses and deaths are increasing yearly across the nation, state and county, according to all available data, but the overall conversation lacks focus, those close to the issue have said. One Long Island man whose line of work leaves him with little insulation from the problem said it is worse than most would imagine.

Dan Moloney, who along with his brother Peter owns six Long Island locations of Moloney Family Funeral Homes, said in an exclusive interview that he believes the problem facing Suffolk County deserves a harsher spotlight. Moloney, who has an unenviable front row seat to the horrors that come from the addictive and powerful substance, said the problem reached a tipping point for him in 2009.

After a funeral for a Rocky Point student who overdosed, the Moloneys decided to try to use their platform to deliver an important message. They had posters made up with the words “Some kids are dying for a high” in bold letters on top of an image of a flower arrangement with a card that read, “With Deepest Sympathy, The class of ’10.” Below the image, the funeral director’s message read in part: “The last thing we want to see is a death that could have been prevented. Help us make sure we don’t.”

The Moloneys tried to distribute the posters to school districts around the Island, though they couldn’t find any takers.

Maloney’s Funeral home still has stacks of this poster. Photo by Alex Petroski
Moloney’s Funeral home still has stacks of this poster. Photo by Alex Petroski

“Nobody wants to talk about it,” Dan Moloney said. “Nobody wants to hear from the funeral director.”

On the surface, in Suffolk County, it would appear heroin abuse is a daily conversation in one way or another, from politicians sponsoring initiatives to news outlets covering arrests and overdoses, to firsthand accounts from former addicts in various forms.

Moloney said he wouldn’t agree — not only is the problem receiving too little attention, he said, but also the wrong people are doing the talking.

“Are people sitting in the bleachers talking about the heroin problem?” he said. “But if their kid had some sort of disease, they’d be talking about it. They’d be doing fundraisers to help them find a cure.”

The two go hand-in-hand — heroin and opioids — or at least they should, Moloney said. Heroin is an illegal and highly addictive version of an opioid, according to the Centers for Disease Control and Prevention. However, statistics reporting deaths related to one or the other are not always paired.

The CDC’s website said health care providers wrote nearly a quarter of a billion prescriptions for legal opioids in 2013. Supply and demand for prescription pain medication doesn’t always dry up at the same rate. When the prescribed pills are gone and the desire for more lingers, the cheaper, stronger drug becomes a logical alternative.

In 2013, New York State’s Internet System for Tracking Over-Prescribing — Prescription Monitoring Program, also known as I-STOP/PMP, went into effect. The system works as a registry for practitioners to consult and track dispensed prescription histories for patients. The program has restricted supply of opioids to addicts, though it has done nothing to curb their demand. No tracking system exists for the neighborhood heroin dealer.

Moloney said one of his business’s facilities held funerals for three heroin overdose victims in just one day earlier this year. The closest comparison he could come up with to a public health concern inflicting that much damage in one day is a car crash that kills a vehicle full of people. He said that in some years, only two to three motorcycle-related deaths occur over the course of entire summer, which the public tends to find alarming, but that pales in comparison to heroin- and opioid-related deaths.

The difficulties in securing relevant and timely statistics on overdose-related deaths in New York State has contributed to undermining the understanding of the severity of Suffolk County’s problem, according to Moloney.

“Are people sitting in the bleachers talking about the heroin problem? But if their kid had some sort of disease, they’d be talking about it. They’d be doing fundraisers to help them find a cure.”

— Dan Maloney

“New York State is terrible,” he said about the state’s demographic record-keeping, which is an insight few could offer outside of the funeral business. “Three years down the road — the latest data you have is from three years ago. With the technology we have today, there’s absolutely no reason for that. And I know from colleagues that I have in other states, when you can’t get the information about how many deaths occurred in a certain place for two or three years, or what they were — because all of that is tracked — I just think the data that’s out there is antiquated and the situation is worse than the data they’re using shows.”

Father Francis Pizzarelli, director of Hope House Ministries in Port Jefferson, has been a regular contributor of insight and opinions regarding heroin and opioid addiction among young people in Suffolk County for about as long. He, like Moloney, said the problem is likely worse than anyone in the county realizes.

“The level of denial among parents continues to be deeply disturbing,” Pizzarelli wrote in a April 2016 column featured in this newspaper. Alcoholics Anonymous and Narcotics Anonymous, “which are a vital lifeline and network in our community for those working on recovery and wellness, have to worry that drug dealers are now waiting outside these meetings to prey on men and women in early recovery.”

Pizzarelli said his tipping point, much like that of Moloney’s, came in 2009. So far, though, he added, it has not been enough.

Suffolk County Police Commissioner Tim Sini said in May there were 103 fatal heroin overdoses in Suffolk County in 2015. New York State Comptroller Tom DiNapoli (D) released a report on June 9 saying there were more than 200 deaths in which heroin or opioids played a role in Suffolk County in 2014.

Regardless of how and when the deaths are identified with a specific cause or a contributing factor being opioids, one thing is clear to Moloney: the number is higher than we think.

According to the Suffolk County Police Department, since the act of administering the medication Narcan to reverse an opioid overdose became commonplace in August 2012, more than 630 saves have been recorded through Sept. 22.

In addition to conflicting stats, Moloney said an issue that he encounters is the stigma parents feel about losing a child to an overdose and what it might suggest about their aptitude as a parent. Most of the time, parents decline to immediately identify a heroin or opioid overdose as their child’s cause of death, he said. In fact, Moloney estimated that nine out of 10 parents whose child died of an overdose don’t address the issue and the cause isn’t added to a death certificate until about three months later, when lab reports are complete.

“It almost creates an environment where there doesn’t have to be an acknowledgement —not publicly,” Moloney said. “Of course there’s a lot of shame.”

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