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Dietary changes can have a dramatic effect

By David Dunaief, M.D.

Dr. David Dunaief

When we say we “have hemorrhoids,” what we really mean is that our hemorrhoids are irritating and painful. Hemorrhoids are vascular structures that help control our stool, and they can become inflamed.

This type of hemorrhoid pain is very common. Both men and women experience it, although women have a higher propensity during pregnancy and childbirth.

When our hemorrhoids are irritated, we may experience itchy and painful symptoms, making it hard to concentrate and uncomfortable to sit. This is because the veins in your rectum are swollen. They can also bleed, especially during a bowel movement, which can be scary. Fortunately, they don’t portend more serious diseases.

There are two types of hemorrhoids: external, occurring outside the anus; and internal, occurring within the rectum.

Treating external hemorrhoids

Fortunately, external hemorrhoids tend to be mild and can be treated with over-the-counter options. These analgesic creams or suppositories contain hydrocortisone. Another treatment option is a sitz bath.

For a more complete solution, the most effective way to reduce hemorrhoid bleeding and pain is to increase your fiber intake (1). 

If you have rectal bleeding and either have a high risk for colorectal cancer or are over the age of 50, you should consult your physician to confirm it is not due to a malignancy or other cause, such as inflammatory bowel disease.

Treating internal hemorrhoids

Internal hemorrhoids are a bit more complicated. The primary symptom is bleeding with bowel movement. Because the hemorrhoids are usually above the point of sensation in the colon, called the dentate line, there is rarely pain. If there is pain and discomfort, it’s often because the internal hemorrhoids have prolapsed, or fallen out of place, due to weakening of the muscles and ligaments in the colon. This allows them to fall below the dentate line.

The first step for treating internal hemorrhoids is the same as for external hemorrhoids: add fiber through diet and supplementation. Study after study shows significant benefit. For instance, in a meta-analysis, fiber reduced the occurrence of bleeding by 53 percent (2). In another study, after two weeks of fiber and another two-week follow-up, daily incidence of bleeding decreased dramatically (3).

What are the treatments for persistent hemorrhoid pain?

There are several minimally invasive options to address persistent and painful hemorrhoids, including banding, sclerotherapy and coagulation. The most effective of these is banding, with an approximate 80 percent success rate (4). This is usually an office-based procedure where rubber bands are placed at the neck of each hemorrhoid to cut off the blood flow. To avoid complications from constipation, patients should also take fiber supplementation.

Side-effects of the procedure are usually mild, and there is very low risk of infection. However, severe pain may occur if misapplication occurs with the band below the dentate line. If this procedure fails, hemorrhoidectomy (surgery) would be the next option.

What can help prevent hemorrhoid problems?

Sitting on the toilet for a long time puts a lot of pressure on the veins in the rectum, which can increase your risk of inflammation. As soon as you have finished moving your bowels, it is important to get off the toilet.

Soften the stool and prevent constipation by drinking plenty of fluids. Exercise also helps. You should not hold in a bowel movement; go when you have the urge to keep the stool from becoming hard, which can lead to straining and more time on the toilet.

Consuming more fiber helps create bulk for your bowel movements, reducing constipation, diarrhea and undue straining.

How much fiber should I consume?

Americans, on average, consume about 16g per day of fiber (5). This is well below the U.S.D.A.’s recommendation: 14 grams of fiber for every 1,000 calories we consume (6). The difference between guidelines and actual consumption has prompted the medical community to express concern about the “fiber gap.”

Fiber underconsumption has greater implications than just hemorrhoids. It contributes to weight control issues, increased insulin sensitivity and chronic inflammation, among others (7). Fiber’s benefits are so great that I recommend many patients target 40 grams a day.

You may want to increase your fiber consumption gradually to minimize the potential for gas and bloating during the first week or two. It will take your system a bit of time to adjust.

I typically recommend making diet adjustments before trying supplementation. Fruits, vegetables, whole grains, nuts, beans and legumes all have significant amounts of fiber. Grains, beans and nuts have among the highest levels. For instance, one cup of black beans contains 12g of fiber.

References:

(1) Dis Colon Rectum. Jul-Aug 1982;25(5):454-6. (2) Cochrane.org. (3) Hepatogastroenterology 1996;43(12):1504-7. (4) Dis Colon Rectum 2004 Aug;47(8):1364-70. (5) usda.gov. (6) Am J Lifestyle Med. 2017 Jan-Feb; 11(1): 80–85. (7) Nutrients. 2020 Oct; 12(10): 3209.

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

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Mike Kilano. Courtesy Paws of War

By Lauren Feldman

Mike Kilano, a United States Marine veteran, veteran advocate and crisis coordinator for Paws of War, will participate in the 22 PAC PTSD Awareness Challenge Aug. 30. This event aims to raise awareness for PTSD and veteran suicides, and to bring together over 20 veteran-related nonprofits.

Kilano, a North Babylon resident, will kayak 22 miles with others across Long Island Sound, starting in Bridgeport, Connecticut, and ending in Port Jefferson.

Kayaks will leave Bridgeport at 10:30 a.m. and are due to arrive in Port Jeff at 5:30 p.m. There will be a reception party, open to the public, at the Village Center with free food, drinks and a band from 4 to 8 p.m.

For Kilano, the challenge is a way to support his fellow servicemen and women. It symbolizes the 22 veterans who tragically take their lives each day.

Kilano understands the profound impact of combat-derived PTSD. He served in the U.S. Marine Corps from 1999 to 2003 and was deployed to the Middle East shortly after the Sept. 11, 2001, attacks, participating in Operation Enduring Freedom.

His service left him with deep scars. After just three months of deployment, Kilano began to notice how the sights, sounds and experiences of war were affecting his mental health.

Upon returning home, his struggles intensified. “I couldn’t sleep, tried to go to school, couldn’t focus … my anger took control, I got into some pretty reckless behaviors,” he said. “My isolation was so bad for two or three years, and I had a family. So you can imagine my kids and my wife having secondary PTSD because their father — her husband — had all these issues we didn’t even know about.”

Helped by Paws of War

Veteran Mike Kilano demonstrates kayak skills at Steers Beach, in Northport, in advance of the 22 PAC challenge. Courtesy of Paws of War

After nearly 20 years, Kilano was diagnosed with combat-related PTSD and began receiving services through the VA. He has slowly found ways to manage his PTSD, greatly aided by his service dog, Nova, who was paired with him through Paws of War. Nova is not only a fully trained service dog but also a beloved family member.

Paws of War, located in Nesconset, trains and places shelter dogs to serve and provide independence to U.S. military veterans who suffer from the emotional effects of war.

Inspired by Paws of War, Nova and the positive changes in his life, Kilano now works full time with the organization, helping other veterans navigate their struggles. “For a lot of veterans, their animals are their lifeline. If I can make them aware of the help of a service dog, I feel like I’m making a difference,” he said.

“As tough as things get, I know there’s a community of veterans like me,” he added. “If I can be that voice or that encouragement to my brothers or sisters, then it makes my mission away from the mission in combat worthwhile. I can sleep better because I’m helping someone out.”

Kilano is excited about participating in the 22 PAC challenge. “I love kayaking,” he said. The activity provides him with an outlet and forces him to slow down and focus: “As I start training, I’m out in the open water, I’m able to breathe, no one’s around. You’re able to focus on your breathing, your muscles. You have to get that energy out. You can’t have much negative energy when you’re in the middle of the ocean.”

Mike Kilano. Courtesy Paws of War

In preparation for the challenge, Kilano conducted kayak training at Steers Beach, Northport, Aug. 16 and spoke about his experiences with PTSD and the support he has received. “As a veteran advocate, I think it’s important to showcase groups like 22 PAC and what they’re about so that others get encouraged,” he said.

Kilano plans to continue his advocacy beyond the 22 PAC challenge. Readers interested in donating to the fundraiser and learning more about Paws of War can visit the websites 22pac.org and pawsofwar.org.

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Stony Brook doctor, tending to a newborn baby. Courtesy Stonybrookchildrens.org

By Daniel Dunaief

Water inside a house isn’t just bad for the structure, it can also be damaging to your health.

Local health care professionals suggested that Stony Brook residents whose basements flooded from this weekend’s heavy rainfall should be careful about the growth of mold or mildew, which can be especially problematic for anyone with chronic breathing issues.

“People can inhale spores over a period of time and can develop respiratory symptoms,” said Dr. Sunil Dhuper, Chief Medical Officer at Port Jefferson’s St. Charles Hospital.

People with asthma, chronic obstructive pulmonary disease, bronchitis and emphysema “need to be particularly concerned about some of these issues,” he continued.

Dr. Sharon Nachman, Chief of Division of Pediatric Infectious Diseases at Stony Brook Children’s Hospital, suggested that residents of Stony Brook, who experienced a localized 10 inches of rain this weekend, should “aggressively clean” their basements, from any standing water, as mold and mildew can start growing within a few days.

“You won’t see it because it’s small,” but people should dry the walls and under the floorboards and carpet, she said. “You want to get the water out.”

Local doctors, also, recommended dumping standing water off any surface that might become a breeding ground for mosquitoes, who can carry the West Nile virus.

At this point, the County Department of Health believed the West Nile threat wasn’t likely particularly high.

“The heavy rains and wind might have washed away adult larvae and adult mosquitoes,” Dr. Scott R. Campbell, Laboratory Chief in the Arthropod-Borne Disease Laboratory at the Suffolk County Department of Health Services, explained in an email.

“Wet springs and hot, dry summers — in which mosquitoes and birds may congregate at limited sources of water — may be conducive to higher West Nile virus transmission.”

The heavy rain, which was triple the usual average for the entire month of August, according to Weather Spark, likely reduced area mosquitoes.

Local medical care professionals suggested that residents should still remove standing water as a way to protect themselves against any remaining mosquitoes.

Congenital viral infection

Apart from the impact of local flooding, doctors discussed a host of other medical issues.

New York State has been testing newborns, since last fall, for congenital cytomegalovirus, or CMV, which infected mothers can give to their unborn children.

The testing so far has shown that CMV is less prevalent than previous estimates.

The state started the one-year study of the virus to track children who might develop symptoms, such as hearing loss or learning challenges, later on.

“The earlier you identify babies with hearing deficits, the sooner you can act, and there will be fewer ramifications on their intellectual development, as a result of it,” said Dr. Andrew Handel, pediatric infectious diseases expert at Stony Brook Children’s Hospital, and a co-leader, along with Dr. Nachman, of one of the 11 units across the state.

Dr. Sharon Nachman. Courtesy Stony Brook Medicine Facebook page

Earlier medical sources estimated that the infection rate for newborns was about one in 200 babies. But, with about 300 newborns testing positive, the rate is closer to one in 325.

The percentage of symptomatic babies is tracking with previous expectations, at around 10 percent. Symptoms of congenital CMV at birth include hearing loss, jaundice, low birth weight, seizures and retinitis.

“Our numbers are matching up with the 90 percent” of those who have the virus, but are asymptomatic, Handel added.

“That’s why we feel screening is so important.”

For the asymptomatic newborns, about 10 percent will develop permanent hearing loss, which is why doctors are tracking them so closely.

The virus, which is a relative of the Epstein Barr virus, which causes mononucleosis, is spread through direct contact with body fluids, such as tears, saliva or urine. Over half of all adults have had a CMV infection, with some studies estimating the rate as high as 80 percent.

Adults can shed the virus for a few weeks after contracting it, while children can shed it for a few months.

While all newborns will receive CMV screening after birth, parents have five days to opt out of any link to a report of the presence of the virus in their children.

At this point, fewer than one percent of parents are opting out of the testing. Some of the parents aren’t interested in the test, others don’t believe it’s useful, while some believe their babies look fine, and don’t want the additional test.

Most parents appreciate the opportunity to gather information about their children’s health. Patients are “grateful the state has this program,” said Dr. Sunil Sood, Systems CMV specialist at Northwell Health.

At Stony Brook and other hospitals, doctors are monitoring those babies who test positive.

The County Department of Health supports the testing, as well.

“Routine screening of newborns for [congenital CMV] will help identify affected infants early on so they can receive appropriate follow-up and treatment,” Cynthia Friedman, Director of Public Health Suffolk County Department of Health Services, explained in an email.

“Infants who screen positive … should be followed closely by their pediatricians and referred to specialists as needed to ensure early detection of problems with hearing, vision or development so that appropriate care and support can be implemented.”

Once the funding for the testing runs out, which will be around October, hospitals around the state will no longer perform the test.

Parents can ask for a urine test, which doctors estimate could cost between $50 and $100, but which insurance, likely, won’t pay for — especially if the child is asymptomatic.

Legislators, including Assemblymember Linda Rosenthal (D-NYC) plan to introduce a bill in January that would fund tests, in future years.

“We would advocate that that become a permanent part of infant testing,” said Sood. “There are diseases that are far less common than CMV that have made it into the newborn testing programs.”

Immunization

Amid pushes by some pharmacies to encourage people to get flu shots, health care experts suggest waiting until closer to late September, or early October, for the inoculation.

“Vaccine efficacy is about three to four months,” said Nachman. “If you get it in August, when the flu season hits in January, you may not have much protection.”

The Centers for Disease Control and Prevention recommends similar timing, around September or October.

At the same time, Nachman expects a new batch of Covid vaccines will be available around September.

She recommends getting both shots at the same time, which increases both vaccines’ effectiveness.

Pharmaceutical giant, Pfizer, and BioNTech, recently reported that a single combined shot for Covid and flu was not effective against influenza B, which means that people interested in receiving vaccines this fall should plan to get two shots.

Covid numbers

As for Covid, the current strain has made the rounds this summer.

“Everybody and their neighbor had Covid,” said Nachman, who added that the virus has spread across all ages. Covid was “clearly more infectious than what we had in the spring” and people were sicker for longer.

While the number of infected people has decreased, the start of the fall semester could trigger an increase.

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Gordon Heights and Patchogue Seventh Day Adventists Churches will host a Community Health Fair at Granny Road Park, 615 Granny Road, Medford on Sunday, Aug. 25 from 10 a.m. to 3 p.m. The event will feature free health screenings, free counseling, free massages, Stony Brook Hospital mammogram information and sign up, along with information on cancer prevention, cardiovascular disease prevention, stroke education & prevention, nutritional counseling, behavioral and mental health counseling, real estate education, and much more. For more information, call 631-384-9060 or 631-698-0912.

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Jennifer M. Cushman, MD

New York Spine & Pain Specialists, a division of New York Health (NY Health), has announced the addition of Jennifer M. Cushman, MD, to its Interventional Pain and Spine team. 

Dr. Cushman is dedicated to providing support and interventions to treat chronic pain and joint-related pathologies, improve ambulation and function, and improve her patients’ independence and quality of life. She also specializes in treating various chronic pain and joint conditions, including low back pain, knee, shoulder, and various joint-related pathologies using both ultrasound and fluoroscopy techniques. 

She speaks English, Spanish, and Polish.

“We are thrilled to welcome Dr. Jennifer Cushman to our team,” said Dr. Chris Ng, MD, Executive Director of NY Health. “Her extensive training, clinical research background, and commitment to patient-centered care align perfectly with our mission to provide the highest-quality pain management services.”

“I am excited to join New York Health, a rapidly growing practice renowned for its wide array of interventional and minimally invasive surgical treatment options for chronic pain,” said Dr. Cushman. “NY Health offers numerous academic opportunities that will allow me to pursue clinical research and advance cancer pain management, ultimately helping patients who are suffering.”

Dr. Cushman will practice at 5316 Nesconset Highway, Port Jefferson Station and 300 Old Country Road, Suite 1, Riverhead. To make an appointment, please call 631-474-0707. 

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Supplements may not have the same benefits

By David Dunaief, M.D.

Dr. David Dunaief

A cataract is an opacity or cloudiness of the eye’s lens, which decreases vision as it progresses. Although there are different types of cataracts, most often it’s caused by oxidative stress. As we age, the likelihood increases that cataracts will affect our vision.

In the U.S., estimates suggest that 26.6 million Americans over age 40 have a cataract in at least one eye or have had surgery to remove a cataract (1). By age 80, this increases to approximately 50 percent of Americans.

Chronic diseases, such as diabetes and metabolic syndrome; steroid use; and physical inactivity can contribute to your risk.

The good news is that we can take an active role in preventing cataracts. Protecting your eyes from the sun and injuries, quitting smoking, and increasing your consumption of fruits and vegetables can improve your odds. Here, we will focus on the dietary factor.

What effect does meat consumption have on cataracts?

Diet has been shown to have substantial effect on cataract risk (2). One of the most expansive studies on cataract formation and diet was the Oxford (UK) group, with 27,670 participants, of the European Prospective Investigation into Cancer and Nutrition (EPIC) trial. Participants completed food frequency questionnaires between 1993 and 1999. Then, they were checked for cataracts between 2008 and 2009.

There was an inverse relationship between cataract risk and the amount of meat consumed. In other words, those who ate more meat were at higher risk of cataracts. “Meat” included red meat, fowl and pork.

Compared to high meat eaters, every other group demonstrated a significant reduction in risk as they progressed along a spectrum that included low meat eaters (15 percent reduction), fish eaters (21 percent reduction), vegetarians (30 percent reduction) and finally vegans (40 percent reduction).

There was not much difference in meat consumption between high meat eaters, those having at least 3.5 ounces, and low meat eaters, those having less than 1.7 ounces a day, yet there was a substantial decline in cataracts. This suggests that you can achieve a meaningful effect by reducing or replacing your average meat intake, rather than eliminating meat from your diet.

I’ve had several patients experience cataract reversal after they transitioned to a nutrient-dense, plant-based diet. This positive outcome and was confirmed by their ophthalmologists.

Do antioxidants help prevent cataracts?

Oxidative stress is one of the major contributors to cataract development. In a review article that looked at 70 different trials for the development of cataract and/or maculopathies, such as age-related macular degeneration, the authors concluded antioxidants, which are micronutrients found in foods, play an integral part in eye disease prevention (3).

The authors go on to say that a diet rich in fruits and vegetables, as well as lifestyle modification with cessation of smoking and treatment of obesity at an early age, help to reduce the risk of cataracts. You are never too young or too old to take steps to protect your vision.

Among antioxidant-rich foods studied that have shown positive effects is citrus. The Blue Mountains Eye Study found that participants who had the highest dietary intake of vitamin C reduced their 10-year risk for nuclear cataracts (4). The same effect was not seen with vitamin C supplements. Instead, a high dose of a single-nutrient vitamin C supplement actually increased cataract incidence (5).

How effective is cataract surgery?

The only effective way to correct cataracts is with surgery; the most typical type is phacoemulsification. Ophthalmologists remove the opaque lens and replace it with a synthetic intraocular lens in an outpatient procedure. Fortunately, this surgery has a very high success rate.

Of course, there are always potential risks with invasive procedures, such as infection, even when the chances of complications are low. In a small percentage of cases, surgery complications have resulted in blindness.

You can reduce your risk of cataracts with diet and other lifestyle modifications, plus avoid potential consequences from cataract surgery, all while reducing your risk of other chronic diseases. Why not choose the win-win scenario?

References:

(1) nei.nih.gov. (2) Am J Clin Nutr. 2011 May; 93(5):1128-1135. (3) Exp Eye Res. 2007; 84: 229-245. (4) Am J Clin Nutr. 2008 Jun; 87(6):1899-1305. (5) Nutrients. 2019 May; 11(5): 1186.

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

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The Renaissance School of Medicine (RSOM) welcomed the incoming Class of 2028 in August. Set for their medical school training are, from left, students Gabriel Chan, Henry Wilmot, Reinaldo Powell, and Emily Cahill. Photo by Arthur Fredericks/SBU
The 136 students comprising the incoming Class recite the Hippocratic Oath for the first time. Photo by Arthur Fredericks/SBU

 

Family experiences, commitment to service, intrigue with biotech advances, drive many of the new 136 RSOM students to pursue medicine

At the Renaissance School of Medicine’s (RSOM) White Coat Ceremony, 136 incoming students officially began their medical school training by taking the Hippocratic Oath and wearing their physician “white coats” for the first time. Held at Stony Brook University’s Staller Center on August 9, the annual ceremony brings students, their families, and faculty together as the academic year begins. The RSOM has held a White Coat Ceremony since 1998.

The incoming Class of 2028 is a highly select group, as only eight percent of all applicants to the RSOM for this academic year were accepted into the program. Collectively, the students received their undergraduate degrees from 57 different colleges and universities around the nation. Stony Brook University had the most representation, as 33 students earned their undergraduate degrees at Stony Brook. While a good portion of the students are from around the country, nearly 75 percent are from New York State.

Peter Igarashi, MD, Knapp Dean of the RSOM, congratulated the incoming class and told the students they are entering the field at a time when the practice of medicine is rapidly evolving and where discoveries to diagnose and treat disease are advancing and newer practices such as telemedicine are becoming commonplace. He emphasized the RSOM’s commitment to science-based medicine, and also urged the students to place the heart of their work around patients, as the practice of medicine is best with a “focus on a strong doctor/patient relationship.”

While the students’ paths into medicine and reasons for choosing the profession are varied, their experiences with family members who suffered from diseases, interest in service to people, and intrigue with advances in biotechnology, appeared to be some common factors for pursuing medicine.

New student stories

Gabriel Chan, a Long Island native, says that a turning point for him when deciding to pursue medicine was when his grandfather was diagnosed with Parkinson’s disease. He has entered the RSOM’s Medical Scientist Training Program, or MD/PhD program. Chan starts medical school fresh from a Fulbright Scholar experience in France where he conducted computational neuroscience research at Centre Borelli in Paris.

Reinaldo Powell, graduated in 2024 from Stony Brook with a Bachelor’s Degree in Health Sciences. He was eager to enter medicine and felt at home with the RSOM and its approach to education.

“I was always enamored by the role a physician can play in improving the lives of their patients. This was further exacerbated when I lost my mother to lymphoma when I was 14, and this inspired me to pursue a career to help those who hurt and one that looks to understand the specifics behind disease,” says Powell.

Two of the new med students are using their experience in the military as an inspiration and catalyst toward entering medicine.

Juan Diego Carvajal Ramirez, who most recently lived in California, spent time in the U.S. Army as a combat medic. That training sparked his interest in trauma medicine, and he hopes to ultimately specialize in trauma surgery. Additionally, he chose the RSOM because during a conversation with a current fourth-year medical student in the interview process he learned how much hands-on training and mentorship the RSOM faculty provides, something he sees as essential for trauma and emergency training.

Another Stony Brook University graduate and U.S. Army Second Lieutenant, Pamela Chen, found that all of her army training drills, including combat medic training, fit her pursuit of medicine given the discipline the work requires and its focus on teamwork and caring for soldiers.

Chen’s experience of losing her father at a young age due to Parkinson’s disease, her life in the New York City foster care system, and eventually growing up with a permanent family in Bethpage, NY, made her sensitive to the needs of people and families, especially when family members are ill.

Emily Cahill, who hails from Rockland County, NY, worked at Regeneron Pharmaceuticals in a cell culture lab producing therapeutic antibody candidates for drug development. While she enjoyed the science and laboratory work, it was a program she was involved as an undergraduate at Johns Hopkins University designed to improve communication between patients and their caregivers that drove her interest in patient care and people’s stories themselves, not just their illnesses.

Cahill is interested in caring for children. She is enrolled in the RSOM’s three-year MD program and will continue on in a Pediatric Residency position at Stony Brook Medicine after graduation.

Another student, Massachusetts native Henry Wilmot, recently worked in the biotech/pharmaceutical industry in Manhattan in a consulting capacity where he collaborated with clients to support commercialization for products geared to treat rare diseases. Working in biotechnology, he says, was fascinating and had impact but he also felt a disconnect.

Wilmot comes from a family of service professionals including a social worker, paramedic and pediatrician. He felt moved to add this aspect to his career path.

“I knew that I wanted to interact at the human level with patients and bring my experience from the business side of healthcare into the clinic to advocate for patients seeking complex therapeutics.”

 

Captions:

The Renaissance School of Medicine (RSOM) welcomed the incoming Class of 2028 in August. Set for their medical school training are, from left, students Gabriel Chan, Henry Wilmot, Reinaldo Powell, and Emily Cahill.

 

The 136 students comprising the incoming Class recite the Hippocratic Oath for the first time.

 

Photo Credit:

Arthur Fredericks

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Student falling asleep at his desk. Courtesy MetroCreative Connection

By Daniel Dunaief

Imagine a typical school classroom filled with adults, listening as intently as they can to a detailed lecture about the finer points of tax law or multivariable calculus.

The adults in the room who weren’t particularly interested in the topic might struggle to concentrate, and several of them might try — perhaps unsuccessfully — to stay awake.

Now, bring a group of 8-year-olds into the same room, with the same instructor, and the same material. The likelihood that any of those younger students would fall asleep in their chair is far lower.

One reason for that difference is that the younger set, consistently, gets more sleep, while the older generation, from high school students on up the chain, typically, are not as well-rested.

“We think it’s normal, if you’re bored, to fall asleep, but it’s not,” said Dr. Steven Feinsilver, director of the Center for Sleep Medicine at Northwell Lenox Hill Hospital. “Falling asleep in a lecture that doesn’t interest you means that you either have a sleep [problem] or, more likely, are sleep deprived.”

Indeed, the percentage of the population that is sleep deprived is estimated at around 50% or more, a staggering number, which means that at least half the population needs more restorative sleep.

With the start of another academic year just under a month away, sleep experts are urging students to start shifting back to their respective school sleep schedule in the coming weeks.

These sleep experts suggest that students who may sleep until 9 a.m. or later during the summer, but will soon get up for school at, say, 6 a.m., are experiencing a type of jet lag people often feel when they travel across the Atlantic.

Sleep experts say that changing an adolescent’s schedule to an earlier waking routine, a week or more before school starts, can ease that school-year transition, while others recommend shifting up wake-up time, by an hour earlier per day during the September lead-up.

“If you know you’re going to have to be waking up at 6 a.m. for the first day of high school, you should be starting to wake up within that hour, within three days or so, before that so your body gets used to it,” said Lauren Hale, professor of preventive medicine and sleep behavior expert at Stony Brook Medicine.

Routines, including getting enough sleep, are important in preparing for the mental effort required to meet daily learning challenges.

“Our brains like a consistent schedule,” said Brendan Duffy, director of Sleep Services at Catholic Health, which includes Port Jefferson-based St. Charles Hospital and Smithtown-based St. Catherine of Siena. “It’s important to get up at the same time,” even on weekends.

Teenagers need more sleep

The academic age group that needs the most sleep is the one that is often getting the least.

High schools often start just after 7 a.m., in part because after-school activities such as athletic practices and events, as well as other extra-curricular activities, take up the hours between the end of school and the onset of darkness.

“Between 15 and 25, everybody’s clock tends to run slow,” Feinsilver said.

The school districts that have pushed high school start times back have seen their test scores go up, added Feinsilver.

He acknowledged that it’s challenging for parents who are managing their own work schedules to balance their children’s academic hours. Parents and schools can and should try to compromise, he urged.

Benefits on the athletic field

Boy chases a soccer ball. Pixabay photo

A return to school also means the restarting of athletic programs, some of which begin before the first day of the new academic calendar.

Student-athletes are pushing their minds and bodies, as they juggle demanding academic requirements with training and competition.

Sleeping the estimated optimum of seven to nine hours per night not only helps improve an athlete’s competitive skills but also helps prevent physical problems.

Sleeping enough is a “way to avoid injuries,” said Duffy, who has been talking to students in a range of ages all the way through college.

Duffy added that professional teams are also encouraging athletes to budget for the sleep their minds and bodies need.

Additionally, he suggests sleep is a form of prehab, as sufficient rest can prevent injuries that would require rehabilitation.

Duffy has spoken with several area teams about the importance of sleep, including the Stony Brook women’s soccer team.

“For 90% of the players, this is the first time” they hear about the importance of sleep athletically, said Tobias Bischof, the head coach of SBU women’s soccer team. “My players are 18-to-22 years old and it’s not on their radar yet how important sleep is.”

He describes sleep as “probably the greatest recovery tool we have” and believes it’s “super important for injury prevention.”

As a coach, Bischof has started journaling his sleep patterns and believes he and others can be better coaches with enough rest.

He suggested that coaches are under tremendous pressure and sleep helps him become more patient.

Numerous factors contribute to success on and off the field with these student athletes, including nutrition, hydration, self-care and relationships with their families, as well as sleep, Bischof added.

The soccer coach doesn’t ask about sleep when he’s speaking with high school players who might join the SBU team, but it comes up when athletes ask about ways the school works with athletes beyond training.

He describes mental health support as well as sleep education.

“You always want to make them a better version of themselves,” Bischof said.

Jim Taylor, who specializes in the psychology of sports and parenting and who has been a consultant to the U.S. and Japanese ski teams, met Duffy when they were on a podcast panel related to sport psychology in 2022. Taylor suggested that sleep is much more than a physical process, as it has psychological and emotional implications.

“One of the most powerful tools that athletes have is sleep, which impacts them in so many ways,” he explained in an email.

Taylor, who competes in triathlons, has seen his results improve from top 20 in his age group to two national championship titles and three world championship podiums.

“Of course, I’m sure other factors contributed to my improved results, but I know that improved sleep was a key contributor,” he explained.

Mental health

Sleep can also be a sign of, or a contributing factor to, mental health issues.

In a Sleep-to-Rise campaign, the Sun Belt Conference suggests that talking about sleep is a gateway to discussing mental health.

Not getting enough sleep or poor sleep quality can increase the risk for mental health issues, while poor sleep itself can reflect mental health challenges.

In its sleep-to-rise online effort, the conference urges athletes to consider sleep a “competitive advantage.”

“With student-athletes, we emphasized the importance of prioritizing your sleep,” Lauren Shear, assistant commissioner of Championships & Sports Administration at the Sun Belt Conference, explained in an email. “This meant highlighting how sleep affects both mental health and physical health.”

Shear added that the conference tries to provide educational resources on mental health, nutrition, sleep and other factors to equip the student-athletes with the information they need to succeed in and outside competition.

She tries to get seven to eight hours of sleep per night and has noticed that when she gets six or less, she’s more irritable and lethargic. She’s also more likely to get sick.

Stony Brook’s Hale added that sleep, unlike diet or other life changes, can provide a noticeable benefit.

“People can see immediate results quicker than other behaviors,” Hale said. “If you choose not to have dessert, you might feel like you lost something and you don’t see a benefit the next day. If you actually got a full night of sleep, you might feel the benefits that day.”

Sleep tips from SBU’s Hale

•  Prioritize your sleep health

• Try to have regular sleep times, even on

weekends

• Make sure you get morning light

• Avoid substance use, like caffeine late in

the afternoon

• Put screens away before bedtime

• Sleep in a cool, dark, quiet place

• Pay attention to your body. Figure out when you get restorative rest compared with when you don’t.

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Sauces and breads are among the sneakiest offenders

By David Dunaief, M.D.

Dr. David Dunaief

If you have high blood pressure, you’ve probably been told to reduce your sodium. But what about the rest of us? 

According to the Centers for Disease Control and Prevention, about 90 percent of Americans consume too much sodium. This puts our health at risk — and not just for high blood pressure (1).

What are the effects of too much sodium?

In addition to increasing our risk of high blood pressure (hypertension), with consequences like stroke and heart disease, sodium can affect our kidney function, even without high blood pressure.

The Nurses’ Health Study evaluated kidney function in approximately 3,200 women, assessing estimated glomerular filtration rate (GFR) as related to sodium intake (2). Over 14 years, those with a daily sodium intake of 2,300 mg had a much greater chance of a 30 percent or more reduction in kidney function when compared to those who consumed 1,700 mg per day.

Kidneys are an important part of our systems for removing toxins and waste. They are also where many hypertension medications work, including ACE inhibitors, ARBs, and diuretics (water pills). If kidney function declines, it can be harder to treat high blood pressure. Worse, it could lead to chronic kidney disease and dialysis. Once someone has reached dialysis, most blood pressure medications are not very effective.

What are sodium recommendations?

Interestingly, the current recommended maximum sodium intake is 2,300 mg per day, or one teaspoon. If you’ve been paying attention, you’ve probably noticed that’s the same level that led to negative effects in the study. However, Americans’ average intake is 3,400 mg a day (1).

If we reduced our consumption by even a modest 20 percent, we could reduce the incidence of heart disease dramatically. Current recommendations from the FDA and the American Heart Association indicate an upper limit of 2,300 mg per day (3, 4). The American Heart Association goes further, suggestion an “ideal” limit of no more than 1,500 mg per day (3).

What are the biggest sodium sources?

More than 70 percent of our sodium intake comes from processed and packaged foods and from restaurants, not the saltshaker. There is nothing wrong with eating out or ordering in on occasion, but you can’t control how much salt goes into your food. Even when you request “no salt,” many items are pre-seasoned, and sauces can contain excessive amounts of sodium.

One approach to reduce your sodium intake is to choose products that have 200 mg or fewer per serving indicated on the label. Foods labeled “low sodium” have fewer than 140 mg of sodium. This is not the same as foods labeled “reduced sodium.” These have 25 percent less than the full-sodium version, which doesn’t mean much. For example, soy sauce has about 1,000 mg of sodium per tablespoon, but low-sodium soy sauce still has about 600 mg per tablespoon.

Salad dressings, sauces and other condiments, where serving sizes are small, add up quickly. Mustard has about 120 mg per teaspoon. Most of us use more than one teaspoon. Make sure to read the labels on all packaged foods and sauces very carefully, checking for sodium and for serving size. In restaurants, ask for sauces on the side and use them sparingly, if at all.

Bread products are another hidden source. Most contain a decent amount of sodium. I have seen a single slice of whole wheat bread include up to 200 mg. of sodium. That’s one slice. Make a sandwich with four ounces of lower sodium deli meat and mustard, and you could easily consume 1240 mg in a single sandwich.

Soups and canned goods are notoriously high in sodium. There are a few on the market that have no sodium. Look for these and add your own seasonings. Restaurant soups are a definite “no.”

Become an avid label reader. Sodium hides in all kinds of foods that don’t necessarily taste salty, such as cheeses, sweet sauces and salad dressings. Put all sauces and dressings on the side, so you can control how much — if any — you choose to use.

Is sea salt better than table salt?

Are sea salts better for you than table salt? Not really. They can have a slightly lower level of sodium, but that’s because their crystal shape means fewer granules fit in a teaspoon. I recommend not using either. In addition to causing health issues, salt dampens your taste buds, masking other flavors.

As you reduce your sodium intake, you might be surprised at how quickly your taste buds adjust. In just a few weeks, foods you previously thought didn’t taste salty will seem overwhelmingly so, and you will notice new flavors in unsalted foods.

When seasoning your food at home, use salt-free seasonings, like Trader Joe’s 21 Seasoning Salute or, if you prefer a salty taste, consider a salt substitute, like Benson’s Table Tasty.

References:

(1) cdc.gov. (2) Clin J Am Soc Nephrol. 2010;5:836-843. (3) heart.org. (4) fda.gov.

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

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Mather Hospital in Port Jefferson has announced that it has received five stars from the Centers for Medicare & Medicaid Services (CMS) for the second consecutive year, the highest rating possible using data that evaluates outcomes, patient experience and process. Mather was one of only three Northwell hospitals and 381 hospitals nationwide to earn the top rating. 

Northern Westchester and Glen Cove were the other five-star Northwell hospitals. Northwell achieved four-star ratings at Huntington Hospital, Lenox Hill Hospital in Manhattan, North Shore University Hospital in Manhasset and South Shore University Hospital in Bay Shore. 

CMS assigns star ratings to U.S. hospitals based on 46 hospital quality measures, which are divided into five quality categories: safety of care, mortality, patient experience, readmission rates, and timely and effective care 

“I am exceptionally proud of the entire Mather team for this rating that reflects our culture of providing high-quality patient care and exceptional patient experience,” said Executive Director Kevin McGeachy. “By maintaining a five-star rating for a second time, Mather is distinguished in the minds of our patients and the community as the place to go for consistently providing the highest levels of care. We are committed to continuous improvement in safety and patient satisfaction and will continue to invest in resources and initiatives that enhance the care we provide to our community.”

To learn more about the CMS ratings and the hospital rating data base, go to https://www.medicare.gov/care-compare/

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