Health

METRO photo

By Leah S. Dunaief

Leah Dunaief,
Publisher

Speaking of our health, which we often do with friends, there were a couple of interesting bits of news this week in that department.

Probably the most dramatic is the idea that by delaying the onset of menopause, a woman’s life and good health might be extended. The health benefits that women have before menopause lessen as we age past that mark. So current longevity research is asking if the whole picture could be slowed. And so, Dr. Jill Biden announced from the White House a new health initiative to pursue this concept, with Dr. Renee Wegrzyn steering the research.

Ovaries, which seem to play a role throughout a woman’s lifetime, not just until menopause, are the main focus. “Researchers think that prolonging their function, better aligning the length of their viability with that of other organs, could potentially alter the course of a woman’s health—and longevity research overall,” according to Tuesday’s front page story in The New York Times.

Using hormones like estrogen and progesterone, ovaries communicate with every other organ in the body. When they stop communicating, “all kinds of problems arise.” They stop when the eggs that they carry are gone, at which point risk increases for dementia, cardiovascular disease, osteoporosis and other age-related diseases and lifespan, according to The Times. Women whose ovaries have been prematurely removed for other health reasons are at greater risk, which suggests that even after all the eggs are gone, ovaries may still play a protective role.

All of this is subject to much further investigation. Researchers are not sure whether aging negatively affects the ovaries or if the ovaries cause other organs to age. But prolonging ovarian function in lab animals does seem to improve their health and longevity. This encourages further research into reducing the number of eggs lost by a woman during each menstrual cycle, thus preserving ovarian function. (Women shed may eggs many cycle but one ovulates). A current drug, rapamycin, which is an immunosuppressant used in organ transplants, is being studied for that role.

Anti-aging research is highly popular among scientists these days.

Another surprising article in the same issue of The Times, this one in the ScienceTimes section, has to do with our sense of smell. Though it lessens with age (and might as the result of infections, like Covid), “A diminished ability to smell is associated with worsening memory, cognition and overall well-being—as well as dementia and depression.”  The good news is that such a situation may be reversible. 

We can train our noses with smelling exercises, and our ability to smell, in turn, may improve not only depression but also help remember words faster. One explanation for this is “the areas of the brain involved in smelling are uniquely connected to parts involved in cognition, such as the prefrontal cortex.”  Further to the point, “The olfactory system is the only sensory system that has a direct superhighway projection into the memory centers and the emotional centers of your brain,” according to Professor Michael Leon of the University of California, Irvine.

So take out products from your kitchen cabinets and alternately smell cinnamon, honey, coffee, wine or others and sniff each of them at least 30 seconds at a time, once in the morning and once more at night. Small studies have indicated this not only tests one’s power to smell but also enhance cognitive abilities.

Finally for this column, I would like to quote the Times’ article on the Walking Cure for Lower Back Pain. Although those with pain may be loathe to exercise, movement can strengthen muscles that support the back and ease the pain. This is a conclusion that is supported with any number of studies over the past few years. 

“Researchers found that regular exercise combined with physical education was the most effective way to prevent lower back pain from recurring,” according to The NYT.

Walking can help strengthen the support muscles at the base of the spine. When they weaken, it can lead to pain.

So, as the song goes, “Shake, Shake, Shake Your Booty,” for good health. 

Photo courtesy of Stony Brook Medicine

Breast cancer research at the Stony Brook Cancer Center is taking a long-lasting, impactful leap forward thanks to the generous support from the Carol M. Baldwin Breast Cancer Research Fund. The Fund, which has been supporting research grants at Stony Brook for the last 25 years, has established a new $5.5 million endowment that will be used in perpetuity to fund breast cancer research at Stony Brook Medicine.

Carol M. Baldwin dedicated her life to helping other women overcome the struggles associated with breast cancer after her own diagnosis in 1990 and enduring a double mastectomy. After raising her six children on Long Island, New York, she formed the Fund in 1996 with her family, friends and health professionals with a mission to fight and ultimately win the battle against breast cancer. That same year, Stony Brook dedicated the Carol M. Baldwin Breast Care Center in recognition of her efforts to raise funds for cancer research. The care center continues to operate today within the Stony Brook Cancer Center. In addition to cancer care, the center treats patients with benign conditions of the breast and offers community education on overall breast health and cancer prevention.

“Carol was very supportive of local women who were newly diagnosed and would become their advocate to make sure they received the right treatment,” said Brian J. O’Hea, MD, director of the Carol M. Baldwin Breast Care Center. “This newly endowed fund will allow the expert care and research to continue and will ensure Carol’s legacy will always live on here at Stony Brook.”

Over the past few decades, the Fund has provided seed grants to more than 100 researchers at Stony Brook Medicine as they investigate the causes, prevention and treatment of breast cancer. In memory of Carol, who passed away in 2022, the new endowed Fund will ensure that breast cancer research at Stony Brook will continue for years to come. With the State Endowment Match Challenge and the Simons Infinity Investment Challenge, this gift will have an impact of $16.5 million.

“Through the support of the Carol M. Baldwin Breast Cancer Research Fund, our researchers will learn more about breast cancer, providing us better methods of detection and treatment,” said William Wertheim, MD, interim executive vice president of Stony Brook Medicine. “This endowed gift will allow that important work to continue in perpetuity as our researchers search for advances in technology and medicine.”

This past May, the National Accreditation Program for Breast Centers (NAPBC) awarded the center a full three-year reaccreditation. According to O’Hea, NAPBC-accredited programs have demonstrated excellence in organizing and managing a breast care center to facilitate multidisciplinary, integrated and comprehensive breast cancer services.

By Samantha Rutt

Although your backyard pool or local beach may seem like the perfect oasis, they can also pose significant safety risks. Following decades of decline, the Centers for Disease Control and Prevention reports drowning deaths are on the rise in the United States. Based on a study released on May 14, from 2020-22, over 4,500 people died from drowning each year — 500 more per year compared to 2019. 

In all of New York State, Suffolk County holds the third highest rate of drownings at county regulated facilities, sitting only behind New York City and Nassau County, according to data from the New York State Department of Health.

“There was a rescue almost everyday,” former facility manager at the Centereach Pool, Shannon Ryan said. “It is important that everyone knows how to swim, after all, we live on an island surrounded by water.” 

Who is most at risk?

Statistics reveal that children and teenagers are most at risk of drowning. The CDC reports that drowning is the leading cause of unintentional injury death for children ages 1-4 and the second leading cause for children ages 5-14. 

Young children are particularly vulnerable around residential pools, while older children and teenagers face risks in larger bodies of water such as the ocean or lakes.

Additionally, African American children ages 10-14 are 7.6 times more likely to drown in swimming pools compared to their White peers. 

“You may be surprised as to how many people do not know how to swim,” Ryan shared in an interview. “Either not knowing how to swim or oftentimes a parent not paying close attention to their children I’d say is the most common reason we make rescues,” the facility manager said of her experience.

Almost 40 million adults in the United States do not know how to swim and over half have never taken a swimming lesson, according to CDC compiled data. 

What to do in an emergent situation

Though not daily, emergent situations at the pool are frequent. If you or someone near you witnesses a swimmer in distress, it is important to notify a lifeguard immediately. 

“In an emergency situation it is first that the lifeguard or facility staff activates EAP [emergency action protocol] which involves making necessary whistle codes and assessing the victim for any further medical attention,” Ryan said. “Usually, thankfully, additional care like CPR or rescue breathing is avoided thanks to the in-depth training our guards practice.” 

Advice from a lifeguard

Ryan, who has also spent a handful of summers as a senior lifeguard at Cedar West Beach in Mount Sinai, shared some helpful tips for those looking to the waters this season. 

“It is important to know how to swim and if you don’t, to take the right precautions by wearing a floatation device or having parental supervision or assistance,” Ryan said.

She emphasized the need to stay hydrated, sunblocked and knowing where help can be found, if needed.

“Especially in the dense heat of the summer, is it important to stay hydrated. We have seen people who are in the sun all day without proper fuel or shade and these are the situations to look out for,” Ryan said. “Wearing sunblock for UV protection and knowing where first aid and all the guard towers can be found are great ways to help protect yourself when you are by the water.”

Dr. William Wertheim. Photo by Jeanne Neville/Stony Brook Medicine

Stony Brook University President Maurie McInnis has announced that William Wertheim, MD, MBA, has been promoted to executive vice president, Stony Brook Medicine. Dr. Wertheim, who has been serving as the interim executive vice president role will continue to report to the university’s president and is a member of the senior leadership team. In this role, he will continue to work in partnership with academic, hospital and clinical leadership and with community partners to ensure the continued development and excellence of the premier academic medical center and health system. Stony Brook Medicine’s leadership team will continue to report to Dr. Wertheim.

“I have been impressed by Dr. Wertheim’s engaging leadership style that prioritizes collaboration and action,” said President McInnis. “He is deeply respected for his approach that has fostered a culture of teamwork and inclusivity and as a result, Stony Brook Medicine continues to make meaningful strides in expanding patient access, elevating research, and innovating in its approach to teaching and learning. I am confident that Stony Brook Medicine will continue to thrive under his leadership.”

Under Dr. Wertheim’s leadership, Stony Brook has grown patient visits throughout its hospitals, ambulatory centers and clinical practice groups. The recruitment of 28 new providers to the East End has allowed Stony Brook Medicine 14,000 additional patient visits in the community. From supporting the development of clinical research spaces at Stony Brook University Hospital and the Lake Grove and Commack Advanced Specialty Care centers to participation in student and resident research days across the institution, it is clear Dr. Wertheim wholeheartedly believes in Stony Brook Medicine’s research mission and supports innovation in clinical practice.

Dr. Wertheim joined Stony Brook in 1996 and previous to his interim position, served as vice dean for academic affairs of Stony Brook’s Renaissance School of Medicine (RSOM). He also holds the Endowed Chair in Graduate Medical Education at RSOM and is president of the Stony Brook Medicine Community Medical Group.

A graduate of Harvard University and New York University School of Medicine, Dr. Wertheim completed his internal medicine residency at University of Michigan Hospitals, where he also served as chief resident. He worked as a clinical faculty member at the University of Michigan’s Veterans Administration Hospital, then moved to New York, where he worked at The Brooklyn Hospital Center.

“Having been part of this remarkable academic healthcare center for years, I’ve seen the unwavering commitment, the tireless dedication and the profound impact we make on the lives of our patients and their families,” said William A. Wertheim, MD, MBA, executive vice president for Stony Brook Medicine. “Together, we’ve championed excellence in healthcare and education, solidifying our position as a leader in academic medicine. I am deeply excited about the journey ahead and the future we will shape together.”

Call 911 at the first sign of a heart attack. METRO photo

By David Dunaief, M.D.

One person every 40 seconds: that’s how prevalent heart attacks still are in the U.S. (1). Your gender and race don’t matter, we’re all susceptible. Of these 805,000 annual heart attacks, one in five is “silent” — you might not be aware you’ve had it, but your body is still affected. The good news is that your potential outcomes are significantly better if you recognize the symptoms while having a heart attack and receive immediate medical attention.

What are heart attack symptoms?

The most recognizable symptom is chest pain. However, there are an array of more subtle symptoms, such as discomfort or pain in the neck, back, jaw, arms and upper abdominal areas. You might also experience nausea, shortness of breath, sweating, light-headedness and tachycardia (racing heart rate). Unfortunately, most people don’t recognize these as symptoms of heart attack (2). According to one study, about 10 percent of patients present with atypical symptoms and no chest pain (3).

Are heart attack symptoms really different for men and women?

There has been much discussion about whether men and women have different symptoms when it comes to heart attacks. What does the research tell us?

There is data showing that, although men have heart attacks more commonly, women are more likely to die from a heart attack (4). In a Swedish study of 54,000 heart attack patients, one-third were women.  After having a heart attack, a significantly greater number of women died in the hospital or near-term when compared to men. The women received aggressive treatments, such as reperfusion therapy, artery opening treatment that includes medications or invasive procedures, less often than the men.

However, recurrent heart attacks occurred at the same rate, regardless of sex. Both men and women had similar findings on an electrocardiogram.

One theory about why women receive less aggressive treatment when first presenting in the ER is that they have different and more subtle symptoms — even chest pain symptoms may be different. Is this true? Not according to studies.

In one observational study of 2,500 patients, results showed that, though there were some subtle differences, when men and women presented with chest pain as the main symptom, it was of a similar nature (5). There were 34 chest pain characteristic questions used to determine if a difference existed. These included location, quality or type of pain and duration. Of these, there was some small amount of divergence: the duration was shorter for a man (2 to 30 minutes), and pain subsided more for men than for women. The authors concluded that determination of heart attacks with chest pain symptoms should not factor in the sex of patients.

This trial involved an older population; patients were a median age of 70 for women and 59 for men, with more men having had a prior heart attack. The population difference was a conspicuous weakness of an otherwise solid study, since age and previous heart attack history are important factors.

In the GENESIS-PRAXY study, another observational study, the median age of both men and women was 49. Results showed that chest pain remained the most prevalent presenting symptom in both men and women (6). However, of the patients who presented without distinct chest pain and with less specific EKG findings, significantly more were women than men.

Those who did not have chest pain symptoms may have experienced back discomfort, weakness, discomfort or pain in the throat, neck, right arm and/or shoulder, flushing, nausea, vomiting and headache. If the patients did not have chest pain, regardless of sex, the symptoms were diffuse and nonspecific. 

Some studies imply that up to 35 percent of patients do not present with chest pain as their primary complaint (7).

Is someone having a heart attack?

Call 911 immediately, and have the patient chew an adult aspirin (325 mg) or four baby aspirins, provided they do not have a condition that precludes taking aspirin. The purpose of aspirin is to thin the blood quickly, but not if the person might have a ruptured blood vessel. The 911 operator or emergency medical technician who responds can help you determine whether aspirin is appropriate.

Don’t hesitate to seek immediate medical attention; it’s better to have a medical professional rule out a heart attack than to ignore one.

The most frequently occurring heart attack symptoms

Most patients have similar types of chest pain, regardless of gender. However, this is where the complexity begins. The percentage of patients who present without chest pain seems to vary depending on which study you review — ranging from less than 10 percent to 35 percent.

Non-chest pain heart attacks have a bevy of diffuse symptoms, including obscure pain, nausea, shortness of breath and light-headedness. This is seen in both men and women, although it occurs more often in women. It’s important to recognize heart attack symptoms, since quick action can save your life or a loved one’s.

References:

(1) csc.gov. (2) MMWR. 2008;57:175–179. (3) Chest. 2004;126:461-469. (4) Int J Cardiol. 2013;168:1041-1047. (5) JAMA Intern Med. 2014 Feb. 1;174:241-249. (6) JAMA Intern Med. 2013;173:1863-1871. (7) JAMA. 2012;307:813-822.

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.

As the ribbon was cut on the “soft opening” of the new Memory Support Neighborhood and Assisted Living upgrades at Jefferson’s Ferry Life Plan Community in South Setauket on May 29, the packed house of spectators burst into spontaneous applause. Representative of the latest innovations in memory support living, “The Grove,” was welcomed by community residents, family members, supporters, and Jefferson’s Ferry board trustees. 

“This is a very special day for us as we open the doors to this beautiful, welcoming, and secure space,” said Jefferson’s Ferry President and CEO Bob Caulfield. “The Grove will help us accommodate the increased demand for memory support services within Jefferson’s Ferry and in the larger Long Island community in a state-of-the-art and homelike environment. The number of people experiencing memory loss has increased and is expected to continue to rise as more people live into their 90s and even 100s. Jefferson’s Ferry strives to provide a community where every resident is able to live their best life, no matter what challenges they may be facing.” 

The Grove will be home to 20 residents inhabiting private studio apartments. A variety of community spaces include an activities room, den, dining room and outdoor porch and garden, creating an inviting living space where residents, family members, and friends can spend time together socializing and pursuing meaningful and purposeful activities. Its circular layout is specially designed to allow for residents to wander within the safety of their environment with more choice and control of their daily activities. 

“There are abundant opportunities for socializing and activities for every resident to enjoy, ranging from soothing aromatherapy treatments to awe-inspiring virtual reality programming,” explained Dawn Flowers-Leib, director of admissions for The Grove. “Through virtual reality tools, our residents can travel to any place on Earth, from Paris to their old neighborhoods (using Google Maps and Street View). They can also ‘meet’ with family and friends to look at photos, play games, watch movies or simply enjoy each others’ company.” 

Grove activities will be specifically tailored to the interests and abilities of the residents, including smaller, more intimate activities that encourage greater opportunities for meaningful and engaged participation. Pet therapy, music and art therapy and other programs will also be available to residents.

Caulfield thanked the residents and staff for their enthusiasm and support throughout the entire multi-year Journey Toward Renewal initiative that includes the opening of The Grove and renovations to the dining options in Assisted Living. Journey Toward Renewal also added 60 new studio and one- and two-bedroom independent living apartments, some with a den, six distinct dining venues, expanded the Healthy Living Center, the Fitness Center, and its state-of-the-art Rehabilitation Therapy Center.

“Since Jefferson’s Ferry opened in 2001 as the first not for profit Life Plan community on Long Island, we have endeavored to set the standard for continuing care for older adults, providing a vibrant, caring, community and peace of mind to our residents,” concluded Caulfield. “Over our more than 20 years in operation, Jefferson’s Ferry has continued to evolve to meet the changing needs of the people who call Jefferson’s Ferry home. The opening of The Grove and our overall Journey Toward Renewal is evidence of this unswerving and ongoing commitment to excellence.”

World Trade Center worker. Photo courtesy Steven Spak

By Daniel Dunaief 

First responders who raced to the World Trade Center site on 9/11 or who helped with the massive clean up effort did so at risk to themselves.

That was as true during those days and weeks after the attack as it is now, with many of the first responders experiencing a range of diseases and conditions linked to the difficult work they did in 2001.

In a study released recently in the journal JAMA Network Open, Sean Clouston, Professor in the Program in Public Health and in the Department of Family, Population and Preventive Medicine in the Renaissance School of Medicine at Stony Brook University, showed that 4.6 percent of the responders in a study developed dementia. That compares with 0.5 percent for the general population of people who would develop cognitive declines in a similar age group.

Between November of 2014 and January of 2023, 228 responders without dementia and under 60 years old at the start of the study developed dementia over the next five years.

“It’s stunning to see these kinds of symptoms in such young people,” said Clouston.

Through the Stony Brook WTC Health and Wellness Program, Clouston and other researchers have documented some of the cognitive declines in this population, who likely inhaled the kinds of fine particulate matter that can enter the brain and cause damage even as the immune system fights to try to target the unwelcome contaminants.

“We assume this made it in the brain, but in such a way that it wasn’t overwhelming immediately,” said Clouston. “Once you get into a neurodegenerative space, most of these diseases take a long time to develop” with neurodegenerative processes sometimes taking decades to occur.

The exposure could have caused an immune reaction. They are not sure whether symptoms emerged because the reaction was stronger or if the symptoms developed because higher exposure triggered a stronger reaction.

“It’s like trying to fight a fire, and the truck rolls over a garden to do it,” said Clouston.

Fortunately, the brain has considerable redundancy, which makes it possible to reroute brain signals to compensate for problems. Over time, however, that ability might be damaged by that work or by the exposure.

Determining which particular chemical or chemicals causes the greatest damage is difficult, particularly because the collapse and burning of the buildings caused a heterogeneous mixture of so many industrial products to enter the air. It may not matter much, as any material in the brain could be a problem. The type of exposure may also affect the severity of the immune reaction or which parts of the brain are damaged.

Scientists suggest that some of the contaminants that have contributed to health defects may come from the various tools in offices, such as computers and air conditioners.

“As we go forward [with other studies], that will be a focus of ours, to see if we can’t isolate at least one or maybe a couple” of chemicals that could exacerbate the cognitive decline, Clouston said.

Different exposures

Clouston and his collaborators used surveys to find out exposure at the site.

Some of the first responders, for example, used face masks and wore personal protective equipment, including hazmat suits. The incidence of dementia among that group was considerably lower than it was for those who didn’t wear masks.

Five or six out of every 1,000 workers who wore PPE developed dementia, while those without protection developed cognitive decline at the much higher rate of 42 out of 1,000.

The researchers tried to address the possibility that those people who were masks lived a healthier lifestyle prior to 9/11 and may have already been less likely to develop diseases or health conditions.

“We tried to account for that,” Clouston said. In most cases, people aren’t avoiding the kinds of activities or decisions that likely contribute to dementia, such as diet and exercise, which, the general population “widely ignores already,” he said.

Additionally, while a family history of dementia or other medical conditions mattered to some degree for the reported cases, they weren’t sufficient to invalidate the statistically significant result.

To be sure, Clouston acknowledged that the study could have a screening bias, as cognitive evaluations every 18 months likely far exceeds how often most people in the same age group receive testing for their mental acuity.

This is one reason they developed a minimally exposed group that could account for that bias. In that group, dementia was close to, but still higher than the expected rates for the general population.

The number of first responders with dementia far exceeded this group.

Other health threats

Medical professionals have been studying the impacts of other events that release aerosolized particles that could be hazardous to people’s health and could damage the environment.

Burn pits, which the military used in Iraq and Afghanistan, among other locations, contributed to cancers and other diseases among members of the military serving overseas.

Natural disasters, such as the Maui fire last August that not only burned through forests but also destroyed commercial buildings, also create a hazard.

People fled the fire quickly and then returned to search for their loved ones, Clouston said, which exposed them to aerosolized dust.

It would be “good to think about studies to consider risk of dementia” from these events, he added. 

“These studies would probably take a while to complete as the risk grows with time and with age.”

Catholic Health hosts a Community Health Fair at 245 Old Country Road, Melville on Saturday, June 22 from 11 a.m. to 3 p.m. Enjoy a day of healthy fun with free health screenings, CPR/First Aid demonstrations, free narcan kits, and educational activities for all ages including a teddy bear clinic. Meet with Catholic Health specialists and other vendors and enjoy lots of free giveaways. Rain date is June 23. For more information and to register for a free gift, please call 516-705-3839.

METRO Photo
PPIs may affect vitamin absorption and increase fracture risk

By David Dunaief, M.D.

Dr. David Dunaief

Who hasn’t had “reflux” or “heartburn” after a meal? Most of us have experienced these symptoms on occasion. When they are more frequent, you should see a physician to rule out serious causes, like Gastroesophageal reflux disease (GERD).

GERD is estimated to affect between 18.1 and 27.8 percent of U.S. adults, although the real number might be higher, since many self-treat with over-the-counter (OTC) medications (1).

Proton pump inhibitors (PPIs), first launched in 1989, have become one of the top-10 drug classes prescribed or taken OTC. Familiar OTC brands include Prilosec (omeprazole), Nexium (esomeprazole), and Prevacid (lansoprazole), among others. They are also available by prescription.

PPIs are not intended for long-term use, because of their robust side effect profile. The FDA currently suggests that OTC PPIs should be taken for no more than a 14-day treatment once every four months. Prescription PPIs should be taken for 4 to 8 weeks (2).

However, their OTC availability can lead patients to take them too long or too often to manage reflux rebound effects when PPIs are discontinued without physician oversight.

Among potential associations with long-term use are chronic kidney disease, dementia, bone fractures, increased cardiac and vascular risks, vitamin malabsorption issues and Clostridium difficile, a bacterial infection of the gastrointestinal tract.

Do PPIs affect the kidneys?

In two separate studies, results showed that there was an increase in chronic kidney disease with prolonged PPI use (3). All patients started the study with normal kidney function, based on glomerular filtration rate (GFR). In the Atherosclerosis Risk in Communities (ARIC) study, there was a 50 percent increased risk of chronic kidney disease, while the Geisinger Health System cohort study found there was a 17 percent increased risk.

The first study had a 13-year duration, and the second had about a six-year duration. Both demonstrated modest, but statistically significant, increased risk of chronic kidney disease. But as you can see, the medications were used on a chronic basis for years. In an accompanying editorial to these published studies, the author suggests that there is overuse of the medications or that they are used beyond the resolution of symptoms and suggests starting with diet and lifestyle modifications and a milder drug class, H2 blockers (4).

Do PPIs increase dementia risk?

A German study looked at health records from a large public insurer and found there was a 44 percent increased risk of dementia in the elderly who were using PPIs, compared to those who were not (5). These patients were 75 or older. The authors surmise that PPIs may cross the blood-brain barrier and potentially increase beta-amyloid levels, markers for dementia. With occasional use, meaning once every 18 months for a few weeks to a few months, there was a much lower, 16 percent, increased risk.

The researchers also suggested that PPIs may be significantly overprescribed in the elderly. The research was not perfect. For example, researchers did not consider high blood pressure, excessive alcohol use or family history of dementia, all of which can influence dementia occurrence.

Do PPIs increase fracture risk?

In a meta-analysis of 18 observational studies, results showed that PPIs can increase the risk of hip fractures, spine fractures and any-site fractures (6). Interestingly, when it came to bone fractures, it did not make a difference whether patients were taking PPIs for more or less than a year.

They found increased fracture risks of 58, 26 and 33 percent for spine, hip and any-site, respectively. It is not clear what may potentially increase the risk; however, it has been proposed that it may have to do with calcium absorption. PPIs reduce acid, which may be needed to absorb insoluble calcium salts. In another study, seven days of PPIs were shown to lower the absorption of calcium carbonate supplements when taken without food (7).

PPIs & vitamin absorption

In addition to calcium absorption issues, PPIs may have lower absorption effects on magnesium and B12. In one observational study, PPIs combined with diuretics caused a 73 percent increased risk of hospitalization due to low magnesium (8). Diuretics are commonly prescribed for high blood pressure, heart failure and swelling.

Another study’s results showed long-term use of over two years increased vitamin B12 deficiency risk by 65 percent (9).

The bottom line

It’s best if you confer with your doctor before starting PPIs. You might benefit from a milder medication, such as an H2 blocker (Zantac, Pepcid). In addition, PPIs can interfere with other drugs you are taking, such as Plavix (clopidogrel).

Even better, start with lifestyle changes. Try not eating later at night, raising the head of the bed, losing weight and stopping smoking, if needed, before you consider medications (10).

If you do need medication, recognize that PPIs don’t give immediate relief and should only be taken for a short duration to minimize their side effects.

References:

(1) nih.gov. (2) fda.gov. (3) JAMA Intern Med. 2016;176(2). (4) JAMA Intern Med. 2016;176(2):172-174. (5) JAMA Neurol. online Feb 15, 2016. (6) Osteoporos Int. online Oct 13, 2015. (7) Am J Med. 118:778-781. (8) PLoS Med. 2014;11(9):e1001736. (9) Mayo Clinic Proceedings. 2018 Feb;93(2):240-246. (10) Am J Gastroenterol 2015; 110:393–400.

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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Batter up and give blood! Town of Brookhaven Councilwoman Jane Bonner and Knights of Columbus #5814, 683 Route 25A, Rocky Point will host a Community Blood Drive on Wednesday, June 19 from 1 to 7 p.m.  Each donor will receive a pair of New York Mets tickets (while supplies last). Appointments preferred by calling 1-800-933-2566 or visit www.nybc.org  but walk-ins welcome.  For more information, call Jennifer at 516-310-2382.