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Consequences can be greater than snoring and fatigue

By David Dunaief, M.D.

Dr. David Dunaief

Good sleep contributes to our physical and mental wellbeing, however many of us struggle to get quality, restful sleep. For those with obstructive sleep apnea (OSA), quality sleep is especially elusive.

Sleep apnea is an abnormal pause in breathing that occurs at least five times an hour while sleeping. It can have an array of causes, the most common of which is airway obstruction. Some estimates suggest that about 30 million people suffer from sleep apnea in the United States (1).

Obstructive sleep apnea (OSA), also known as sleep-disordered breathing, may affect up to 30 percent of adults. OSA diagnoses are classified as either mild, moderate or severe. It’s estimated that roughly 80 percent of moderate and severe OSA sufferers are undiagnosed.

Risk factors for OSA include chronic nasal congestion, large neck circumference, excess weight or obesity, alcohol use, smoking and a family history (2). Many of these factors, however, are modifiable.

Significant symptoms of OSA tend to be quality of life issues and include daytime fatigue, loud snoring, breathing cessation observed by another, impaired concentration and morning headaches. While these are significant, it’s more concerning that OSA is also associated with an array of more serious health consequences, such as cardiovascular disease, high blood pressure and depression.

Fortunately, we have an arsenal of treatment options, including continuous positive airway pressure (CPAP) devices; oral appliances; lifestyle modifications, such as diet, exercise, smoking cessation and reduced alcohol intake; and some medications.

What is the impact on cardiovascular disease risk?

In an observational study, the risk of cardiovascular mortality increased in a linear fashion with the severity of OSA (3). For those with mild-to-moderate untreated sleep apnea, there was a 60 percent increased risk of death; for those in the severe group, this risk jumped considerably to 250 percent. However, the good news is that treating patients with CPAP considerably decreased their risk by 81 percent for mild-to-moderate patients and 45 percent for severe OSA patients. This study involved 1,116 women over a six-year duration.

Another observational study with male subjects showed similar risks of cardiovascular disease with sleep apnea and benefits from CPAP treatment (4). There were more than 1,500 men in this study with a 10-year follow-up. The authors concluded that severe sleep apnea increases the risk of nonfatal and fatal cardiovascular events, and CPAP was effective in curbing these occurrences.

In a third study, this time involving the elderly, OSA increased the risk of cardiovascular death in mild-to-moderate patients and in those with severe OSA by 38 and 125 percent, respectively (5). But, as in the previous studies, CPAP decreased the risk in both groups significantly. In the elderly, an increased risk of falls, cognitive decline and difficult-to-control high blood pressure may be signs of OSA.

Is there a cancer connection?

In sleep apnea patients under age 65, a study showed an increased risk of cancer (6). The authors believe that intermittent low levels of oxygen, caused by the many frequent short bouts of breathing cessation, may be responsible for the development of tumors and their subsequent growth.

The greater the percentage of time patients spend in hypoxia (low oxygen) at night, the greater the risk of cancer. For those patients with more than 12 percent low-oxygen levels at night, there was a twofold increased risk of cancer development when compared to those with less than 1.2 percent low-oxygen levels.

Does OSA affect male sexual function?

It appears that erectile dysfunction (ED) may also be associated with OSA. CPAP may decrease this incidence. This was demonstrated in a small study involving 92 men with ED (7). The surprising aspects of this study were that, at baseline, the participants were overweight, not obese, on average and were only 45 years old. In those with mild OSA, the CPAP had a beneficial effect in over half of the men. For those with moderate and severe OSA, the effect was still significant, though not as robust, at 29 and 27 percent, respectively.

An array of other studies on the association between OSA and ED have varying results, depending on the age and existing health challenges of the participants. Some study authors have postulated that other underlying health problems may be the cause in some patient populations.

Can diet help?

For some of my patients, their goal is to discontinue their CPAP. Diet may be an alternative to CPAP, or it may be used in combination with CPAP to improve results.

In a small study of those with moderate-to-severe OSA levels, a low-energy diet showed positive results. A low-energy diet implies a low-calorie approach, such as a diet that is plant-based and nutrient-rich. It makes sense, this can help with weight loss. In the study, almost 50 percent of those who followed this type of diet were able to discontinue CPAP (8). The results endured for at least one year.

The bottom line is that if you think you or someone else is suffering from sleep apnea, it is important to be evaluated at a sleep lab and then follow up with your doctor. Don’t suffer from sleep apnea and, more importantly, don’t let obstructive sleep apnea cause severe complications, possibly robbing you of more than sleep. There are many effective treatments.

References: 

(1) sleepapnea.org. (2) JAMA. 2004;291(16):2013. (3) Ann Intern Med. 2012 Jan 17;156(2):115-122. (4) Lancet. 2005 Mar 19-25;365(9464):1046-1053. (5) Am J Respir Crit Care Med. 2012;186(9):909-916. (6) Am J Respir Crit Care Med. 2012 Nov. 15. (7) Sleep. 2012;35:A0574. (8) BMJ. 2011;342:d3017.

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.

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Photo from Mather Hospital

The American Association of Critical-Care Nurses (AACN) has awarded a gold-level Beacon Award for Excellence to Mather Hospital’s Critical Care team in Port Jefferson.

The Beacon Award for Excellence — a significant milestone on the path to exceptional patient care and healthy work environments — recognizes unit caregivers who successfully improve patient outcomes and align practices with AACN’s six Healthy Work Environment Standards. Units that achieve this three-year, three-level award with gold, silver or bronze designations meet national criteria consistent with the ANCC Magnet Recognition Program®, the Malcolm Baldrige National Quality Award and the National Quality Healthcare Award.

“I want to extend my congratulations to Mather Hospital’s Critical Care team on earning a gold-level Beacon Award for Excellence from the American Association of Critical-Care Nurses,” said Mather Hospital CNO/VP for Nursing Marie Mulligan, PhD, RN, CNOR, NEA-BC. “This designation is the highest level of recognition that Critical Care services can achieve for this award.”

“Achieving the gold level AACN Beacon Award for Excellence is a tremendous honor and validates our nursing team’s efforts for providing high quality care and optimal patient outcomes,” said Laura O’Brien RN MSN CRN, NE-BC, Nursing Director of Critical Care at Mather Hospital.

AACN President Beth Wathen, MSN, APRN, CCRN-K, applauded the commitment of the Critical Care caregivers at Mather Hospital for working together to meet and exceed the high standards set forth by the Beacon Award for Excellence. “The Beacon Award for Excellence is a testament to a team’s commitment to providing safe, patient-centered and evidence-based care to patients and families. Creating healthy and supportive work environments empowers nurses and other team members to make their optimal contribution,” Wathen said. 

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This rendered image of the brain via a technique called diffusion tractography reveals parts of the brain’s white matter in a compilation of WTC responders experiencing cognitive impairment (CT). These areas depicted by various colors illustrate where the brain is more vulnerable to neurodegenerative processes. The different colors represent differences in the heath of various parts of the brain including the limbic system. Credit: Chuan Huang
Stony Brook-led imaging study sheds light on PTSD-associated mental decline

A study that assessed the brains of 99 World Trade Center (WTC) responders by using diffusion tractography, a 3-D imaging technique, showed that WTC responders with cognitive impairment (CI), a possible sign of dementia, and post-traumatic stress disorder (PTSD), have a different presentation of the white matter in their brains compared to responders with CI without PTSD. Led by researchers at Stony Brook University affiliated with the Stony Brook WTC Health and Wellness Program, the study suggests a specific form of dementia could be affecting WTC responders who also have PTSD. The findings are published early online in the Journal of Alzheimer’s Disease.

According to the authors, this is the first study to examine white matter alterations using connectometry in a sample of WTC responders in mid-life (average age: 56) with and without concurrent PTSD. The goal of the study was to examine and elucidate the extent to which white matter tract integrity might be impaired in WTC responders with CI and/or PTSD. Previously, the researchers had identified changes in white matter diffusivity in small numbers of responder patients.

“Our findings are by no means conclusive in terms of defining CI or dementia in WTC responders, and if this study provides evidence of a new form of dementia emerging,” says Sean Clouston, PhD, lead author and Associate Professor in the Program in Public Health, and in the Department of Family, Population, and Preventive Medicine at Stony Brook University.

“Overall, the study supports the view that responders with CI have neurological changes consistent with neurodegenerative disease, but they are inconclusive as to the type of disease,” he adds. “Our findings do show that dementia due to PTSD is clearly different from non-PTSD dementia in this responder population.”

Subjects in the study were matched by age, gender, occupation, race and education. Cognitive status was determined by using the Montreal Cognitive Assessment, and PTSD status was determined by using the Diagnostics and Statistics Manual-IV. The researchers used diffusion tensor imaging via a mMR scanner, and they used connectometry to examine whole-brain tract level differences in white matter integrity as reflected by fractional anistrophy (FA) values.

In summary, the team found that FA was negatively correlated with CI and PTSD status in the fornix, cingulum, forceps minor of the corpus callosum, and the right uncinate fasciculus. Additionally, FA was negatively correlated with PTSD status, regardless of the CI status in the superior thalamic radiation and the cerebellum.

The authors conclude that the brain imaging results “suggest that WTC responders with early-onset CI may be experiencing an early neurodegenerative process characterized by decreased FA in white matter tracts.”

The technique and other findings

Clouston and colleagues used the imaging technique diffusion tractography to examine how healthy axons are in the brain’s white matter. The technique helped to determine that responders with CI had signatures in their white matter that did not match patterns seen in old-age Alzheimer’s disease and other related dementias.

By using the imaging technique, they also compared responders with PTSD and dementia to those with dementia but without PTSD. The imaging revealed a lot of similarities between the groups but also showed a remarkable difference in the white matter of those with PTSD and dementia – showing evidence of cerebellar atrophy, a finding that is inconsistent with other studies of dementia.

The research for the study was supported in part by the National Institutes of Health’s National Institute on Aging (grant # R01AG049953), and the Centers for Disease Control and Prevention (grant # U010H011314) and the National Institute for Occupational Safety and Health, NIOSH, (grant # 200-2011-39361).

 

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Narcan kit

The Town of Smithtown Horizons Counseling & Education Center will mark International Overdose Awareness Day and Recovery Month by holding NARCAN® training events for the community. On Wednesday, August 31 at noon and Tuesday, September 13 at 7 p.m., there will be free NARCAN® training seminars in the Community Room of Horizons Counseling and Education Center, located at 161 E. Main Street, Smithtown.

“An event such as this is imperative in these times we are experiencing as a country, state, county and town. With rising stressors facing our communities, behavioral health awareness and support are in great need. Alcohol and substance abuse continue to plague communities, we see opioid overdose numbers front and center in conversations, media reports and the starring role on the screen when turning on the television or opening the newspaper. An event such as this allows for Horizons to outreach our community to increase awareness and capacity for the town residents and equip them with the knowledge and skills to provide lifesaving acts such as opioid overdose reversal with Narcan. Continued discussion and education on opioid overdose and awareness will encourage a decrease in stigma and create an environment supportive of recovery for those who are seeking recovery for opioid use disorder. This event will provide exactly that to our local community,” said Joe Bieniewicz, Director of Drug and Alcohol Counseling Services.

On International Overdose Awareness Day, people and communities come together to raise awareness of one of the world’s most urgent public health crises – one that, unfortunately, is only getting worse. Having an outpatient drug and alcohol agency right in the township is an asset for the community. Additionally, learning the signs of an overdose can help save a life.

“International Overdose Awareness Day is important not only to acknowledge those who have been lost to the disease of addiction, but also to educate and offer hope to those who are still struggling,” said Alexa Stern, Drug and Alcohol Community Coordinator.

Narcan kits will be provided for free. Horizons Counseling & Education Center resource tables will be set up around the training area, filled with information about recovery services, the outpatient program and substance misuse prevention education. All are welcome to attend to get trained and to hear about the drug and alcohol treatment and prevention services that Horizons provides.

Space is limited and on a first come first serve basis. Residents can reserve space by contacting Horizons Counseling & Education Center at 631-360-7578, via email at [email protected] or registering online at http://events.constantcontact.com/register/event?llr=4qqg9a4ab&oeidk=a07ejc7ez2h6982f465

About International Overdose Awareness Day:

Observed on the 31st of August every year, International Overdose Awareness Day (IOAD) seeks to create better understanding of overdose, reduce the stigma of drug-related deaths, and create change that reduces the harms associated with drug use. International Overdose Awareness Day is convened by Penington Institute, an Australian not-for-profit.

International Overdose Awareness Day is the world’s largest annual campaign to end overdose, remember without stigma those who have died and acknowledge the grief of the family and friends left behind. It began in 2001, led by Sally J Finn at The Salvation Army in St Kilda, Melbourne. Since then, communities, governments, and organizations work to raise overdose awareness about one of the world’s worst public health crises, and promote action and discussion about evidence-based overdose prevention and drug policy.

About Substance Abuse and Mental Health Services Administration Recovery Month:

Substance Abuse and Mental Health Services Administration (SAMHSA) Recovery Month is a national observance held every September to promote and support new evidence-based treatment and recovery practices, the emergence of a strong and proud recovery community, and the dedication of service providers and community members across the nation who make recovery in all its forms possible.

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Different dietary approaches may help modulate the immune system

By Dr. David Dunaief

Dr. David Dunaief

Autoimmune disease is when the body’s immune system attacks the organs, cells and tissues and causes chronic inflammation. However, this umbrella term refers to more than 80 different diseases (1). Some are familiar names, like type 1 diabetes, lupus, rheumatoid arthritis (RA), psoriasis, multiple sclerosis, and inflammatory bowel disease. Others, like Lambert-Eaton myasthenic syndrome and Cogan syndrome, are less well-known.

Chronic inflammation is the main consequence of immune system dysfunction, and it is the underlying theme tying these diseases together. Unfortunately, autoimmune diseases tend to cluster (2). Once you have one, you are at high risk for acquiring others. They disproportionately affect women, although men are also at risk.

Treating autoimmune diseases with meds

The primary treatment is immunosuppressives. In RA, for example, where there is swelling of joints bilaterally, a typical drug regimen includes methotrexate and TNF (tumor necrosis factor) alpha inhibitors, like Remicade (infliximab). These therapies seem to reduce underlying inflammation by suppressing the immune system and interfering with inflammatory factors, such as TNF-alpha. Disease-modifying anti-rheumatic drugs (DMARDs), a class that also includes Plaquenil (hydroxychloroquine), may slow or stop the progression of joint destruction and increase physical functioning.

However, there are several concerning factors with these drugs. First, the side-effect profiles are substantial. They includes risks of cancers, opportunistic infections and even death, according to black box warnings (the strongest warning required by the FDA) (3). Opportunistic infections include diseases like tuberculosis and invasive fungal infections.

It is no surprise that suppressing the immune system would increase the likelihood of infections. Nor is it surprising that cancer rates would increase, since the immune system helps to fend off malignancies. In fact, a study showed that after 10 years of therapy, the risk of cancer increased by approximately fourfold with the use of immunosuppressives (4).

Second, these drugs were tested and approved using short-term clinical trials; however, many patients are prescribed these therapies for 20 or more years.

So, what other methods are available to treat autoimmune diseases? Medical nutrition therapy using bioactive compounds and supplementation are being studied. Medical nutrition therapy may have immunomodulatory (immune system regulation) effects on inflammatory factors and on gene expression.

Managing inflammation with nutrition

Raising the level of beta-cryptoxanthin, a carotenoid bioactive food component, by a modest amount has a substantial impact in preventing RA. Several studies have also tested dietary interventions in RA treatment (5). Included were fasting followed by a vegetarian diet; a vegan diet; and a Mediterranean diet, among others. All mentioned here showed decreases in inflammatory markers, including c-reactive protein (CRP), and improvements in joint pain and other quality of life concerns.

Fish oil’s effects

Fish oil helps your immune system by reducing inflammation and improving your blood chemistry, affecting as many as 1,040 genes (6). In a randomized clinical study, 1.8 grams of eicosapentaenoic acid (EPA) plus docosahexaenoic acid (DHA) supplementation had anti-inflammatory effects, suppressing cell signals and transcription factors (proteins involved with gene expression) that are pro-inflammatory.

In RA patients, fish oil helps suppress cartilage degradative enzymes, while also having an anti-inflammatory effect (7). A typical recommendation is to consume about 2 grams of EPA plus DHA to help regulate the immune system. Don’t take these high doses of fish oil without consulting your doctor, since fish oil may have blood-thinning effects.

Probiotic supplements

Approximately 70 percent of your immune system lives in your gut. Probiotics, by populating the gut with live beneficial microorganisms, have immune-modulating effects that decrease inflammation and thus are appropriate for autoimmune diseases. Lactobacillus salvirus and Bifidobacterium longum infantis are two strains that were shown to have positive effects (8, 9).

In a study with Crohn’s disease patients, L. casei and L. bulgaricus reduced the inflammatory factor TNF-alpha (10). To provide balance, I recommend probiotics with Lactobacillus to my patients, especially with autoimmune diseases that affect the intestines, like Crohn’s and ulcerative colitis.

Increasing fiber intake

Fiber has been shown to modulate inflammation by reducing biomarkers, such as CRP. In two separate clinical trials, fiber either reduced or prevented high CRP in patients. In one, a randomized clinical trial, 30 grams, or about 1 ounce, of fiber daily from either dietary sources or supplements reduced CRP significantly compared to placebo (11).

In the second trial, which was observational, participants who consumed the highest amount of dietary fiber (greater than 19.5 grams) had reductions in a vast number of inflammatory factors, including CRP, interleukin-1 (IL-1), interleukin-6 (IL-6) and TNF-alpha (12).

Immune system regulation is complex and involves over 1,000 genes, as well as many biomarkers. Dysfunction results in inflammation and, potentially, autoimmune disease. We know the immune system is highly influenced by bioactive compounds found in high-nutrient foods and supplements. Therefore, bioactive compounds may work in tandem with medications and/or may provide the ability to reset the immune system through immunomodulatory effects, treating and preventing autoimmune diseases.

References: 

(1) niaid.nih.gov. (2) J Autoimmun. 2007;29(1):1. (3) epocrates.com. (4) J Rheumatol 1999;26(8):1705-1714. (5) Front Nutr. 2017; 4: 52. (6) Am J Clin Nutr. 2009 Aug;90(2):415-424. (7) Drugs. 2003;63(9):845-853. (8) Gut. 2003 Jul;52(7):975-980. (9) Antonie Van Leeuwenhoek 1999 Jul-Nov;76(1-4):279-292. (10) Gut. 2002;51(5):659. (11) Arch Intern Med. 2007;167(5):502-506. (12) Nutr Metab (Lond). 2010 May 13;7:42.

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.

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Stock photo from Metro

Amid the typical questions about returning to school, such as finding friends in their classes and navigating to the right room at the right time, students on Long Island and elsewhere are preparing for the third year of the pandemic while other health care concerns loom.

As the summer enters its final weeks, health officials have found mosquitoes that have the West Nile virus, monkeypox has become a national health emergency, and Rockland County and New York City have reported cases of polio.

With all those health concerns, however, medical officials emphasized numerous pieces of good news that they hope will provide less of a disruption to communities, parents, teachers and students.

For starters, the Centers for Disease Control and Prevention last week eased some COVID-19 restrictions. In the past two years, some students had switched back and forth from in-person to remote learning after a positive test.

The CDC advises students, staff members and workers who were exposed to a person who tested positive for COVID-19 to wear face coverings for 10 days and to get tested, instead of urging them to quarantine.

At the same time, the CDC is no longer suggesting that unvaccinated students get tested regularly in order to attend school.

“Part of the reason they’re easing the restrictions is that the current strain that’s circulating is fairly non aggressive, there are not a lot of hospitalizations and there is not a lot of severe illnesses,” said Dr. Philip Nizza, chief of Infectious Disease at Mather Hospital and attending infectious disease physician at St. Charles Hospital.

The cases Nizza has seen in the hospitals are “very mild” and he hasn’t had an intensive care unit patient with a ventilator in well over a month.

Dr. Susan Donelan, medical director of the Healthcare Epidemiology Department at Stony Brook Medicine, suggested that the shift in the CDC guidance likely reflects the reality that non-pharmaceutical mitigation measures are of more limited use in an era when opportunities exist to receive effective vaccines, which are well tolerated, and safe therapeutics have become a tool to manage those people who are acutely affected.

“The shift now appears to be focused on self-assessment of risk [for self, close family members or others who may be adversely impacted if infected] and thus individual risk mitigation,” Donelan explained in an email.

Still, Nizza, among other health care providers in Suffolk County, urged people to continue to receive vaccinations and to stay up to date with their boosters.

Nizza suggested that a new booster, which could provide protection against the infectious Ba.5 omicron strain that has become the dominant variant in the county and in the United States, could be a “game changer.”

Doctors cautioned people in higher risk groups, such as those who are immunocompromised, have chronic lung disease or are significantly overweight to be vigilant about their exposure to the SARS-CoV2 virus, which causes COVID-19.

As of earlier this week, Suffolk County reported a 7.8% positive test rate on a seven-day average using lab-reported PCR tests, which doesn’t include the rapid tests. At the same time, the number of positive cases on a seven-day average stood at 33.8 per 100,000, according to the New York State Department of Health.

“If you’re not a high-risk patient the danger zone is lower,” said Nizza.

Monkeypox

Meanwhile, monkeypox continues to be a threat to the county, the state and the nation, as the availability of vaccines against the virus lags the need for shots.

New York State continues to have the greatest number of cases of the virus, with close to 2,300 out of about 12,000 cases in the country, according to the CDC. Most of the New York State cases are in the city.

The virus has affected men who have been intimate with other men, although the virus can spread through physical contact.

Nizza described monkeypox as “generally a nonfatal infection with a high presentation rate amongst the undocumented high-risk groups,” he said. “I don’t think the general population needs to rush out and get the monkeypox vaccine, unless [you] are in a high risk group.

Nizza doesn’t anticipate that the virus will spread at anywhere near the rate that COVID did.

“There is a vaccine available, which is much different than COVID, which caught us unaware,” he added.

West Nile virus

As of earlier this month, 38 mosquitoes had tested positive for the West Nile virus, including samples in Setauket and Port Jefferson Station.

The virus was first detected in birds and mosquitoes in Suffolk County in 1999.

People who contract the virus typically experience mild or no symptoms. In a small number of cases, people can have high fever, headaches, stiff necks and may have vision loss, numbness and even paralysis.

Symptoms can last several weeks and the neurological effects can be permanent.

The CDC recommends people use insect repellent to reduce the chance of getting bitten by a mosquito that harbors the virus. Additionally, reducing any standing water around the outside of the house cuts back on the opportunity for these virus-bearing insects to breed.

Suffolk County Health Commissioner Dr. Gregson Pigott recommended that people minimize outdoor activities between dusk and dawn, make sure windows and doors have screens and, at places where mosquitoes are active, wear shoes and socks and long pants and long sleeved shirts.

As of late last week, Mather and St. Charles didn’t have any reported cases of West Nile virus.

The people who are especially vulnerable include the elderly and anyone on drugs that suppress their immune systems.

Polio

Health officials in Rockland County and New York City reported two cases of people with polio.

This disease, which spreads from contact with infected feces, has been largely eradicated after the widespread use of an effective vaccine.

“Most people have their children vaccinated as a part of a routine series,” Nizza said. “It’s a much lower risk.”

The doctor urged people to remain vigilant about other threats that might come this fall, particularly the flu.

With masks and social distancing, the incidence of the flu declined over the last few years. As people return to work and school on a full time basis, the chance for the spread of a problematic strain rises.

“The flu is always bound to rear its head in the fall and winter months,” Nizza said, as he reminded people to get their shots and to continue to wash their hands before eating.

Even if people feel healthy and are in low risk groups, they can and should help others the way they might lend a hand to their neighbors after a storm.

“We have to protect those who have a high risk of mortality,” Nizza said. “We need herd compassion, to protect those who can’t protect themselves.”

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Community Blood Drive

Suffolk County Legislator Rob Trotta is collaborating with St. Joseph’s Church in Kings Park, to host a blood drive on Thursday, August 25, from1 p.m. to 7 p.m. at Travis Hall – Lower Level, behind St. Joseph’s at 59 Church Street. The drive is to benefit the blood banks maintained by Long Island Blood Services, which provides blood to hospitals throughout Long Island.

To be eligible to donate blood, a person must be between the ages of 16 (16 with parental consent) and 76, (if older than 76, you need permission from your doctor), weigh over 110 pounds and not have had a tattoo in the last three months. Please bring a valid photo ID with you. LI Blood Services recommends that you eat and drink plenty of fluids before donating. Previous donors should bring their blood donor card with them.

Leg. Rob Trotta at a blood drive in  June.

As a thank you for donating a pint of blood, each donor will receive a voucher for a free pint of beer, glass of cider, wine or soda at one of the participating breweries such as Destination Unknown Beer Co., Jamesport Farm Brewery, Riverhead Cider House, Long Island Beer Company, Tradewinds Brewing, Eastern Front Brewing Co., Ubergeek Brewing and others on Long Island and throughout the tristate area.

“Hospitals are always in need of blood supplies so it is important that if you can donate blood to do so because one pint of blood can help save three lives. We just did a blood drive in June and I thank those who attended and hope you will return as enough time has passed to donate again,” said Suffolk County Legislator Rob Trotta. For more information, please call Legislator Trotta’s district office at 631-854-3900.

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The Biden Administration has declared a national public health emergency for the monkeypox outbreak across the country. “This public health emergency will allow us to explore additional strategies to get vaccines and treatments more quickly out to the impacted communities. And it will allow us to get more data from jurisdictions so we can effectively track and attack this outbreak,” the White House said in a statement.

Monkeypox vaccines are available for Suffolk County residents at Northwell Health and Stony Brook Medicine Clinics. For more information, including links to schedule appointments, click here or call 311.

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Crab Meadow Beach in Northport. File photo by Rohma Abbas

Suffolk County Department of Health Services announced Aug. 14 that Crab Meadow Beach in Northport is closed to bathing due to the finding of bacteria at levels in excess of acceptable criteria.

The following beaches remain closed: Tanner Park Beach in Copiague; Venetian Shores Beach in Lindenhurst; Knollwood Beach, Huntington Beach Community Association Beach, Baycrest Association Beach, and Wincoma Beach in Huntington; Fiddlers Green Association Beach in Lloyd Nek, Valley Grove Beach in Eatons Neck, Beech Road Beach in Rocky Point; Sound Beach Property Owners’ Association Beach, and Sayville Marina Park Beach.

Terraces on the Sound Beach in Rocky Point; Fleets Cove Beach in Huntington; Steers Beach and Asharoken Beach in Northport; and Hobart Beach and Prices Bend Beach in Eatons Neck have reopened.

According to Suffolk County Commissioner of Health Dr. Gregson Pigott, bathing in bacteria-contaminated water can result in gastrointestinal illness, as well as infections of the eyes, ears, nose, and throat.

Beaches will reopen when further testing reveals that the bacteria have subsided to acceptable levels.

 For the latest information on affected beaches, call the Bathing Beach HOTLINE at 631-852-5822 or contact the Department’s Office of Ecology at 631-852-5760 during normal business hours.

Program information:

http://www.suffolkcountyny.gov/Departments/HealthServices/EnvironmentalQuality/Ecology/BeachMonitoringProgram.aspx

Interactive map of beach closures/advisories: https://ny.healthinspections.us/ny_beaches/

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Many people suffer from IBS.
Fructose, lactose and gluten may be contributors

By David Dunaief, MD

Dr. David Dunaief

If you suffer from irritable bowel syndrome (IBS), its symptoms can directly affect your quality of life. They include abdominal pain, cramping, bloating, constipation and/or diarrhea.

According to estimates, 10 to 15 percent of the population suffers from IBS symptoms, although only five to seven percent have been diagnosed (1).

Diagnosing IBS is challenging. While the general perception is that IBS symptoms are somewhat vague, there are discrete criteria physicians use to provide a diagnosis it and eliminate more serious possibilities.

The Rome IV criteria comprise an international effort to help diagnose and treat functional gastrointestinal disorders. Using these criteria, which include frequency of pain and discomfort over the past three months, in combination with a physical exam helps provide a diagnosis.

So, what can be done to improve symptoms? There are a number of possibilities that require only modest lifestyle changes.

Addressing your mental state

The “brain-gut” connection refers to the direct connection between mental state, such as nervousness or anxiety, to gastrointestinal issues, and vice versa.

Mindfulness-based stress reduction was used in a small, but randomized, eight-week clinical trial with IBS (2). Those in the mindfulness group (treatment group) showed statistically significant results in decreased severity of symptoms compared to the control group, both immediately after training and three months post-therapy.

Those in the treatment group were instructed to do meditation, gentle yoga and “body scanning” — focusing on one area of the body for muscle tension detection. The control group attended an IBS support group once a week.

Possible link with migraines

A preliminary study has suggested there may be a link between IBS and migraine and tension-type headaches. The study of 320 participants, 107 with migraine, 107 with IBS, 53 with episodic tension-type headaches (ETTH), and 53 healthy individuals, identified significant occurrence crossover among those with migraine, IBS and ETTH. Researchers also found that these three groups had at least one gene that was different from that of healthy participants. Their hope is that this information will lead to more robust studies that could result in new treatment options (3).

Gluten consumption a factor?

In a small randomized clinical trial, patients who were given gluten were more likely to complain of uncontrolled symptoms than those who were given a placebo, 68 percent vs. 40 percent, respectively (4). These results were highly statistically significant. The authors concluded that nonceliac gluten intolerance may exist. Gluten sensitivity may be an important factor in for some IBS patients (5). I suggest to my patients that they might want to start avoiding gluten and then add it back into their diets slowly to see the results.

What about fructose?

Some IBS patients may suffer from fructose intolerance. In a study, IBS researchers used a breath test to examine this possibility (6). The results were dose-dependent, meaning the higher the dose of fructose, the greater the effect researchers saw. When patients were given a 10 percent fructose solution, only 39 percent tested positive for fructose intolerance, but when they were given a 33 percent solution, 88 percent of patients tested positive.

The symptoms of fructose intolerance included gas, abdominal pain, bloating, belching and alternating bowel habits. The authors concluded that avoidance of fructose may reduce symptoms in IBS patients.

According to another study, about one-third of IBS patients are fructose intolerant. When on a fructose-restricted diet, symptoms appeared to improve (7). Foods with high levels of fructose include certain fruits, like apples and pears, but not bananas.

Considering the effects of lactose

Another small study found that about one-quarter of patients with IBS also have lactose intolerance. Two complications are at play here. One, it is very difficult to differentiate the symptoms of lactose intolerance from IBS. The other is that most IBS trials are small and there is a need for larger trials. Of the IBS patients who were also lactose intolerant, there was a marked improvement in symptomatology at both six weeks and five years when placed on a lactose-restricted diet (8).

Though the trial was small, the results were statistically significant, which is impressive. Both the patient compliance and long-term effects were excellent, and visits to outpatient clinics were reduced by 75 percent. This demonstrates that it is probably worthwhile to test patients who have IBS symptoms for lactose intolerance.

Are probiotics part of the solution?

Treatment with probiotics from a study that reviewed 42 trials shows that there may be a benefit to probiotics, although the endpoints, or objectives, were different in each trial. The good news is that most of the trials reached one of their endpoints (9). Probiotics do show promise, including the two most common strains, Lactobacilli and Bifidobacteri, which were covered in the review.

All of the above provides hope for IBS patients. These are treatment options that involve modest lifestyle changes. I believe there needs to be a strong patient-doctor connection in order to select an approach that results in the greatest symptom reduction for a specific patient.

References: 

(1) American College of Gastroenterology [GI.org]. (2) Am J Gastroenterol. 2011 Sep;106(9):1678-1688. (3) American Academy of Neurology 2016, Abstract 3367. (4) Am J Gastroenterol. 2011 Mar;106(3):508-514. (5) Am J Gastroenterol. 2011 Mar;106(3):516-518. (6) Am J Gastroenterol. 2003 June;98(6):1348-1353. (7) J Clin Gastroenterol. 2008 Mar;42(3):233-238. (8) Eur J Gastroenterol Hepatol. 2001 Aug;13(8):941-944. (9) Aliment Pharmacol Ther. 2012 Feb;35(4):403-413.

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.

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