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James Konopka. Photo by Susan Watanabe

By Daniel Dunaief

Most of the time, the fungus Candida albicans, which is ubiquitous on the skin, inside people’s mouths, throat, and guts, among other places, doesn’t cause problems. It can, however, be an opportunistic infection, particularly in people who are immunocompromised, leading to serious illness and even death.

Antifungal infections work best during the early stage of an infection. Once a severe infection becomes established, it responds less well to drugs, as resistance can become a problem.

James “Jamie” Konopka, Professor in the Department of Microbiology and Immunology in the Renaissance School of Medicine at Stony Brook University, is working to find the mechanism that enables C. albicans to resist attack by the immune system. His long term goal is to identify ways to make the fungus more vulnerable to immune defenses.

In a paper published recently in the journal mBio, which is published by the American Society of Microbiology, Konopka identified the mechanism by which hypochlorous acid, which is produced by cells in the immune system, attacks C. albicans.

He expanded this by testing forms of the fungus that lack specific genes. These mutants can be more vulnerable to attack by hypochlorous acid, which is produced by neutrophils and is also called “human bleach.” Longer term, Konopka hopes to find ways to sensitize the fungus to this acid, which would bolster the ability of the immune system to respond to an infection.

His study showed that hypochlorous acid disrupts the plasma membrane, which is a layer of lipids that surround the cell. Once this is breached, parts of the cell leak out, while more bleach can damage the fungus.

Hypochlorous acid reacts with proteins, lipids and DNA.

The activated immune system produces several chemicals known as “reactive oxygen species.” In some cells, particularly neutrophils, hydrogen peroxide is converted into hypochlorous acid to strengthen and diversify the attack.

To be sure, the discovery of the mechanism of action of hypochlorous acid won’t lead to an immediate alternative therapeutic option, as researchers need to build on this study.

Future studies will examine how some genes promote resistance, and which are likely to be the most promising targets for drug development, Konopka explained.

Increase sensitivity

These are C. albicans cells growing invasively into tissue in a mouse model of an oral infection. The candida hyphae are stained black, and the tissue is stained a blue/green. Image from James Konopka

Konopka suggested that increasing the sensitivity of the fungus to hypochlorous acid would likely prove more effective and less potentially toxic than increasing the amount of the acid, which could also damage surrounding tissue.

“Our idea is to sensitize fungal pathogens” to hypochlorous acid “rather than upping the dose of bleach, which could lead to negative consequences,” Konopka said. Ideally, he’d like to “take the normal level and make it more effective” in eradicating the fungus.

Other scientists funded by the National Institutes of Health created a set of about 1,000 different strains of the fungus, which provides a valuable resource for Konopka and others in the scientific community.

In a preliminary screen of plasma membrane proteins, Konopka and his team found that most of the mutants had at least a small increase in sensitivity. Some, however, had stronger effects, which will guide future experiments.

One of the challenges in working with a fungus over pathogens like bacteria or viruses is that fungi are more closely related biologically to humans. That means that an approach that might weaken a fungus could have unintended and problematic consequences for a patient.

“Although they may look very different on the outside, the inner workings of fungi and humans are remarkably similar,” Konopka explained in an email. This has made it difficult to find antifungal drugs that are not toxic to humans.

An ‘overlooked’ ally

Konopka suggested that scientists have been studying hydrogen peroxide, which is also made by immune system combatants like macrophages and neutrophils.

“It seemed to us that somehow bleach had been overlooked,” Konopka said. “It hadn’t been studied in the fungal world, so we launched” their research.

Konopka also believes the plasma membrane represents an effective place to focus his efforts on developing new drugs or for making current drugs more effective. 

Hydrochlorous acid “fell into our wheel house,” he said. In initial tests, Konopka discovered that human bleach caused damage to the membrane within minutes if not sooner, allowing outside molecules to enter freely, which could kill the potentially dangerous infection.

Considering the ubiquitous presence of the fungus, immunocompromised people who might conquer an infection at any given time could still be vulnerable to a future attack, even after an effective treatment. Even people with a healthy immune system could be reinfected amid a large enough fungal load from a biofilm on a medical device or catheter.

Providing vulnerable people with a prophylactic treatment could lower the risk of infection. When and if those patients develop an ongoing and health-threatening infection, doctors could use another set of drugs, although such options don’t currently exist.

In other work, Konopka has identified proteins in C. albicans that help CoQ, or ubiquinone, protect the plasma membrane from oxidation by agents such as hydrogen peroxide and hypochlorous acid.

People can purchase ubiquinone at local stores, although Konopka urges residents to check with their doctors before taking any supplement.

Fish and beer

An organizer of a department wide Oktoberfest, Konopka was pleased that faculty, post doctoral researchers and students were able to decompress and enjoy the fall festival together for the first time since 2019.

In addition to a range of beer, attendees at the event, which occurred half way between the start of the semester and final exams, were able to partake in German food from Schnitzels in Stony Brook Village, which was a big hit.

An avid fly fisherman who catches and releases fish, Konopka said he caught some bigger striped bass this year than in previous years.

When he’s fishing, Konopka appreciates the way the natural world is interconnected. He pays attention to variables like the weather, water temperature, bait fish and the phases of the moon.

He particularly enjoys the wind and fresh air. This year, Konopka marveled at the sight of a bald eagle.

As for his work, Konopka said basic research may have an immediate effect or may contribute longer term to helping others in the scientific community build on his results, which could lead to the next breakthrough.

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Health Outreach Bus

Emma Clark Library, 120 Main St., Setauket welcomes the Catholic Health Mobile Outreach Bus to its parking lot on Thursday, Jan. 18 from 10 a.m. to 2 p.m. (Last screening begins at 1:45 p.m.) Registered nurses will provide blood pressure, cholesterol, body mass index, and glucose screenings, along with patient education and referrals as needed. They will also offer free flu vaccinations. No appointments are necessary, there are no fees, and insurance is not required. Questions? Email [email protected] or call 631-941-4080.

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Graphic showing the number of pertussis cases from 2019 to 2023 in Suffolk County. Photo courtesy Suffolk County Department of Health

Cases of whooping cough, which is caused by the Bordatella pertussis bacteria, have spiked in Suffolk County this year, raising concerns for the health of newborn babies who don’t have the kind of immunological tools to fight off the infection and its potential consequences.

The Suffolk County Department of Health reported that 113 people had whooping cough, which is dramatically higher than the four people suspected of contracting this bacteria last year.

Whooping cough is “highly contagious,” explained Dr. Gregson Pigott, Suffolk County Health Commissioner in an email. “It is a cyclical disease with outbreaks occurring every three to five years.”

A large majority of people who have pertussis – 105 of the 113 – reported contracting the illness after November 28th, according to Dr. Pigott. Most of those who are sick are school aged children and their families, he added. 

The surge in infections this year may be because immunity from the routine vaccination series, which is given between ages two months to six years, wanes over time.

The Centers for Disease Control and Prevention recommends that people receive the TDaP booster, which offers immunological protection from diphtheria, tetanus and pertussis, every 10 years.

Vaccination rates are “fairly high in Suffolk County, but we do know that some residents fell behind in their vaccinations during the height of the Covid pandemic,” Dr. Pigott added. 

A preventable problem

Doctors urged residents, particularly those who might be interacting with young children or whose health is compromised, to check with their doctors on their vaccination status.

“Pertussis is a completely preventable disease,” said Dr. Adrian Popp, Chair of Infection Control at Huntington Hospital.

Indeed, doctors suggested that some of the people who aren’t receiving the vaccine may have pulled back from their normal inoculations amid the political discussion about the Covid vaccine.

“Covid has polarized our society in terms of vaccinations,” said Dr. Popp. Pertussis has “fallen prey” to this kind of thinking.

The pertussis shot has been around for over 50 years and can prevent bacterial infection, doctors said.

The vaccine is “completely safe and efficacious,” said Dr. Galinkin, infectious disease specialist at Port Jefferson-based St. Charles Hospital.

Dr. Galinkin, who has been practicing medicine in Suffolk County since 2004, said this is the highest level of whooping cough he’s seen in the county.

Indeed, even before the pandemic, the number of people infected with pertussis was 64 in 2019, according to the Department of Health.

The pertussis vaccine doesn’t completely prevent infection, but it does create a much milder case than it would for those who have no immunity, doctors said.

The incidence of pertussis can wax and wane, said Dr. Sharon Nachman, chief of the Division of Pediatric Infectious Diseases at Stony Brook Children’s Hospital. The increase in cases this year likely means that “it won’t happen next year” as people do what they can to protect themselves, their family and their community when the numbers rise, as they have this year.

Indistinct early symptoms

Like other respiratory illnesses that are actively circulating among the Suffolk County population, whooping cough starts out as a cough and can include a runny nose and a low grade fever.

 A whooping cough, however, often transitions into a more distinctive sound, as people who have it struggle to catch their breath after they cough.

Threat to infants

Health care providers suggested that pregnant mothers receive a booster for pertussis between the 27th and 36th week of pregnancy, which can not only reduce the risk of infection for the mom but can also provide some immunological benefit to the unborn child.

Doctors urged who are expecting a newborn to encourage anyone who has regular contact with the child in the first few months after birth to have updated immunizations, including for pertussis.

“The household of a newborn should consider being vaccinated,” said Dr. Popp. Infants who contract pertussis and who don’t have protection can develop complications such as encephalitis.

Pertussis is “an incredibly big problem for infants in the first year of life,” said Dr. Nachman.

Adults who contract pertussis can receive antibiotics, which generally eradicates the illness within five days. Untreated, however, pertussis symptoms and contagiousness can persist for weeks or even months.

Untreated pertussis can also lead to secondary pneumonia, added Dr. Nachman.

Respiratory illnesses climb

The combination of respiratory syncytial virus (RSV), flu, and Covid continues to keep emergency rooms busy during the start of the new year.

Doctors urged adults who are immunocompromised or who are vulnerable to follow the same habits that reduced their risk during the worst of the pandemic, which includes washing their hands, keeping a safe distance from anyone who is sick, and wearing masks when they are in densely-populated indoor areas with less ventilation.

“You don’t necessarily want to isolate yourself to an extreme, but there are certain ways to decrease the chance of getting exposed to illnesses in general,” said Dr. Popp. People who are riding on crowded trains to and from work might want to search for cars that have fewer people when that’s an option, he suggested.

Hospitals are taking precautions to limit the likelihood of passing along infections. The staff in the emergency room at Stony Brook is wearing masks on rounds, said Dr. Nachman.

At this point, people who come to the hospital are offered masks, but are not required to wear them.

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METRO photo

By David Dunaief

Dr. David Dunaief

Happy 2024! If you’ve watched any media in the past week, you’ve probably been inundated by ads for weight loss plans, apps and other tools intended to help us achieve our New Year’s resolutions. Many of these are oriented around helping us increase the “stickiness factor” of our new habits.

Setting a goal that is simple and singular helps. We often overdo it by focusing on an array of resolutions, like eating better, exercising, developing better sleep habits, and managing stress better. While these are all admirable, their complexity diminishes your chances of success. Instead, pick one to focus on, and make the desired impact part of your goal, for example: improve health by losing weight and reversing disease. 

Changing habits is always hard. There are some things that you can do to make it easier, though. 

Your environment is very important. According to David Katz, M.D., Director, Yale-Griffin Prevention Research Center, it is not as much about willpower as it is about your environment. Willpower, Dr. Katz notes, is analogous to holding your breath underwater; it is only effective for a short time. Instead, he suggests laying the groundwork by altering your environment to make it conducive to attaining your goals. Recognizing your obstacles and making plans to avoid or overcome them reduces stress and strain on your willpower. 

According to a study, people with the most self-control utilize the least amount of willpower, because they take a proactive role in minimizing temptation (1). If your intention is to eat better, start by changing the environment in your kitchen to one that prompts healthy food choices.

Support is another critical element. It can come from within, but it is best when reinforced by family members, friends and coworkers. In my practice, I find that patients who are most successful with lifestyle changes are those whose household members are encouraging or, even better, when they participate in at least some portion of the intervention, such as eating the same meals.

How long does it take to form a new habit?

When does a change become a new habit, or automaticity? The rule of thumb used to be it takes approximately three weeks of daily practice. However, the results of a study at the University of London showed that the time to form a habit, such as exercising, ranged from 18 days to 254 days (2). The good news is that, though there was a wide variance, the average time to reach this automaticity was 66 days, or about two months.

How do you choose a diet that will help you achieve your goals?

US News and World Report ranks diets annually and sorts them by objective, such as weight loss, healthy eating, diabetes diets, heart-healthy diets, etc. (3). Three of the diets highlighted include the Mediterranean diet, the DASH (Dietary Approach to Stop Hypertension) diet, and the Flexitarian diet, ranked one through three, respectively. These were also the top three for healthy eating, for diabetes, and for heart health, although their rankings among the top three shift in some cases.

What do all the top diets have in common? They focus on nutrient-dense foods. In fact, the lifestyle modifications I recommend are based on a combination of the top diets and the evidence-based medicine that supports them.

For instance, in a randomized cross-over trial, which means patients, after a prescribed time, can switch to the more effective group, showed that the DASH diet is not just for patients with high blood pressure. The DASH diet was more efficacious than the control diet in terms of diabetes, decreasing hemoglobin A1C 1.7 percent and 0.2 percent, respectively; weight loss, with patients losing 5 kg/11 lbs. vs. 2 kg/4.4 lbs. It also achieved better results with HDL (“good”) cholesterol, LDL (“bad”) cholesterol and blood pressure (4).

Interestingly, patients still lost weight, although caloric intake and the percentages of fats, protein and carbohydrates were the same between the DASH and control diets. However, the DASH diet used different sources of macronutrients. The DASH diet also contained food with higher amounts of fiber, calcium and potassium and lower sodium than the control diet. 

Therefore, diets high in nutrient-dense foods may be an effective way to lose weight while also treating and preventing disease. 

I will share one more tip: take it day by day, rather than obsessing over the larger picture. I have found many patients make better headway by choosing to change one meal at a time — like starting with what they choose to eat for breakfast or for snacks each day. Once this is a habit, they shift their focus to another meal.

Best to you for optimal health in 2024!

References:

(1) J Pers Soc Psychol. 2012;102: 22-31. (2) European Journal of Social Psychology, 40: 998–1009. (3) www.usnews.com/best-diet. (4) Diabetes Care. 2011;34: 55-57.

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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Gurwin Jewish Nursing and Rehabilitation Center in Commack has been recognized on Newsweek Magazine’s list of America’s Best Nursing Homes 2024, securing a top 15 spot on the list of Best Nursing Homes in New York 2024.

Compiled in partnership with global data research firm Statista, Newsweek’s annual ranking evaluates skilled nursing providers throughout the United States.  Data used to determine the best nursing homes is culled from five sources, including Centers for Medicaid and Medicare Services performance data, peer survey data, management of COVID-19, as well as accreditation and resident satisfaction data from The Joint Commission and Commission.

“We are extremely proud of our continued recognition on Newsweek’s top nursing home list,” said Stuart B. Almer, President and CEO of Gurwin Healthcare System. “To be acknowledged once again for providing the highest quality healthcare services is a testament of the hard work and dedication of our entire team, and the compassionate, person-centered care they provide to all those who turn to Gurwin in their time of need.” For more information, visit www.gurwin.org.

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METRO photo

By David Dunaief, M.D.

Dr. David Dunaief

Dear Santa,

It’s that time of year again and, like so many others, I have a last-minute request. You are a model for kindness and generosity around the world, for which I’m grateful. I would like you to be a role model in another arena, as well — health.

Kids marvel at your round belly, which shakes when you laugh like a bowl full of jelly. They literally feed that belly by setting out cookies and other sweets for you on Christmas Eve to sustain you during your travels.

I have nothing against your round belly, but I’m concerned about the message it sends. We’re currently facing an epidemic of overweight kids and an ever-increasing number of children with type 2 diabetes. According to the CDC, the percentage of U.S. children between ages 10 and 19 with type 2 diabetes nearly doubled from 2001 to 2017. You, Santa, with your influence, can help reverse this trend.

Obesity has a high risk of shortening your life span, not to mention affecting your quality of life. The most dangerous type of obesity is visceral adipose tissue, which means central belly fat. An easy way to tell if someone is too rotund is if their waistline, measured from the navel, is 40 inches or more for a man and 35 inches or more for a woman. Risks for pancreatic cancer, breast cancer, liver cancer and heart disease increase dramatically with this increased fat.

Santa, here is your opportunity to lead by example — and, maybe fit back into that skinny tracksuit you’ve had in the back of your closet since the 16th century, when you were trim.

Think of the personal advantages of losing that extra belly weight. Your joints won’t ache with the winter cold; it will improve your posture, so your back doesn’t hurt as much; and you will have more energy. Plus, studies show that a diet that emphasizes fruits, vegetables and whole grains can reverse clogged arteries and help you avoid strokes, heart attacks and peripheral vascular disease. With a simple change, like eating a small handful of raw nuts each day, you can reduce your heart disease risk significantly.

Losing weight will also change your center of gravity, which will make it easier for you to keep your balance on those steep, snowy rooftops. No one wants you to take a tumble and risk a broken bone – or worse.

Exercise will help, as well. Maybe this Christmas Eve, you could walk or jog alongside the sleigh for the first continent or so. During the “offseason” you and the elves could form small groups of workout buddies to keep each other on track with your workout goals. And who doesn’t love an impromptu game of tag with the reindeer? With time, you’ll start to tighten your abs and slowly see fat disappear from your midsection.

This might also make it easier to steal a base or two during the North Pole Athletic League’s Softball season. The elves don’t even bother holding you on base anymore, do they?

Of course, the cookies don’t help. You might take a cue from the reindeer, who love their raw carrots and celery. Broadcast that the modern Santa enjoys fruits, especially berries and veggies, with an emphasis on cruciferous veggies like broccoli florets dipped in humus, which have substantial antioxidant qualities and can help reverse disease.

And, of course, skip putting candy in our stockings. We don’t need more sugar, and I’m sure that, over the long night, it’s hard to resist sneaking a few pieces. Why not reduce the temptation? This will also help you minimize the waves of fatigue you feel as you pull your worldwide all-nighter.

As for your loyal fans, you could place active games under the tree. You and your elves could create an app or website with free workout videos for those of us who need them; we could follow along as you showed us “12 Days of Dance-Offs with Santa and Friends.”

You could gift athletic equipment, such as baseball gloves, footballs and basketballs, instead of video games. Or wearable devices that track step counts and bike routes. Or stuff gift certificates for dance lessons into people’s stockings.

As you become more active, you’ll find that you have more energy all year round, not just on Christmas Eve. If you start soon, Santa, maybe by next year, you’ll be able to park the sleigh farther away and skip from chimney to chimney.

The benefits of a healthier Santa will ripple across the world. Your reindeer won’t have to work as hard. You might fit extra presents in your sleigh. And Santa, you will be sending kids and adults the world over the right message about taking control of their health through nutrition and exercise. That’s the best gift you could give!

Wishing you good health in the coming year,

David

P.S. If you have a little extra room in your sleigh, I could use a new baseball bat. I know the Yankees need help, so I’ve been practicing.

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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Photo from Suffolk County District Attorney's office
Photo from Suffolk County District Attorney's office

Suffolk County District Attorney Raymond A. Tierney and Long Island Council on Alcoholism and Drug Dependance (LICADD) Executive Director Steven Chassman held a joint public service announcement on Dec. 14 to remind Suffolk County residents that, in light of the increased prevalence of overdose during the holiday season, there are reputable agencies in Long Island that can help those struggling with addiction as well as their families.

“Unfortunately, I spend many hours meeting with families who have lost loved ones to addiction or because somebody made the dangerous decision to get behind the wheel while under the influence of drugs or alcohol,” said District Attorney Tierney. “Their grief is immeasurable. Keeping our streets safe is of the utmost importance to me and this office. That is why my office has partnered with LICAAD to do this public service announcement because we understand how important it is to take a proactive approach to addressing the addiction crisis in this county. However, make no mistake, if you are selling illegal and dangerous substances in Suffolk County, profiting off the backs of those suffering from substance use disorder and other addictions, we will prosecute you.”

“LICADD realizes that substance use disorder (SUD) is a disease that needs to be treated like any other,” said Steve Chassman LCSW, CASAC, Executive Director of LICADD. “While our clients need to be held responsible for their actions for public safety, the best thing they or their family can do is seek help before destructive decisions are made. LICADD is here 24/7/365 to support those with SUD during the stressful holiday season.”

District Attorney Tierney believes Suffolk County can be kept safe by utilizing aggressive prosecutions of drug dealers that prey on our vulnerable citizens, but also by spreading the word that there is help out there for those who are suffering. For those suffering from addiction and mental health co-occurring disorders, the Suffolk County District Attorney’s Office urges you to make a phone call to one of the many treatment and prevention resources that the county has to offer. There is help.

Help us fight addiction. You can always contact the SCPD if you suspect illegal drug activity. However, you can also report it anonymously through our website at: www.suffolkcountyny.gov under the “Contact Us” tab then Click on “Contact the DA.”

The Long Island Council on Alcoholism and Drug Dependence is a non-profit organization with offices in Hauppauge and Westbury whose mission is to address the addictive climate of our times by providing initial attention and referral services to individuals, families, and children, through intervention, education, and professional guidance to overcome the ravages of alcohol and other substance-use related problems. If you are or know of anyone who is experiencing an alcohol and/or substance-use related issue and need help, please call LICADD’s 24-hour hotline at 631- 979-1700.

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Most thyroid nodules are found incidentally. METRO photo

By David Dunaief, M.D.

Dr. David Dunaief

Thyroid nodules are often diagnosed incidentally on radiologic exams, such as CT scans of the chest, MRI scans, PET scans and ultrasounds of the carotid arteries in the neck. It’s rarely because of symptoms. More than 50 percent of people have thyroid nodules detectable by high-resolution ultrasound. Fortunately, most are benign. Depending on the study, the percent that are malignant can range from 1.1 to 6.5 percent of nodules. 

This leaves us with the question of what to do with a thyroid nodule. What’s the short answer? It depends on the size. If it is over one centimeter, usually it is biopsied by fine needle aspiration (FNA). While most are asymptomatic, if there are symptoms, these might include difficulty swallowing, difficulty breathing, hoarseness, pain in the lower portion of the neck and a goiter.

FNA biopsy is becoming more common. In a study evaluating several databases, there was a greater than 100 percent increase in thyroid FNAs performed over a five-year period from 2006 to 2011. This resulted in a 31 percent increase in thyroidectomies, surgeries to remove the thyroid partially or completely.

However, the number of thyroid cancers diagnosed with surgery did not rise in this same period. Thyroid nodules in this study were least likely to be cancerous when the initial diagnosis was by incidental radiologic exam.

Addressing indeterminate FNA results

As much as 25 percent of FNA biopsies are indeterminate. We are going to look at two techniques to differentiate between benign and malignant thyroid nodules when FNA results are equivocal: a PET scan and a molecular genetics test.

A meta-analysis of six studies of PET scan results showed that it was least effective in resolving an unclear FNA biopsy. The PET scan was able to rule out patients who did not have malignancies, but it did not do a good job of identifying those who did have cancer.

On the other hand, a molecular-based test was able to potentially determine whether an indeterminate thyroid nodule by FNA was malignant or benign.

Unlike in the PET scan study above, the researchers were able to not only rule out the majority of malignancies but also to rule them in. It was not perfect, but the percent of negative predictive value (ruled out) was 94 percent, and the positive predictive value (ruled in) was 74 percent. The combination test improved the predictive results of previous molecular tests by 65 to 69 percent. This is important to help decide whether or not the patient needs surgery to remove at least part of the thyroid.

What is the significance of calcification?

Microcalcifications in the nodule can be detected with an ultrasound. The significance of this may be that patients with microcalcifications are more likely to have malignant thyroid nodules than those without them, according to a small prospective study involving 170 patients. This does not mean that a patient has malignancy with calcifications, but that there is a higher risk.

The ‘wait and follow-up’ approach

As I mentioned above, most thyroid nodules are benign. The results of one study go even further, showing that most asymptomatic benign nodules do not progress in size significantly after five years. The factors that did contribute to growth of about 11 percent of the nodules were age (<45 years old had more growth than >60 years old), the existence of multiple nodules, greater nodule volume at baseline, and being male.

The study authors’ suggestion is that, after the follow-up scan, the next ultrasound scan might be five years later instead of three. However, they did discover thyroid cancer in 0.3 percent after five years.

How does thyroid function affect outcomes?

In considering risk factors, it’s important to note that those who had normal thyroid stimulating hormone (TSH) were less likely to have a malignant thyroid nodule than those who had high TSH, implying hypothyroidism. There was an almost 30 percent prevalence of cancer in the nodule if the TSH was greater than >5.5 mU/L (13).

Fortunately, most nodules are benign and asymptomatic, but the number of cancerous nodules found is growing. Why the mortality rate remains the same, year over year for decades, may have to do with the slow rate at which most thyroid cancers progress, especially of the two most common forms, follicular and papillary.

References:

(1) uptodate.com. (2) AACE 2013 Abstract 1048. (3) Thyroid. 2005;15(7):708. (4) European Thyroid Journal. 2022 Jun 29;11(4) online. (5) AACE 2013 Abstract 1048. (6) thyroid.org. (7) AAES 2013 Annual Meeting. Abstract 36. (8) AACE 2013 Abstract 1048. (9) Cancer. 2011;117(20):4582-4594. (10) J Clin Endocrinol Metab. Online May 12, 2015. (11) Head Neck. 2008 Sep;30(9):1206-1210. (12) JAMA. 2015;313(9):926-935. (13) J Clin Endocrinol Metab. 2006;91(11):4295.

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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METRO photo

By David Dunaief, M.D.

Dr. David Dunaief

Erectile dysfunction (ED) is a very common problem with a stigma. In fact, I have had several patients who resisted telling me they suffered from this malady. Because it can be a symptom of other diseases, it is crucial that you share this information with your doctor.

ED affects approximately 1 in 10 men on a chronic basis. If it occurs less than 20 percent of the time, it is normal; whereas if it occurs more than 50 percent of the time, there is a problem that requires therapy, according to the Cleveland Clinic (1). 

There are oral medications for ED. You’ve probably seen ads for them everywhere. Its prevalence has led pharmaceutical companies to saturate the airwaves, especially during sporting events. Approved medications include sildenafil (Viagra, or the “little blue pill”), tadalafil (Cialis), vardenafil (Levitra, Staxyn), and avanafil (Stendra). These drugs work by affecting the endothelium, or inner layer, of blood vessels and causing vasodilation, or enlargement of blood vessels, which increases blood flow to the penis. Unfortunately, this does not solve the medical problem, but it does provide a short-term fix for those who are good candidates for treatment.

ED’s prevalence increases with age. In a multinational MALES study, ED affected 8 percent of those aged 20-30 and 37 percent of 70-75-year-olds (2). What was surprising was that advanced age had the least association with ED, increasing the odds by only five percent. So, what contributes to the rest of the increase as we age? Disease processes and drug therapies.

What is the relationship between medical conditions and ED?

Chronic diseases significantly contribute to ED. The opposite may also be true; ED may be a harbinger of disease. Typical contributors include metabolic syndrome, diabetes, high blood pressure, cardiovascular disease and obesity. In the Look AHEAD trial, ED had a greater than two-fold association with hypertension and a three-fold association with metabolic syndrome (3). In another study, ED was associated with a 2.5-times increase in cardiovascular disease (4).

A randomized clinical trial (RCT) showed that patients with ED had significantly more calcification, or atherosclerosis, in the arteries when compared to a control group (5). They were more than three times as likely to have severe levels of calcification. They also had more inflammation, measured by C-reactive protein. 

How do medications contribute to ED?

About 25 percent of ED cases are thought to be associated with medications, such antidepressants; NSAIDs, such as ibuprofen and naproxen sodium; and hypertension medications. Unfortunately, the most common antidepressant medications, SSRIs, have the greatest impact on ED of all antidepressants. 

The California Men’s Health Study, with over 80,000 participants, showed that there was an association between NSAIDs and ED, with a 38 percent increase in ED in patients who use NSAIDs on a regular basis (6). The authors warn that patients should not stop taking NSAIDS without consulting their physicians.

Also, high blood pressure drugs have a reputation for causing ED. Beta blockers were thought to be the main culprit. A meta-analysis of 42 studies showed that beta blockers have a small effect, but thiazide diuretics (water pills) more than doubled ED, compared to placebo (7).

How does diet affect ED?

The Mediterranean-type diet has been shown to treat and prevent ED, improving one’s health and sex life at the same time. It’s the green leafy alternative to the little blue pill. The foods are rich in omega-3 fatty acids and high in monounsaturated fats and polyunsaturated fats, as well as in fiber. Components include whole grains, fruits, vegetables, legumes, walnuts, and olive oil. 

In two RCTs lasting two years, those who followed a Mediterranean-type diet saw improvements in their endothelial functioning (8, 9). They also had reduced inflammation and decreased insulin resistance.

In another study, men who had the greatest compliance with the Mediterranean-type diet were significantly less likely to have ED, compared to those with the lowest compliance (10). Even more impressive was that the group with the highest compliance had a 37 percent reduction in severe ED versus the low compliance group.

A study of participants in the Health Professionals Follow-up Study looked more closely at both the Mediterranean-type diet and an Alternative Healthy Eating Index 2010 diet, which emphasized consuming vegetables, fruits, nuts, legumes, and fish or other sources of long-chain fats, as well as avoiding red and processed meats (11). At this point, it probably won’t surprise you to hear that the greater participants’ compliance with either of these diets, the less likely they were to experience ED.

Therefore, it is important to bring ED to the attention of your physician. 

There are very effective lifestyle alternatives to oral medication that provide positive overall health effects and treat associated chronic diseases, while also helping patients eliminate medications that contribute to ED.

References:

(1) clevelandclinic.org. (2) Curr Med Res Opin. 2004;20(5):607. (3) J Sex Med. 2009;6(5):1414-22. (4) Int J Androl. 2010;33(6):853-60. (5) J Am Coll Cardiol. 2005;46(8):1503. (6) Medicine (Baltimore). 2018 Jul;97(28):e11367. (7) JAMA. 2002;288(3):351. (8) Int J Impot Res. 2006;18(4):405-10. (9) JAMA. 2004;292(12):1440-6. (10) J Sex Med. 2010 May;7(5):1911-7. (11) JAMA Netw Open. 2020 Nov 2;3(11):e2021701.

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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Jefferson's Ferry

Jefferson’s Ferry, a Life Plan community located in South Setauket, was recently named among the top nursing homes in New York State by U.S. News and World report. Jefferson’s Ferry received a 5 out of 5 rating overall, also achieving the top (3 out of 3) high performance rating in multiple categories including short term rehabilitation and long term care.

The rigorous U.S. News & World Report standards for Best Nursing Homes in New York is determined by state-conducted health inspections, nursing staffing and medical quality measures. They evaluate more than 15,000 nursing homes on care, safety, infection rates, staffing and health inspections. Of the more than 600 nursing homes in New York, Jefferson’s Ferry stood out as one of the best in the state and one of only 10 recognized for excellence on Long Island.

“Being named among the Best Nursing Homes in New York is a great honor and a testament to the outstanding care our exceptional staff provides each day to every resident,” said Bob Caulfield, President and Chief Executive Officer of Jefferson’s Ferry. “We take great pride in cultivating and recognizing the exceptional talent and compassion demonstrated by our staff, which has a direct impact on the superior care we provide to our residents. This is what is at the heart of Jefferson’s Ferry.”

Anthony Comerford, Vice President of Health Services at Jefferson’s Ferry concurred and added, “This prestigious acknowledgement not only showcases Jefferson’s Ferry commitment to providing outstanding care and service to its residents, it is especially gratifying to our staff and management to have their commitment and professionalism documented by such a well recognized outside authority.” For more information visit www.jeffersonsferry.org

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