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Long-term PPI use increases serious risks. Stock photo

By David Dunaief, M.D,

Dr. David Dunaief

Reflux is common after a large meal. This is when stomach contents flow backward up the esophagus. It occurs because the valve between the stomach and the esophagus, the lower esophageal sphincter, relaxes for no apparent reason. Many incidences of reflux are normal, especially after a meal, and don’t require medical treatment (1).

However, gastroesophageal reflux disease (GERD) is a more serious disorder. It can have long-term health effects, including erosion or scarring of the esophagus, ulcers, and increased cancer risk. Researchers estimate it affects as much as 28 percent of the U.S. adult population (2). No wonder pharmaceutical firms line drug store shelves with over-the-counter and prescription solutions.

GERD risk factors range from lifestyle — obesity, smoking and diet — to medications, like calcium channel blockers and antihistamines. Other medical conditions, like hiatal hernia and pregnancy, also contribute (3). Dietary triggers, such as spicy, salty, or fried foods, peppermint, and chocolate, can also play a role.

One study showed that both smoking and salt consumption increased GERD risk significantly, with increases of 70 percent in people who smoked or who used table salt regularly (4). Let’s examine available treatments and ways to reduce your risk.

What medical options can help with GERD?

The most common and effective medications for treating GERD are H2 receptor blockers (e.g., Zantac and Tagamet), which partially block acid production, and proton pump inhibitors (e.g., Nexium and Prevacid), which almost completely block acid production (5). Both classes of medicines have two levels: over-the-counter and prescription strength. Let’s focus on proton pump inhibitors (PPIs), for which just over 90 million prescriptions are written every year in the U.S. (6).

The most frequently prescribed PPIs include Prilosec (omeprazole) and Protonix (pantoprazole). Studies show they are effective with short-term use in treating Helicobacter pylori-induced peptic ulcers, GERD symptoms, and gastric ulcer prophylaxis associated with NSAID use (aspirin, ibuprofen, etc.) as well as upper gastrointestinal bleeds.

Most of the data in the package inserts is based on short-term studies lasting weeks, not years. The landmark study supporting long-term use approval was only one year. However, maintenance therapy usually continues over many years.

Concerns about long-term usage effects and overprescribing have led to calls among pharmacists to take an active role in educating patients about their risks – along with educating patients about the need to take them before eating for them to work (7).

What are PPI risks?

Side effects after years of use can include increased risk of bone fractures and calcium malabsorption; Clostridium difficile (C. difficile), a serious bacterial infection in the intestines; potential vitamin B12 deficiencies; and weight gain (8).

The FDA has amplified its warnings about the increased risk of C. difficile, which must be treated with antibiotics. Unfortunately, it only responds to a few antibiotics, and that number is dwindling. Patients need to contact their physicians if they develop diarrhea when taking PPIs and the diarrhea doesn’t improve (9).

Suppressing stomach acid over long periods can also result in malabsorption issues. In a study where PPIs were associated with B12 malabsorption, it usually took at least three years’ duration to cause this effect. While B12 was not absorbed properly from food, PPIs did not affect B12 levels from supplementation (10). If you are taking a PPI chronically, have your B12 and methylmalonic acid (a metabolite of B12) levels checked and discuss supplementation with your physician.

Before you stop taking PPIs, consult your physician. Rebound hyperacidity can result from stopping abruptly.

What non-medical options can improve GERD?

A number of modifications can improve GERD, such as raising the head of the bed about six inches, not eating prior to bedtime and obesity treatment, to name a few (11). 

Fiber and exercise. The study that quantified the increased risks of smoking and salt also found that fiber and exercise both had the opposite effect, reducing GERD risk (4). An analysis by Journal Watch suggests that the fiber effect may be due to its ability to reduce nitric oxide production, a relaxant for the lower esophageal sphincter (12).

Manage weight. In one study, researchers showed that obesity increases pressure on the lower esophageal sphincter significantly (13). Intragastric (within the stomach) pressures were higher in both overweight and obese patients on inspiration and on expiration, compared to those with a “normal” body mass index.

Avoid late night eating. One of the most powerful modifications we can make to avoid GERD is among the simplest. A study showed a 700 percent increased risk of GERD for those who ate within three hours of bedtime, compared to those who ate four hours or more before bedtime (14).

While drugs have their place in the arsenal of options to treat GERD, lifestyle changes are the first, safest, and most effective approach in many instances. 

References:

(1) Gastroenterol Clin North Am. 1996;25(1):75. (2) Gut. 2014; 63(6):871-80. (3) niddk.nih.gov. (4) Gut 2004 Dec; 53:1730-1735. (5) Gastroenterology. 2008;135(4):1392. (6) Kane SP. Proton Pump Inhibitor, ClinCalc DrugStats Database, Version 2022.08. Updated August 24, 2022. Accessed October 11, 2022. (7) US Pharm. 2019:44(12):25-31. (8) World J Gastroenterol. 2009;15(38):4794–4798. (9) FDA.gov. (10) Linus Pauling Institute; lpi.oregonstate.edu. (11) Arch Intern Med. 2006;166:965-971. (12) JWatch Gastro. Feb. 16, 2005. (13) Gastroenterology 2006 Mar; 130:639-649. (14) Am J Gastroenterol. 2005 Dec;100(12):2633-2636.

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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Members of the Stony Brook Rotary Club at the Oktoberfest 5K. Photo by Aidan Johnson
Scene from the 2023 Stony Brook Rotary’s Oktoberfest 5K. Photo by Aidan Johnson
Scene from the 2023 Stony Brook Rotary’s Oktoberfest 5K. Photo by Aidan Johnson
Scene from the 2023 Stony Brook Rotary’s Oktoberfest 5K. Photo by Aidan Johnson

By Aidan Johnson

Over 150 people participated in the Stony Brook Rotary Club’s Oktoberfest 5K Run Sunday, Oct. 15.

The event, which saw clear skies and mild temperatures, raised money for the Stony Brook Cancer Center’s Mobile Mammography Van, which goes around to different communities to offer free breast cancer screenings.

“This year, we started our new pledge to Stony Brook Cancer Center, who sponsored the mammogram bus,” explained Debbie Van Doorne, president of Stony Brook Rotary. 

The fundraiser was timed well since October is Breast Cancer Awareness Month, followed by “Movember,” which raises awareness of breast cancer in men, Van Doorne added.

The Bench Bar & Grill on Route 25A in Stony Brook was the starting and finishing point. As runners returned, they were greeted with refreshments and live music by the band Alternate FRED.

 

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Photo by Annie Spratt on Unsplash

News Flash: Generated by ChatGPT, edited by our staff

• FDA approves RSV vaccines for the first time. These vaccines target the respiratory syncytial virus, a seasonal lung-related illness, with recommendations for adults over 60 and pregnant women in specific gestational weeks.

• Infants under eight months born to mothers without the RSV vaccination can receive monoclonal antibody treatment, providing immunological protection against severe RSV symptoms.

• There are challenges in accessing RSV shots, including delayed processing by insurance companies and pharmacy shortages. Health officials urge residents to advocate for themselves, emphasizing the importance of timely vaccinations given the approaching RSV season.

For the first time, vaccines against the respiratory syncytial virus, or RSV — a lung-related illness that crops up during the fall and winter — have been approved by the U.S. Food and Drug Administration.

The FDA recommends that adults ages 60 and older receive a dose of the vaccine, either Pfizer’s Abrysvo or GSK’s Arexvy, within the next few weeks.

Women in their 32nd to 36th week of pregnancy at some point during September through January are also urged to receive Abrysvo.

For babies born to mothers who didn’t receive a dose of the RSV vaccine, the FDA has approved a monoclonal antibody treatment for infants eight months old and younger that will offer immunological protection against a common and prevalent respiratory condition that can lead to severe symptoms and hospitalizations.

Additionally, the Centers for Disease Control and Prevention recommend a dose of RSV antibody for children between eight and 19 months entering their second RSV season if they have chronic lung disease, are severely immunocompromised, have a severe form of cystic fibrosis or are American Indian or Alaska Natives.

Dr. Sharon Nachman, chief of the Division of Pediatric Infectious Diseases at Stony Brook Children’s Hospital. File photo from Stony Brook Medicine

While local doctors welcomed the opportunity to inoculate residents, they said finding these treatments has been difficult.

“People are having a hard time getting” the vaccine, said Dr. Sharon Nachman, chief of the Division of Pediatric Infectious Diseases at Stony Brook Children’s Hospital.

Some pharmacies have told patients to come back, which decreases the likelihood that they will return for vaccinations in time, Nachman said.

Additionally, insurance companies have not immediately processed requests for vaccinations, which also slows the process, she said.

Nachman recommended that residents “continue to go back and advocate for yourself” because that is “the only way you’ll get what you need.”

RSV season starts around November, which means residents qualified to receive the vaccine or parents with infants need to reach out to their health care providers now to receive some protection against the virus.

Childhood illness

According to recent data, RSV caused 2,800 hospitalizations per 100,000 children in the first year of life, Nachman said. The range can go as low as 1,500 per 100,000.

However, that only captures the number of hospitalized people and doesn’t include all the times anxious parents bring their sick children to doctor’s offices or walk-in clinics.

“Hospitalizations are the worst of the group, [but] it’s a much bigger pyramid” of people who develop RSV illnesses, Nachman said.

In addition to recommending monoclonal treatment for children under eight months old, the CDC urges parents to get this treatment for vulnerable children who are under two years old.

Dr. Gregson Pigott, commissioner of the Suffolk County Department of Health Services. File photo

Like other vaccinations, the RSV vaccine won’t prevent people from getting sick. It will, however, likely reduce the symptoms and duration of the illness.

“In trials, RSV vaccines significantly reduced lower respiratory tract lung infections serious enough to require medical care,” Dr. Gregson Pigott, Suffolk County Health Commissioner, explained in an email.

At its worst, the symptoms of RSV — such as fever, cough and serious respiratory illness — are problematic enough that it’s worth putting out extra effort to receive some immune protection.

“If you’re a little kid or an elderly patient, this is a disease you don’t want to get,” Nachman said.

Pigott said that data analysis shows that RSV vaccines are 85% effective against severe symptoms of the virus.

While people can receive the COVID-19 and flu vaccines simultaneously, doctors recommend getting the RSV vaccine two weeks later.

According to preliminary data, eligible residents may benefit from the RSV vaccine for two seasons, which means they would likely need to receive the shot every other year, according to Pigott.

With two vaccines approved for adults, Pigott recommended that people receive whichever shot is available.

“Both reduce a person’s chances of getting very serious lung infections,” Pigott explained, adding that several measures can help people protect themselves from the flu, RSV and COVID.

Getting a vaccine, washing hands, avoiding touching your eyes, nose or mouth, avoiding close contact with people who are sick with respiratory symptoms and wearing a mask in places where respiratory viruses are circulating can all help.

Those who are symptomatic should stay home when they are sick and wear masks when they are around other people.

Suffolk County Department of Health Services officials indicated they are aware of the challenges of getting shots and monoclonal antibodies and “ask people to be patient.”

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'I have seen very good results when treating patients who have eczema with dietary changes.- Dr. David Dunaief METRO photo
New treatments are evolving

By David Dunaief, M.D.

Dr. David Dunaief

If you have eczema, you’re familiar with its symptoms, which can include rashes, itching, pain and redness. What may not be as clear are its causes and potential implications.

Eczema is a chronic inflammatory process, and it’s likely caused by a combination of genetics and lifestyle choices (1).

While there is no cure, some treatments can ease symptoms and reduce flare-ups. These range from over-the-counter creams and lotions, antihistamines for itchiness, prescription steroid creams, oral steroids, and injectable biologics. Some sufferers use phototherapy for severe cases, but there’s not a lot of research suggesting this is effective. Interestingly, diet may play an important role.

Two separate studies have shown an association between eczema and fracture risk, which we will investigate further.

How does diet affect eczema?

In a Japanese study involving over 700 pregnant women and their offspring, results showed that when the women ate either a diet high in green and yellow vegetables, beta carotene or citrus fruit there was a significant reduction in the risk of the child having eczema of 59 percent, 48 percent and 47 percent, respectively, when comparing highest to lowest consumption quartiles (2).

Elimination diets may also play a role. One study’s results showed when eggs were removed from the diet of those who were allergic, according to IgE testing, eczema improved significantly (3).

From an anecdotal perspective, I have seen very good results when treating patients who have eczema with dietary changes. My patient population includes many patients who suffer from some level of eczema. For example, a young adult had eczema mostly on his extremities. When we first met, these were angry, excoriated, erythematous and scratched lesions. However, after several months of a vegetable-rich diet, the patient’s skin improved significantly.

Do supplements help reduce eczema symptoms?

There are two well-known supplements for helping to reduce inflammation, evening primrose oil and borage oil. Are these supplements a good replacement for – or addition to – medications? The research is really mixed, leaning toward ineffective. There are also some important concerns about them.

In a meta-analysis of seven randomized controlled trials, evening primrose oil was no better than placebo in treating eczema (4).

The researchers also looked at eight studies of borage oil and found there was no difference from placebo in terms of symptom relief. While these supplements only had minor side effects in the study, they can interact with other medications. For example, evening primrose oil in combination with aspirin can cause clotting problems (5).

The upshot? Don’t expect supplements to provide significant help. If you do try them, be sure to consult with your physician first.

Are biologics a good alternative?

Injectable biologics are among the newest treatments and are generally recommended when other treatment options have failed (6). There are two currently approved by the FDA, dupilumab and tralokinumab.

In trials, these injectable drugs showed good results, improving outcomes for moderate to severe eczema sufferers when topical steroids alone were not effective. Like other monoclonal antibodies, they work by interfering with parts of your immune system. They suppress messengers of the white blood cells, called interleukins. This leaves a door open for side effects, like serious infections.

Does eczema affect bone health?

Several studies have examined the relationship between eczema and broken bones. One observational study of 34,500 patients showed that those with eczema had a 44 percent increased risk of injury causing limitation and a 67 percent risk of bone fracture and bone or joint injury for those 30 years and older (7).

If you have both fatigue or insomnia in combination with eczema, you are at higher risk for bone or joint injury than having one or the other alone. The researchers postulated that corticosteroids used in treatment could be one reason, in addition to chronic inflammation, which may also contribute to bone loss risk. 

Steroids may weaken bone, ligaments and tendons and may cause osteoporosis by decreasing bone mineral density.

A study of over 500,000 patients tested this theory and found that the association between major osteoporotic fractures and atopic eczema remained, even after adjusting for a range of histories with oral corticosteroids (8). Also, fracture rates were higher in those with severe atopic eczema.

For those who have eczema, it may be wise to have a DEXA (bone) scan.

Eczema exists on a spectrum from annoying to significantly affecting a patient’s quality of life. Supplements may not be the solution, at least not borage oil nor evening primrose oil. However, there may be promising medications for the hard to treat. It might be best to avoid long-term systemic steroids because of their long-term side effects. Diet adjustments appear to be very effective, at least at the anecdotal level.

References:

(1) Acta Derm Venereol (Stockh) 1985;117 (Suppl.):1-59. (2) Allergy. 2010 Jun 1;65(6):758-765. (3) J Am Acad Dermatol. 2004;50(3):391-404. (4) Cochrane Database Syst Rev. 2013;4:CD004416. (5) mayoclinic.org (9) Medscape.com. (6) JAMA Dermatol. 2015;151(1):33-41. (7) J Allergy Clin Immunol Pract. 2021 Sep 24;S2213-2198(21)01018-7. (8) nationaleczema.org.

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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Harmony & Light Wellness
Harmony & Light Wellness
Harmony & Light Wellness
Harmony & Light Harmonic Egg

The Greater Port Jefferson Chamber of Commerce hosted a ribbon cutting ceremony for Harmony & Light Wellness in Port Jefferson on Sept. 30. The event celebrated Harmony’s one-year anniversary and becoming a new chamber partner.

Located at  646 Main Street, Lower Level, the business specializes in helping you relax, recharge, reset and rebalance with holistic and sound therapy including the Harmonic Egg.®

Pictured in photo, from left, Nicole Martinsen, Melissa Fesmire, Town of Brookhaven Councilmember Jonathan Kornreich, owner Megan Fesmire (holding scissor), husband Beau and daughter Cassidy. 

Operating hours are Tuesday, Thursday and Sunday from 10 a.m. to 3 p.m. and Wednesday, Friday and Monday from 10 a.m. to 8 p.m. For more information, call 631-828-5055.

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Image from TOB

Check out some of the Town of Brookhaven’s upcoming fall programs at your local recreation centers.

Henrietta Acampora Recreation Center

39 Montauk Highway, Blue Point, NY 11715

(631) 451-6163

Yoga

This class includes standing postures, strengthening exercises on a mat, seated stretches and guided relaxation. Our practice supports strength, agility, flexibility, and balance, while reducing stress and having fun. Please bring a yoga mat, yoga blocks or a rolled towel.

Date: Mondays, October 23, November 20,27, December 4, 11,18

(Pre-register by Friday, October 20, 2023)

Time: 1pm – 2pm

Fee: $35.00 per 6-week session

 

New Village Recreation Center

20 Wireless Road, Centereach, NY 11720

(631) 451-5307

Zumba

This high-energy cardio aerobics class combines Latin and international beats with salsa, merengue, cha-cha, samba, hip-hop and belly dancing.

Date: Mondays, October 30, November 6, 13, 20, 27, December 4

Fridays, October 20, 27, November 3, 10, 17, December 1

(Pre-register by Wednesday, October 18, 2023)

Time: Mondays 10:30am – 11:30am

Fridays 5:30pm – 6:30pm

Fee: $40.00 per 6-week session

 

Robert E. Reid, Sr. Recreation Center

Defense Hill Road & Route 25A, Shoreham, NY 11786  

(631) 451-5306

 Jump Bunch Jr. (ages 3-5)

Learn a new sport each week. Sports include soccer, football, lacrosse and volleyball. No equipment necessary. Just bring water.

Date: Fridays, October 20, 27, November 10, 17, December 1, 8

(Pre-register by Wednesday, October 18, 2023)

Time: 4pm – 5pm

Fee: $60.00 per 6-week session

 

Jump Bunch (ages 6-9)

Learn a new sport each week. Sports include soccer, football, lacrosse and volleyball. No equipment necessary. Just bring water.

Date: Fridays, October 20, 27, November 10, 17, December 1, 8

(Pre-register by Wednesday, October 18, 2023)

Time: 5:15pm – 6:15pm

Fee: $60.00 per 6-week session

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Dr. Susan Hedayati, right, and Dr. Peter Igarashi attend the ASCI/AAP meeting in Chicago Spring 2023. Photo courtesy Hedayati

She is bringing two important parts of an effective team back together.

Dr. Susan Hedayati — pronounced heh-DYE-it-tee — recently joined the Renaissance School of Medicine at Stony Brook University as vice dean for research. Hedayati was most recently a professor of medicine and associate vice chair for research at the University of Texas Southwestern Medical Center.

Hedayati plans to help improve Stony Brook Medical School’s national and international reputation by coupling frontline research with translational and patient-oriented care and studies.

The combination of a research and clinical care focus will provide for the “betterment of the health of Long Island population of patients,” Hedayati said.

In addition to enhancing clinical care, such an approach would “facilitate funding of investigator-initiated [National Institute of Health] grants and aid in the recruitment and retention of excellent M.D.-investigators,” she explained in an email.

She said she is eager to build an institutional clinical trials infrastructure that would involve a dedicated research support team.

Adding Hedayati to the medical school faculty at Stony Brook University, where she will also serve as the Lina Obeid chair in biomedical sciences, also brings two prominent kidney specialists who have different approaches to their work back together again.

Dr. Peter Igarashi, dean of the Renaissance School of Medicine and a nationally recognized nephrologist, had recruited and collaborated with Hedayati when she joined the University of Texas Southwestern Medical Center after winning first place in a clinical research award at the Southern Society for Clinical Investigation Young Investigator Forum.

When Igarashi first met Hedayati as a judge of the fellowship competition, he suggested that her expertise stood out clearly.

“She has enormous content expertise in the field of nephrology and internal medicine more broadly,” he said.

He was also impressed with her “passion” for research and her “devotion to patients and research,” which has also made her a “perfect fit” for her current position at Stony Brook University.

Combining research and clinical care will enable SBU to provide one-stop shopping at facilities like the specialty practices in Commack and the one recently opened in Lake Grove in the former Sears building at the Smith Haven Mall, he said.

Patients can receive clinical care at the same time that they can enroll in clinical trials for potential treatments of some conditions.

Hedayati “set that up at the University of Texas at Southwestern, and I’m hoping she’ll be able to grow that capability here,” Igarashi said.

Igarashi also described Hedayati, who was offered the job after a committee conducted the search, as “personable and likable.”

Complementary strengths

Igarashi described the different research approaches he and Hedayati take as “complementary” strengths.

Igarashi’s research is basic, wet lab science, while Hedayati has focused on translational and clinical research.

Their backgrounds will “be very helpful for elevating the entire research enterprise, not only in basic science but also in clinical and translational research,” Igarashi noted.

For her part, Hedayati suggested that her short-term goal is to build the physical infrastructure for clinical research and clinical trials.

Such efforts will require a clinical research staff infrastructure composed of research coordinators, research managers, regulatory personnel and biostatisticians.

“I’m hoping that, within a year, we’re going to be making some big strides in those directions,” Hedayati said.

She also hopes to build upon the existing medical scientist training program for M.D./Ph.D. students to establish a physician training program for residents to retain M.D. investigators in academic and biomedical research careers. That, she suggested, is a pool that is dwindling nationally.

Ongoing research

Hedayati, who is transferring most of her grants to Stony Brook, plans to continue conducting her own research.

She has been studying the link between chronic kidney disease, which affects about one in seven people, and other conditions, such as premature cardiovascular disease, susceptibility to depression and the role of inflammation.

“This is an area that’s prevalent, but understudied,” said Igarashi. 

She is searching for nontraditional biomarkers associated with kidney function decline, especially in patients with heart failure.

Patients with heart failure are at increased risk of acute and chronic kidney failure.

Igarashi is confident that Stony Brook’s new vice dean for research will serve patients on Long Island and beyond.

“She would not have taken this job unless we assured her that she would be able to continue to see patients in the clinic as well as in the hospital,” said Igarashi. “That is a core value for her.”

Echoing those sentiments, Hedayati suggested she has a “patient-centered approach in everything I do.”

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Quality years are achievable. METRO photo

By David Dunaief, M.D.

Dr. David Dunaief

On Sunday, former U.S. President Jimmy Carter celebrated his 99th birthday. While he is currently in hospice care, most of his last decade, he has been healthy and active.

Living into your 90s is becoming more common. According to the National Institutes of Health, those in the U.S. who were more than 90 years old increased by 2.5 times over a 30-year period from 1980 to 2010 (1). This group is among what researchers refer to as the “oldest-old,” which includes those aged 85 and older.

What do they all have in common, other than age? According to one study, they tend to have fewer chronic medical conditions or diseases. Because of this, they tend to have greater physical functioning and mental acuity, along with a better quality of life (2).

In a study of centenarians, genetics played a significant role. Characteristics of this group were that they tended to be healthy and then die rapidly, without prolonged suffering (3). In other words, they grew old “gracefully,” staying mobile and mentally alert.

Factors that predict one’s ability to reach this exclusive club may involve both genetics and lifestyle choices. Let’s look at the research.

How important is exercise?

We’re repeatedly nudged to exercise. Why? Results of one study with over 55,000 participants from ages 18 to 100 showed that five-to-ten minutes of daily running, regardless of the pace, can significantly impact our life span by decreasing cardiovascular and all-cause mortality (4).

Amazingly, even if participants ran fewer than six miles a week at a pace slower than 10-minute miles, and even if they ran only one to two days a week, there was still a decrease in mortality compared to nonrunners. Those who ran for this very limited amount of time and modest pace potentially added three years to their life span.

An accompanying editorial to this study noted that more than 50 percent of people in the United States do not meet the current recommendation of at least 30 minutes of moderate exercise per day (5).

A study presented at the European Society of Cardiology Congress in 2022 found that those 85 and older reduced the risk of all-cause mortality 40 percent by walking just 60 minutes a week at a pace that qualified as physical activity, not even exercise (6).

Does reducing animal protein consumption help?

A long-standing dietary paradigm has been that we need to eat sufficient animal protein. However, many are questioning the value of this, especially as it relates to longevity.

In an observational study of 7,000 participants from ages 50 to 65, results show that those who ate a high-protein diet with greater than 20 percent of their calories from protein had a had a 75 percent increase in overall mortality, a four-times increased risk of cancer mortality, and a four-times increased risk of dying from diabetes during the following 18 years (7). 

However, this did not hold true if the protein source was plants. In fact, a high-protein plant diet may reduce the risks, not increase them. The reason, according to the authors, is that animal protein may increase insulin growth factor-1 and growth hormones that have detrimental effects on the body.

The Adventists Health Study 2 trial reinforced these findings. It looked at Seventh-day Adventists, a group that emphasizes a plant-based diet, and found that those who ate animal protein once a week or less had a significantly reduced risk of dying over the next six years compared to those who were more frequent meat eaters (8). This was an observational trial with over 73,000 participants and a median age of 57 years old.

What effect does systemic inflammation have?

In the Whitehall II study, a specific marker for inflammation was measured, interleukin-6. The study showed that higher levels did not bode well for participants’ healthy longevity (9). If participants had elevated IL-6 (>2.0 ng/L) at both baseline and at the end of the 10-year follow-up period, their probability of healthy aging decreased by almost half.

The good news is that inflammation can be improved significantly with lifestyle changes.

The takeaway from this study is that IL-6 is a relatively common biomarker for inflammation. It can be measured with a simple blood test offered by most major laboratories. This study involved 3,044 participants over the age of 35 who did not have a stroke, heart attack or cancer at the beginning of the study.

The bottom line is that, although genetics are important for longevity, so too are lifestyle choices. A small amount of exercise and consuming more plant protein than animal protein can contribute to a substantial increase in healthy life span. IL-6 may be a useful marker for inflammation, which could help predict healthy or unhealthy outcomes. Your doctor can test to see if you have an elevated IL-6. If you do, lifestyle modifications may be able to reduce these levels.

References:

(1) nia.nih.gov. (2) J Am Geriatr Soc. 2009;57:432-440. (3) Future of Genomic Medicine (FoGM) VII. Presented March 7, 2014. (4) J Am Coll Cardiol. 2014;64:472-481. (5) J Am Coll Cardiol. 2014;64:482-484. (6) European Society of Cardiology Congress, Aug. 28, 2022. (7) Cell Metab. 2014;19:407-417. (8) JAMA Intern Med. 2013;173:1230-1238. (9) CMAJ. 2013;185:E763-E770.

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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School of Dental Medicine academic leaders during a panel session at the School’s first Dental Educators Day. From left: Sri Myeni, DDS, MS, PhD; Rekha Reddy, DMD; Christine Valestrand, DMD, and Thomas Manders, DDS. Photo by Brett Mauser

Event is designed to highlight an academic career path to fill a national need  

Driven by the shortage of dental school faculty in New York and across the United States, Stony Brook School of Dental Medicine hosted its inaugural Dental Educators Day on October 5. The event was held in conjunction with World Teachers’ Day, and will be celebrated at Stony Brook on the first Thursday in October each year.

“By sharing the innumerable benefits of being a dental educator, we hope to inspire students to pursue such a pathway, whether their career is here at Stony Brook or elsewhere,” said Patrick M. Lloyd, DDS, MS, Dean of the Stony Brook School of Dental Medicine. “We also hope that other dental schools – in the U.S. and beyond – recognize the value of such a forum and that they consider hosting a dental educators event in the coming years.”

With the increase in class size of many dental schools as well as the emergence of more than a dozen new dental schools in the last 15 years, the need to reinforce the faculty workforce has never been greater. According to an article in the Journal of Dental Education, over 40 percent of full-time dental faculty in the United States reported to be over 60 years of age. Recruitment of faculty is challenged as well by private practice opportunities that often provide greater levels of compensation.

Stony Brook is uniquely positioned to help dental students interested in an academic career get a head start. It is one of few institutions where students can earn an education degree — a Master of Arts in Higher Education Administration — while in dental school with no additional tuition costs. Furthermore, Stony Brook’s general practice residents may complete a second year of training that is focused on developing their skills as didactic and clinical instructors.

“There are many tangible and intangible rewards that I have enjoyed as a faculty member at Stony Brook,” said Thomas Manders, DDS, Director of Stony Brook’s Division of Endodontics, who was one of four panelists to speak with students attending the afternoon’s question-and-answer session with dental faculty. “Dental Educators Day has been a great opportunity to share what motivated me to stay in education at my alma mater, as well as advice for current students who are considering a similar path.”

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By David Dunaief, M.D.

Dr. David Dunaief

Obesity is an ongoing struggle for many in the United States. If you, like many, are struggling to shed those extra “COVID-era pounds,” I’m sure you can relate.

Obesity is defined as a BMI (body mass index) of >30 kg/m2. More importantly, obesity can also be defined by excess body fat, which is more important than BMI.

While the medical community has known for some time that excess body fat contributes to poor health outcomes, it became especially visible during the first few rounds of COVID-19.

In the U.S., poor COVID-19 outcomes have been associated with obesity. In a study involving 5700 COVID-19 patients hospitalized in the New York City area, 41.7 percent were obese. The most common comorbidities contributing to hospitalization were obesity, high blood pressure and diabetes (1). In other words, obesity contributed to more severe symptoms.

In a study in China, results showed that those who were overweight were 86 percent more likely to have severe COVID-19 pneumonia, and that percentage increases to 142 percent when patients qualify as obese (2).

And though age is a risk factor for COVID-19, among those younger than 60 and obese, there is a two-times increased risk of being admitted to the hospital, according to a 3,615-patient study at NYU Langone Health (3).

While these studies were on early variants of COVID, the attention and wide-ranging research provide us with an interesting series of studies in how excess weight might impact progression of other acute respiratory diseases.

Why is the risk for severe COVID-19 higher with obesity? 

According to the prevailing theory, obesity may interfere with mechanical aspects of breathing, thus increasing airway resistance and making gas in exchange more difficult in the lung. It may also impede lung volume by exerting pressure on the lungs and may involve weaker muscles necessary for respiration (4).

Why does excess fat affect health outcomes? 

First, some who have elevated BMI may not have a significant amount of fat; they may have more innate muscle, instead. These people are not necessarily athletes. It’s just how they were genetically put together.

More than 25 percent of my patient population is “solidly built,” which means they have greater muscle mass, but also too much excess fat. Visceral fat, which is wrapped around the organs, including the lungs, is the most important.

Fat cells have adipokines, specific cell communicators that “talk” with other fat cells but also other systems such as the brain, immune system, muscles, and liver. Adipokines can be mediators of both inflammation and insulin resistance (5). It’s the inflammation among obese patients that could be the exacerbating factor for hospitalizations and severe illness, according to the author of a 4000-patient COVID-19 study (6). 

How can you reduce inflammation and lose excess fat?

In a randomized controlled trial with 75 participants comparing a plant-based diet to a control diet, there was a greater than 14 lbs. weight reduction and roughly 10 lbs. fat reduction over a 14-week period (7). Of the weight lost, about 70 percent was excess fat. Remember, excess body fat, through adipokines, may be inflammatory and increase the risk of severe disease. 

Weight reduction with a plant-based approach may be results of dietary fiber increases and dietary fat reductions with plant-based diets, according to Physician’s Committee for Responsible Medicine (PCRM) (8). You also want a diet that has been shown to reduce inflammation.

We published a study involving 16 patients from my clinical practice in 2020. It shows that those who ate a whole food plant-based LIFE (low inflammatory foods everyday) diet over a seven-day period had a significant decrease in inflammation measured by hsCRP (high sensitivity c-reactive protein). This occurred in those who completely changed their diets to the LIFE diet, but also occurred in those who simply added a daily greens-and-fruit-based smoothie to their existing diet (9).

In my practice, I have seen many patients lose substantial amounts of weight over a short period. More importantly, they also lost body fat. For instance, a 70-year-old male lost 19 lbs. of weight and 12 lbs. of body fat over a six-week period. His inflammation, which was very high to start, dropped substantially to the border of optimal levels. This patient and many others have seen tandem reductions in both weight and inflammation. To boot, this was a cardiac patient whose cardiologist had considered a stent, but later said he did not need it after reducing his inflammation.

The most recent health crisis shone a spotlight on the importance of losing excess fat. It’s not just about COVID-19 or other respiratory disease severity, although those are concerning. It’s also about excess fat’s significant known contributions to many other chronic diseases, like cardiovascular disease, high blood pressure, and high cholesterol.

References:

(1) JAMA. online April 22, 2020. (2) Clin Med (Lond). 2020 Jul; 20(4): e109–e113. (3) Clin Infect Dis. 2020 Jul 28;71(15):896-897. (4) Chron. Respir. Dis. 5, 233–242 (2008). (5) Front Endocrinol (Lausanne). 2013; 4:71. (6) MedRxiv.com. (7) Nutr Diabetes. 2018; 8: 58. (8) Inter Journal of Disease Reversal and Prevention 2019;1:1. (9) Amer J Lifestyle Med. 2022;16(6):753-764.

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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