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Blueberries can help lower blood pressure. Pixabay photo
Being modestly overweight increases risk more than smoking

By David Dunaief, M.D.

Dr. David Dunaief

Roughly 47 percent of U.S. adults over the age of 18 have hypertension, or high blood pressure. That’s almost one in two adults, or 116 million people. Of these, roughly 92 million do not have their hypertension controlled (1). These are some scary numbers, considering the probability of complications, such as cardiovascular events and mortality.

What increases our risk? Being significantly overweight or obese, smoking, poor diet, lack of exercise, family history, age, increased sodium, depression, low vitamin D, diabetes and too much alcohol (2).

Fortunately, hypertension is highly modifiable in terms of reducing the risk of cardiovascular disease and mortality (3). 

Of course, antihypertensive (blood pressure) medications treat this disorder. In addition, some nonpharmacological approaches have benefits. These include lifestyle modifications with diet, exercise and potentially supplements.

Weighing risk factors

In an observational study involving 2,763 participants, results showed that those with poor diets had 2.19 times increased risk of developing high blood pressure. This was the greatest contributor to developing this disorder (4). Another risk factor with a significant impact was being at least modestly overweight (BMI >27.5 kg/m²), which put participants at 1.87 times increased risk. This, surprisingly, trumped cigarette smoking, which increased risk by 1.83 times. 

The moral is that a freewheeling lifestyle can have a detrimental impact on blood pressure and cause at least stage 1 hypertension.

Implications of gender, age and race on complications

Stock photo

While the data show that more men than women have hypertension, 50 percent vs. 44 percent, and the prevalence of high blood pressure varies by race, the consequences of hypertension are felt across the spectrum of age, gender and race (5).

One of the most feared complications of hypertension is cardiovascular disease. In a study, isolated systolic (top number) hypertension was shown to increase the risk of cardiovascular disease and death in both young and middle-aged men and women between 18 and 49 years old, compared to those who had optimal blood pressure (6). The effect was greatest in women, with a 55 percent increased risk in cardiovascular disease and 112 percent increased risk in heart disease death. High blood pressure has complications associated with it, regardless of onset age. Though this study was observational, it was very large and had a 31-year duration.

Uncontrolled nighttime hypertension and cardiovascular event risk

Measuring blood pressure in the clinic can be useful. However, in a meta-analysis (involving nine studies from Europe, South America and Asia), results showed that high blood pressure measured at nighttime was potentially a better predictor of myocardial infarctions (heart attacks) and strokes, compared to daytime and clinic readings (6).

For every 10 mmHg rise in nighttime systolic blood pressure, there was a corresponding 25 percent increase in cardiovascular events. This was a large meta-analysis that utilized studies that were at least one year in duration.

Does this mean that nighttime readings are superior in predicting risk? Not necessarily, but the results are interesting. The nighttime readings were made using 24-hour ambulatory blood pressure measurements (ABPM).

There is something referred to as masked uncontrolled hypertension (MUCH) that may increase the risk of cardiovascular events in the nighttime. MUCH occurs in those who are well-controlled during clinic readings for blood pressure; however, their nocturnal blood pressure is uncontrolled. In the Spanish Society of Hypertension ABPM Registry, MUCH was most commonly seen during nocturnal hours (7). Thus, the authors suggest that ABPM may be a better way to monitor those who have higher risk factors for MUCH, such as those whose pressure is borderline in the clinic and those who are smokers, obese or have diabetes.

Previously, a study suggested that taking at least one antihypertensive medication at night may be more effective than taking them all in the morning (8). Those who took one or more blood pressure medications at night saw a two-thirds reduction in cardiovascular event risk. Now we can potentially see why. These were patients who had chronic kidney disease (CKD). Generally, 85 to 95 percent of those with CKD have hypertension.

Eat your berries

Diet plays a role in controlling high blood pressure. In a study, blueberry powder (22 grams) in a daily equivalent to one cup of fresh blueberries reduced systolic blood pressure by a respectable 7 mmHg and diastolic blood pressure by 5 mmHg over 2 months (9).

This is a modest amount of fruit with a significant impact, demonstrating exciting results in a small, preliminary, double-blind, placebo-controlled randomized trial. Blueberries increase nitric oxide, which helps blood vessels relax, reducing blood pressure. While the study used powder, it’s possible that an equivalent amount of real fruit would lead to greater reduction.

In conclusion, high blood pressure and its cardiovascular complications can be scary, but lifestyle modifications, such as taking antihypertensive medications at night and making dietary changes, can have a big impact in altering these serious risks.

References:

(1) millionhearts.hhs.gov. (2) uptodate.com. (3) Diabetes Care 2011;34 Suppl 2:S308-312. (4) BMC Fam Pract 2015;16(26). (5) cdc.gov. (6) J Am Coll Cardiol 2015;65(4):327-335. (7) Eur Heart J 2015;35(46):3304-3312. (8) J Am Soc Nephrol 2011 Dec;22(12):2313-2321. (9) J Acad Nutr Diet 2015;115(3):369-377. (10) JAMA Pediatr online April 27, 2015.

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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Take a Bite of a Better-for-You Energy Booster

(Family Features) Whether you’re a runner, a workout warrior or simply looking for a quick pick-me-up before heading to the office, grab-and-go foods can supply the energy you need for an active day.

Skipping salty snacks and opting for nutritious options can put you ahead of the game. Due to their high carbohydrate content, sweetpotatoes provide a sustaining option both before and after exercise sessions. Plus, with antioxidants that help reduce inflammation and aid in the muscle repair process, they help both your endurance and recovery.

According to the American Diabetes Association, sweetpotatoes are a “diabetes superfood” because they are rich in vitamins, minerals, antioxidants and fiber, all of which are good for overall health and may help prevent disease. Additionally, they offer a “sweet” flavor without the added sugar.

Another fun fact: the one-word spelling of “sweetpotato” was adopted by the National Sweetpotato Collaborators in 1989 in an effort to avoid confusion with the potato and yam among shippers, distributors, warehouse workers and consumers.

As a versatile veggie that’s easy to add to a multitude of recipes for flavor enhancement and nutritional content, they are a key ingredient in these No-Bake Sweetpotato Coconut Ginger Energy Bites from the North Carolina SweetPotato Commission. It takes just 45 minutes to turn cooked sweetpotatoes into tasty treats for much-needed fuel for breakfast or an afternoon snack.

Find more nutritious recipe ideas at ncsweetpotatoes.com.

No-Bake Sweetpotato Coconut Ginger Energy Bites

Recipe courtesy of Sarah Schlichter, MPH, RDN, on behalf of the North Carolina SweetPotato Commission

Total time: 45 minutes

Yield: 14 bites (1 bite per serving)

Ingredients:

1 cup cooked sweetpotato

3/4 cup rolled oats

1/2 cup peanut butter (or desired nut butter)

3 tablespoons honey

1/2 teaspoon ground ginger

1/2 teaspoon cinnamon

1/2 cup unsweetened shredded coconut

Directions:

In large bowl, combine sweetpotato, oats, peanut butter, honey, ginger and cinnamon; stir until well combined. Refrigerate bowl about 20 minutes to firm. Line baking sheet with parchment paper. Remove dough and portion into snack-sized bites. Gently roll bites in shredded coconut and refrigerate 15-20 minutes or freeze 10 minutes. Remove from refrigerator or freezer and serve.

Nutritional information per serving: 115 calories; 7 g fat (11% daily value); 3 g saturated fat (19% daily value); 1 g polysaturated fat; 2 g monosaturated fat; 49 mg sodium (2% daily value); 129 mg potassium (4% daily value); 11 g carbohydrates (4% daily value); 2 g fiber (8% daily value); 5 g sugar (6% daily value); 3 g protein (6% daily value); 1,348 IU vitamin A (27% daily value); 1 mg vitamin C (1% daily value); 11 mg calcium (1% daily value); 1 mg iron (6% daily value); 9 g net carbohydrates.

See video of recipe here: https://youtu.be/KfGXFluT6d8

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Photo from Statepoint

Sticking to a schedule is good for health, wellness and productivity, and the start of a new year is the perfect time to form great habits. Resolve to adhere to a daily routine with the following tips and tricks:

• Write it down: The act of writing things down can help reinforce priorities. Keep a list of short- and long-term goals, events and meetings. Be sure to check items off your list as you complete them. Doing so can help you stay motivated.

• Get a good watch: Keep yourself accountable with a good watch. The line-up of Edifice watches by Casio are not only stylish, they contain must-have productivity features, such as multiple alarms, as well as countdown timers displaying the remaining time until the alarm beeps. They also connect with your smartphone and offer cool, sync-up features that help you keep your essentials organized, such as “phone finder.” If you prefer a sportier timepiece, Pro Trek watches offer similar alarm features, along with step counters and sensor technology like altimeters, compasses and more, all of which are great for hikes, fishing expeditions and other outdoor activities.

• Keep it consistent: Keep both bedtime and the time you awake consistent day-to-day. Doing so can mean better quality slumber so you will be more alert, energized and ready to tackle tasks. Consistent meal times can also be beneficial, helping you maintain your energy throughout the day, manage metabolism and avoid hunger.

• Don’t overdo it: It can be tempting to try to schedule more tasks and to-dos into your day than is actually realistic. Doing so however can leave you feeling constantly stressed, and always in catch-up mode. Be sure your schedule offers you sufficient time to actually complete tasks and travel between appointments.

• Practice self-care: Downtime is essential. Whatever self-care looks like to you, be sure to build it into your schedule, whether that means relaxing with a good book, getting together with friends or working out.

Make 2022 the year you finally create and maintain a well-balanced schedule. With wearable tech and smart habits, you’ll be more inclined to stick with the program.

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Visitors to West Meadow Beach take a stroll down Trustees Road. Photo by Raina Angelier

By Cayla Rosenhagen

Cayla Rosenhagen

As we embark on a new year, many of us have resolved to make this year better than the last. Let’s aim to make 2022 a year to smile more and support our neighbors as well as the planet. Our community has so much to offer in helping us achieve our goals. I’d like to share some of my favorite environmentally conscious, self-care resolutions. 

Improve Your Diet and Shop at Local Farmers’ Markets

Looking for a way to support local businesses, enhance your eating habits, and save the planet? Look no further than the Port Jefferson Winter Farmers Market held on Sundays from 10 a.m. to 2 p.m. in the Village Center, 101-A East Broadway, Port Jefferson through April 25 and the Huntington Farmers Market open on Sundays from 9 a.m. to 1 p.m. at the John J. Flanagan Center, 423 Park Avenue, Huntington. Buying from local vendors has many advantages. Not only are you purchasing a wide variety of nutritious, in-season goods, but you are also supporting the local economy. In addition, you are contributing to energy conservation since local vendors don’t have to transport their products over long distances. 

Get Fit in the Great Outdoors 

Frank Melville Memorial Park. Photo by Cayla Rosenhagen

The ever-popular resolution to start or improve an exercise regimen can have physical, mental, and emotional health benefits. And the green spaces of Long Island’s north shore provide an ideal setting to accomplish your workout goals. With so many to choose from, I’d like to share some of my top picks. 

Historic Frank Melville Memorial Park in Setauket offers a picturesque, 0.4-mile, paved loop around Mill Pond. Enjoy the local wildlife, such as ducks, songbirds, deer, and turtles, within easy view. Only minutes away is Trustees Road at West Meadow Beach in Stony Brook. Formerly home to beachfront cottages, the road is now closed off to car traffic. The paved, scenic, 1-mile path is a popular destination for walking, jogging, biking, and skating, and getting a dose of Vitamin “Sea.”

Setauket Greenway Trail. Photo by Raina Angelier

Stretching 3.5 miles through old-growth forests and neighborhoods, the Setauket to Port Jefferson Station Greenway has trailheads with parking at Limroy Lane in Setauket and Hallock Avenue and Main Street in Port Jefferson Station. On any given day, you can find joggers, families pushing strollers, bicyclists, and people out for a walk with their pooches on this hilly, paved path. If you are looking for a wider array of surfaces and difficulty levels, Sunken Meadow State Park in Kings Park is the place for you. Choose from taking a stroll along their well-maintained, 0.75-mile boardwalk along the Sound, or hiking the many miles of wooded trails, some of which offer challenging inclines. 

Whether you decide to visit one of these parks or one of LI’s dozens more, be sure to keep the health of Mother Nature in mind. Abide by the “leave only footprints” rule and please be mindful of parks where no pets are permitted. If they are allowed, keep your pets leashed and pick up after them. Go that extra mile by toting a reusable water bottle, as opposed to a disposable, plastic one, and bring along something to pick up any litter you may encounter. 

Embrace Your Green Thumb

Oriole on Native Mulberry Tree. Photo by Raina Angeiler

Despite the chilly weather, now is the perfect time to begin planning your own backyard garden. There is no greater satisfaction than eating a homegrown tomato fresh from the vine. In the most literal sense, you get to reap what you sow. Not only will you save money on your produce bill, but gardening is also a natural stress reliever. Beyond the veggie garden, consider planting native plants and making eco-friendly decisions in how you care for your yard. 

For example, traditional fertilizer often finds its way into our water supply and causes a multitude of health issues for us and the planet. Composting is a much safer option. Native plants are evolutionarily designed to thrive in our climate and therefore require less care and less water. To go a step further, make your property a haven for wildlife by providing edible native plants, a water source, and plenty of shelter. By encouraging wildlife such as birds and bats to your yard, these critters will return the favor by eating up the pesky bugs in your yard. This is a wonderful alternative to dangerous pesticides. Reach out to Four Harbors Audubon Society for assistance with this through their “Bird Oasis” program. Visit their website at https://4has.org/bird-oasis.

Prize-winning fruits and vegetables in the horticulture division at a 3VGC Exhibit. Photo by Cayla Rosenhagen

No room to garden at your residence? No problem. How about participating in a community garden? In addition to getting to know fellow neighborhood gardeners, you will also get the chance to learn from experts. I recently spoke with Ann Pellegrino, the president of Hobbs Farm in Centereach. Here, you can volunteer your time to work in their fields without committing to being the sole caretaker of an individual plot. Your efforts can contribute to supplying local soup kitchens and food pantries with about 30,000lbs of organically grown produce annually. If you’re unable to volunteer your time but looking to support the mission of Hobbs Farm while supporting your health, purchase a Community Supported Agriculture membership to receive farm-fresh produce weekly. The farm also runs a farm-stand during the warmer weather. For more information, visit https://hobbsfarm.info.

Cornell Cooperative Extension of Suffolk County is a valuable resource for new and experienced gardeners. In speaking with Roxanne Zimmer, the community horticulture specialist, I learned the cooperative extension offers a variety of learning opportunities at public libraries and you don’t need to be a patron of that library to attend. For anyone interested in becoming a Master Gardener, CCE Suffolk will be accepting applications for their 16-week training program until January 31. More info can be found at ccesuffolk.org/gardening/community-gardens-in-suffolk-county.

Joining the Three Village Garden Club is another wonderful way to learn more about horticulture. They offer a variety of classes, gatherings, and exhibits. The club dates back almost a century and will resume its meetings at the Setauket Neighborhood House in early spring. More info to come soon. 

Reduce Your Meat and Dairy Intake

The animal agriculture industry produces more greenhouse gases than the world’s vehicle exhaust. Aside from this, natural habitats worldwide, including the oxygen-producing rainforests in South America, are being torn down to create pastures for livestock to graze in, dislocating thousands of native species. By partaking in “Meatless Mondays” or simply reducing your meat and dairy intake all-around, you can be part of a worldwide movement to slow the progress of global warming and depletion of the ozone layer. 

Vegan Artichoke Spinach Fettuccine

Reducing your intake of red meat and other animal products has also been scientifically proven to have a plethora of health benefits. Some of these include reduced risk of having a stroke, heart disease, and obesity. Challenge yourself to get creative in the kitchen with vegan and vegetarian recipes with the produce you purchase at local farmers’ markets. Take advantage of the fabulous, free cooking classes presented by our local libraries featuring vegetarian cuisine ranging from veggie stromboli at Middle Country Public Library to vegetable empanadas at Emma S. Clark Memorial Library. Check out your local library’s webpage for more information.

Pay it Forward

Reflect and give thanks by donating to a cause that embraces what’s important to you. Being charitable is not only a gift to others but a gift to yourself. According to multiple studies from around the globe, generous behavior is linked to a happier, healthier, more satisfying, and less stressful life. Whether you make a monetary contribution, a donation of goods, or choose to volunteer your time, there are plenty of local charities that would be grateful for your support. Here are some ideas to consider.

Have some clothing or furniture you no longer use? Angela’s House is a non-profit which assists families with medically frail children and will gladly accept these items for their fundraising Home Store located in Medford. Visit https://www.angelashouse.org to learn more about their mission and ways you can help. Looking for a way to help furry friends? There are many ways to support Save-A-Pet Animal Rescue and Adoption Center in Port Jefferson Station, including financially, assisting with animal care, and donating items from their Wish List. See https://www.saveapetli.net for more information. 

Interested in donating to an organization that benefits many causes? The Harry Chapin Foundation in Huntington awards grants to charities supporting agriculture, the arts, education, and environmental causes. Donate through their website at https://harrychapinfoundation.org. 

In saying goodbye to 2021, let us welcome the new year with these simple, yet impactful resolutions for a happier and healthier you, an even stronger community, and a greener Earth. Happy New Year, everyone!

Cayla Rosenhagen is a local high school student who enjoys capturing the unique charm of the community through photography and journalism. She serves on the board of directors for the Four Harbors Audubon Society and Brookhaven’s Youth Board, and is the founder and coordinator of Beach Bucket Brigade, a community outreach program dedicated to environmental awareness, engagement, and education. She is also an avid birder, hiker, and artist who is concurrently enrolled in college, pursuing a degree in teaching.

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Graduate student John Yuen wearing an N95 mask for fit testing after the mask was disinfected via dry heat. Photo from SBU
Study details published in PLOS ONE could serve as a guide to practical, safe reuse of N95s.

Entering a third year of the COVID-19 pandemic and the latest infection surge nationwide comes with many challenges. One of those is for a continued adequate supply of masks, including the often used N95 respirator masks for healthcare and other settings. A study led by Stony Brook University researchers discovered that a readily available method using dry ovens can be used to disinfect N95s for reuse, in settings where new masks may not be available. Their findings are published in PLOS ONE.

To combat any shortages of N95 masks during the pandemic, many institutions were forced to search for other alternatives to protect health care providers and their patients. While some studies have evaluated the impact of various methods of decontamination on how  well masks filter viral-sized particles, this study adds to such research and also addresses the equally important concept of maintaining proper mask fit after decontamination.

“Our study demonstrated that treatment of N95 face masks using dry heat was sufficient to inactivate COVID-19, while preserving the ability of these masks to filter aerosolized particles for potentially exposed workers,” summarizes Kenneth Shroyer, MD, PhD, lead author and the Marvin Kushner Professor and Chair of Pathology at the Renaissance School of Medicine at Stony Brook University.

Since heat is potentially more readily accessible than other methods of decontamination in many healthcare facilities, the researchers used dry heat sterilization to disinfect the masks. They also used X-ray diffraction, Raman spectroscopy, contact angle, and electron microscopy collected at the Center for Functional Nanomaterials—a U.S. Department of Energy (DOE) Office of Science user facility at DOE’s Brookhaven National Laboratory—to test for changes in the material of N95 masks post decontamination.

By contrast, other methods for disinfection, including treatment with hydrogen peroxide vapor, may be equally effective in specially equipped facilities but are usually not available in most hospitals or outpatient clinical care facilities.

Dr. Shroyer and colleagues also tested autoclaving, which is widely available in most hospitals and is a proven method of sterilization but found that this caused the fit of the respirator onto the user’s face to fail. Thus, the researchers ruled out autoclaving as a safe method to decontaminate N95 masks.

The research involved experts from the School of Medicine, the College of Engineering and Applied Sciences, the College of Arts and Sciences, the Institute for Electrochemically Stored Energy, and the School of Marine and Atmospheric Sciences (SoMAS), along with colleagues in the Interdisciplinary Science Department and the Center for Functional Materials at Brookhaven National Laboratory.

For additional details about the initial studies that served as the foundation for this study – which was launched during the first wave of the pandemic in April 2020 – see this story.

Dr. Shroyer emphasizes that the findings from the study highlight the importance of both optimal disinfection and mask fit and suggest that when no other decontamination alternatives are available, N95 masks can be reused after dry heat treatment to ensure the safety of health care workers.

 

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Medical healthcare holding COVID-19 , Coronavirus swab collection kit, wearing PPE protective suit mask gloves, test tube for taking OP NP patient specimen sample,PCR DNA testing protocol process

In an effort to expand access to testing, Suffolk County Executive Steve Bellone today announced the opening of three new community based testing sites. Rapid Antigen COVID-19 tests, which will be administered by Baseline Health and Reef Technologies, will be on a first come, first served basis.

The first testing site at Hecksher State Park will open on Wednesday, December 29th, the second testing site at Red Creek Park, which was formerly located at Francis S. Gabreski Airport, will open on Monday, January 3rd, and the third testing site located at Cathedral Pines County Park will open on Tuesday, January 4th.

“What we have learned so far is that the Omicron variant is highly transmittable and causing a spike in our daily positivity rate,” said Suffolk County Executive Steve Bellone. “Testing is one of the best tools we have when it comes to containing the spread of this virus. As we approach the New Year, these three new sites will provide quick and convenient results for our residents so that they can protect themselves and their loved ones.”

Rapid Testing sites include:

Hecksher State Park, Field 8 (Opening on Wednesday, December 29th)

1 Heckscher State Parkway

East Islip

Open every Monday through Thursday from 8:00 AM to 4:00 PM

Testing Capacity: Up 1,000 tests a day

 

Red Creek Park (Opening Monday, January 3rd)

102 Old Riverhead Rd

Hampton Bays

Open for school-required testing and community testing

Open on Mondays only from 10:00 AM to 6:00 PM

Testing Capacity: Up to 500 tests per day

 

Cathedral Pines County Park (Opening on Tuesday, January 4th)

116 Yaphank Middle Island Rd

Middle Island

Open on Tuesdays and Fridays from 8:00 AM to 4:00 PM

Testing Capacity: Up to 500 tests per day

 

Residents with any questions can contact Suffolk311.

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The Smithtown Senior Citizens Department has announced that it has recently expanded its Medical Alert Program. In addition to offering in-home medical alert monitoring services, residents now have the option to choose a GPS enabled system that travels where ever they go. The program is open to all residents age 60 and older.

This Medical Alert Program allows seniors to live independently, with the comfort and peace of mind, knowing that help is just a touch away. Through a partnership with American Medical Alert Corporation (AMAC), a Connect America Company, residents simply wear a lightweight, touch activated system that can be worn as a pendant or on the wrist (home based system only). Once an alert is activated, trained emergency operators respond to help with the situation, 24 hours a day, seven days a week.

“Our objective with this personal emergency response system is to ensure the well-being of our seniors and enable them to remain safely in their homes. Perhaps just as important is to provide seniors with the peace of mind knowing that if they ever need help they will get it,” said Doreen Perrino, Smithtown Senior Citizens Department Program Director.

Residents who are interested in obtaining a Connect America Medical Alert system can inquire through the Smithtown Senior Citizens Department at 631-360-7616. The service is available for a low monthly monitoring fee of $18 for the in-home system and $30 for the GPS enabled system. There are no installation fees, long term contracts or cancellation penalties.

For more information on this and other Smithtown services, please contact Smithtown Public Information Officer Nicole Garguilo at 631-360-7600 or via email at [email protected]

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Stock photo
NSAIDs and acetaminophens are not risk-free

By David Dunaief, M.D.

Dr. David Dunaief

What’s in your medicine cabinet? If you’re like most people, you have your typical “go-tos” for pain relief, fever or inflammation. You might have aspirin or other NSAIDs (non-steroidal anti-inflammatory drugs) and acetaminophen (Tylenol). 

Familiar NSAIDs include ibuprofen (Advil, Motrin) and naproxen sodium (Aleve). Over 70 million prescriptions for NSAIDs are written each year in the U.S., and Americans consume more than 30 billion doses, once over-the-counter (OTC) use is factored in (1).

According to a poll of these regular users of OTC NSAIDs, a substantial number — 60 percent — were unaware of their dangerous side effects (2). Acetaminophen is used frequently, as well. On a weekly basis, one quarter of Americans take it. Unfortunately, many think of these drugs as relatively benign. In fact, I find that until I specifically ask about their use, most patients don’t include them in a list of their medications.

NSAID risks

Unfortunately, NSAIDs, according to the Centers for Disease Control and Prevention, are responsible for 7,600 deaths annually and 10 times that number in hospitalizations (3). These are not medications that should be taken lightly. 

NSAIDs increase the risk of several maladies, including heart attacks, gastrointestinal bleeds, exacerbation of diverticular disease, chronic arrhythmias (abnormal heartbeats) and erectile dysfunction. In some instances, the cardiovascular effects can be fatal.

These risks prompted the FDA to strengthen the warning labels on non-aspirin NSAID labels, advising that those taking NSAIDs should immediately seek medical attention if they experience chest pain, shortness of breath or trouble breathing, weakness in one part or side of their body, or slurred speech (4).

Adverse side effects of NSAIDs

In a case control study using the UK Primary Care Database, chronic users of NSAIDs between ages 40 and 89 had a significantly increased risk of a serious arrhythmia (abnormal heartbeat) called atrial fibrillation (5).

Interestingly, chronic users were defined as patients who took NSAIDs for more than 30 days. Those patients who used NSAIDs more than 30 days had a 57 percent increased risk of atrial fibrillation. A Danish study reinforces these results after the first month of use (6). This is not very long to have such a substantial risk. For patients who used NSAIDs longer than one year, the risk increased to 80 percent. 

Caution should be used when prescribing NSAIDs or when taking them OTC. Atrial fibrillation is not an easy disease to treat.

NSAIDs also increase the risk of mortality in chronic users. Older patients who have heart disease or hypertension (high blood pressure) and are chronic NSAIDs users are at increased risk of death, according to an observational study (7). Compared to those who never or infrequently used them over about 2.5 years, chronic users had a greater than twofold increase in death due to cardiovascular causes. High blood pressure was not a factor, since the chronic users actually had lower blood pressure. Yet I have seen with my patients that NSAID use can increase blood pressure. 

Is acetaminophen better?

Acetaminophen does not cause gastrointestinal bleeds, arrhythmias and deaths due to cardiovascular events that NSAIDs can. However, the Food & Drug Administration announced in 2011 that acetaminophen should not exceed 325 mg every four to six hours when used as a prescription combination pain reliever (4). The goal is to reduce and avoid severe injury to the liver, which can cause liver failure. 

There is an intriguing paradox with acetaminophen: Hospitals typically dispense regular-strength 325-mg doses of the drug, whereas OTC doses frequently are found in extra-strength 500-mg tablets, and often the suggested dose is two tablets, or 1 gram. At the FDA’s request, Tylenol lowered its recommended daily dosage for extra strength Tylenol to no more than 3 grams a day to lower the risk of liver damage.

I have patients who have exceeded this, thinking that, because it is OTC, this is “safe.” Unfortunately, this is not true and can be dangerous.

The FDA’s recommendations for limiting the dose result from a conglomeration of data. For instance, one study that showed acute liver failure was due primarily to unintentional overdoses of acetaminophen (8). Accidental overdosing is more likely to occur when taking acetaminophen at the same time as a combination sinus, cough or cold remedy that also contains acetaminophen. OTC and prescription cold medications can contain acetaminophen.

Of course, if you already suffer from liver damage or disease, you should consult with your physician before taking any medications.

In order to be aware of potentially adverse events, you have to be your own best advocate and read labels. Remember to tell your physician if you are taking OTC medications.

If you are a chronic user of NSAIDs or acetaminophen because of underlying inflammation, you may find an anti-inflammatory diet, which is usually plant-based, is an effective alternative.

References:

(1) Medscape.com, 2021 Oct 21 (emedicine.medscape.com/article/816117-overview). (2) J Rheumatol. 2005;32;2218-2224. (3) Annals of Internal Medicine, 1997;127:429-438. (4) fda.gov (5) Arch Intern Med. 2010;170(16):1450-1455. (6) BMJ 2011;343:d3450. (7) Am J Med. 2011 Jul;124(7):614-620. (8) Am J Gastroenterol. 2007;102:2459-2463. 

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 Unsplash

With Christmas this weekend, families are looking to get together for some quality time.

Last Christmas, in the midst of the coronavirus pandemic, people quarantined with just those in their households. It was lonely for some, but they stayed safe, away from contact with other people.

Then 2021 came around and with the vaccines we saw some hope — we began slowly peeling off our masks and traveling again. Families became reunited.

But unfortunately, that was premature and now Suffolk County is at a 14% positivity rate as of Tuesday, Dec. 21.

To put it in perspective, municipalities across New York state were shut down at 5% in the spring of 2020. We have doubled the seven-day average compared to where we were at that time and have not shut down.

And there are reasons for that. Luckily more than a year-and-a-half later we have the vaccines, we have boosters and we know that masks work — we just need to continue using them and continue using common sense.

It’s sad to think that this is the second Christmas where some families might not be able to see their loved ones out of fear. It’s sad that we as a country were doing well and now have fallen back into old habits of not taking care of ourselves and of others.

If we continue not to listen to the Centers for Disease Control and Prevention, our health care providers and the science,

Politicians insist we won’t go into lockdown, but what will happen if the infection rate goes to 20%? What will we do if the hospitals are overfilled again?

With the comfort we felt during this past summer, newly vaccinated with restrictions lifted, some might have forgotten what early 2020 looked like. Visits to grandparents were through a window. Restaurants were not allowed to have inside dining. Disinfectants and masks were impossible to find, while bodies were kept in outside trailers because the morgue was filled to capacity.

We don’t want to head back in that direction, especially with all of the resources now available to us. We have the vaccine, we have the booster, we have masks and we know how to combat this virus. We just need to collectively do it and not treat it lightly.

So, for this holiday season, and throughout the rest of the winter, please take care of yourself, take care of others and be cautious.

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Photo from Stony Brook Medicine

WHAT: 

Livestream Event – Post-COVID: In it for the long haul

According to the CDC, most people with COVID-19 get better within weeks, though some experience long-term effects. Post-COVID conditions are a wide range of new, returning, or ongoing health problems people can experience weeks after first being infected. This Tuesday, December 21, experts from Stony Brook Medicine’s Post-COVID clinic, the first of its kind on Long Island, will discuss these long-term effects and approaches to care.

Stony Brook’s post-COVID facility opened in November of 2020 at Stony Brook Medicine’s Advanced Specialty Care in Commack to provide ongoing care and assessment of adult patients who are recovering from COVID-19. The clinic provides care for patients who are still experiencing symptoms as well as monitors patients for any late effects of COVID-19 infection. Patients have access to specialists in primary care, cardiology, pulmonary medicine, nephrology, vascular and neurology as well as to mental health providers.

For more information visit, https://www.stonybrookmedicine.edu/advancedspecialtycare/post_COVID_clinic

WHEN:

Tuesday, December 21, 2021 at 4:45 PM EST

The livestream event can be seen on:

Facebook at https://www.facebook.com/298909540164955/posts/4578401205549079/

Or

YouTube at https://www.youtube.com/watch?v=5vqCloqgKGg

MODERATOR:

  • Sritha Rajupet, MD, MPH, Director, Population-Based Health Initiatives, Department of Family, Population & Preventive Medicine and Primary Care Lead, Post-COVID Clinic, Stony Brook Medicine

EXPERTS:

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