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There are many fruits and vegetables that are beneficial for kidney health. METRO photo
Increasing fruits and vegetables may protect kidneys

By David Dunaief, M.D.

Dr. David Dunaief

Chronic kidney disease is on the rise in this country. Approximately 37 million U.S. adults have chronic kidney disease (CKD), with as many as 9 in 10 not aware they have it, according to the Centers for Disease Control and Prevention (CDC) (1). In this article, we will look beyond the more obvious causes of chronic kidney disease, like diabetes, smoking, aging, obesity and high blood pressure (2).

Why is early-stage CKD so important? It is associated with a 40 percent increased risk of developing cardiovascular events, such as heart attacks (3). It also significantly increases the risk of peripheral artery disease (PAD). Those with decreased kidney function have a 24 percent prevalence of PAD, compared to 3.7 percent in those with normal kidney function (4). Of course, it can lead ultimately to end-stage renal (kidney) disease, requiring dialysis and potentially a kidney transplant.

One of the problems with early-stage CKD is that it tends to be asymptomatic. However, there are simple tests, such as a basic metabolic panel and a urinalysis, that will indicate whether a patient may have mild chronic kidney disease. These indices for kidney function include an estimated glomerular filtration rate (eGFR), creatinine level and protein in the urine. While the other two indices have varying ranges depending on the laboratory used, a patient with an eGFR of 30 to 59 mL/minute/1.73 m2 is considered to have mild disease. The eGFR and the kidney function are inversely related, meaning as eGFR declines, the more severe the chronic kidney disease.

What can be done to stem early-stage CKD, before complications occur? There are several studies that have looked at medications and lifestyle modifications and their impacts on its prevention, treatment and reversal. Let’s look at the evidence.

Leveraging Medications

Allopurinol is usually thought of as a medication to prevent gout. However, in a randomized controlled trial, with 113 patients, results show that allopurinol may help to slow the progression of CKD, defined in this study as an eGFR less than 60 mL/min/1.73 m2 (5). The group using 100 mg of allopurinol showed significant improvement in eGFR levels (compared to the control group over a two-year period. The researchers concluded that allopurinol slowed CKD progression. Allopurinol also decreased cardiovascular risk by 71 percent.

Fibrates are a class of drug usually used to boost HDL (“good”) cholesterol levels and reduce triglyceride levels, another cholesterol marker. Fibrates have gotten negative press for not showing improvement in cardiovascular outcomes. However, in patients with mild to moderate CKD, a meta-analysis (a group of 10 studies) showed a 30 percent reduction in major cardiovascular events and a 40 percent reduction in the risk of cardiovascular mortality with the use of fibrates (6). This is important, since patients with CKD are mostly likely to die of cardiovascular disease.

The authors concluded that fibrates seem to have a much more powerful beneficial effect in CKD patients, as opposed to the general population. So, there may be a role for fibrates after all.

Diet’s impact

Fruits and vegetables may play a role in helping patients with CKD. In one study, the results showed that fruits and vegetables work as well as sodium bicarbonate in improving kidney function by reducing metabolic acidosis levels (7).

What is the significance of metabolic acidosis? It means that body fluids become acidic, and it is associated with chronic kidney disease. The authors concluded that both sodium bicarbonate and a diet including fruits and vegetables were renoprotective, helping to protect the kidneys from further damage in patients with CKD. Alkali diets are primarily plant-based, although not necessarily vegetarian or vegan diets. Animal products tend to cause an acidic environment. The study was one year in duration with 77 patients.

In the Nurses’ Health Study, results show that animal fat, red meat and sodium all negatively impact kidney function (8). The risk of protein in the urine, a potential indicator of CKD, increased by 72 percent in those participants who consumed the highest amounts of animal fat compared to the lowest, and by 51 percent in those who ate red meat at least twice a week. With higher amounts of sodium, there was a 52 percent increased risk of having lower levels of eGFR.

The most interesting part with sodium was that the difference between higher mean consumption and the lower mean consumption was not that large, 2.4 grams compared to 1.7 grams. In other words, the difference between approximately a teaspoon of sodium and three quarters of a teaspoon was responsible for the decrease in kidney function.

In my practice, when CKD patients follow a vegetable-rich, nutrient-dense diet, there are substantial improvements in kidney functioning. For instance, for one patient, his baseline eGFR was 54 mL/min/1.73 m2. After one month of lifestyle modifications, his eGFR improved by 9 points to 63 mL/min/1.73 m2, which is a return to “normal” functioning of the kidney. Note that this is an anecdotal story and not a study.

Therefore, it is important to have your kidney function checked with mainstream tests. If the levels are low, you should address the issue through medications and/or lifestyle modifications to manage and reverse early-stage CKD. Don’t wait until symptoms and complications occur. In my experience, it is much easier to treat and reverse a disease in its earlier stages, and CKD is no exception.

References:

(1) CDC.gov. (2) JAMA. 2004;291:844-850. (3) N Engl J Med. 2004;351:1296-1305. (4) Circulation. 2004;109:320–323. (5) Clin J Am Soc Nephrol. 2010 Aug;5:1388-1393. (6) J Am Coll Cardiol. 2012 Nov. 13;60:2061-2071. (7) Clin J Am Soc Nephrol. 2013;8:371-381. (8) Clin J Am Soc Nephrol. 2010; 5:836-843.

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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Standing, from left, Angela Cammarata, Service Coordinator for St. Joseph’s Village, Pharmacist Amanda School, Legislator Nick Caracappa, Pharmacist Dan Gambhir, Pharmacist and Owner of Bell Mead Pharmacy Ruby Masson. Seated: St. Joseph’s Village resident Elyse Biederman.
St. Joseph’s Village resident Elyse Biederman gets her vaccine shot.

This week, Legislator Nick Caracappa helped residents of a senior housing community in his district get their first COVID vaccine. St. Joseph’s Village in Selden, which houses approximately 230 residents, is managed by Catholic Charities of Long Island. Legislator Caracappa coordinated with Bell Mead Pharmacy in East Setauket to have pharmacists on-site over a two-day period to administer 50+ Moderna vaccines.

“I was thrilled to be part of what was truly a community effort to get these folks vaccinated,” stated Legislator Nick Caracappa. “A special thank you goes to Ruby Masson, owner of Belle Mead Pharmacy and her friendly staff, Angela Cammarata, Service Coordinator for St. Joseph’s Village who arranged the appointment schedule for the residents, and Lynn Reddy from Catholic Charities for working collaboratively with my office to get this accomplished and help keep our senior population safe.”

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Michael Frohman. Photo from SBU

By Daniel Dunaief

Bringing together researchers and clinicians from six countries, including scientists scattered throughout the United States, a team of scientists co-led by Stony Brook University’s Michael Frohman linked mutations in a gene to congenital heart disease.

Frohman, Chair of the Department of Pharmacological Sciences in the Renaissance School of Medicine at SBU, has worked with the gene Phospholipidase D1 (or PLD1), for over 25 years. Researchers including Najim Lahrouchi and Connie Bezzina at the University of Amsterdam Heart Center linked this gene to congenital heart disease.

“The current study represents a seminal finding in that we provide a robust link between recessive genetic variants of PLD1 and a rather specific severe congenital heart defect comprising right-side valvular abnormalities,” Bezzina wrote in an email. 

Michael Frohman at Glymur Falls in Iceland.

The international group collected information from 30 patients in 21 unrelated families and recently published their research in the Journal of Clinical Investigation.

A number of other genes are also involved in congenital heart disease, which is the most common type of birth defect. People with congenital heart disease have a range of symptoms, from those who can be treated with medication and/or surgery for pre-term infants to those who can’t survive.

The discovery of this genetic link and congenital heart disease suggests that PLD1 “needs to be screened in cases with this specific presentation as it has implications for reproductive counseling in affected families,” Bezzina explained.

Bezzina wrote that she had identified the first family with this genetic defect about five years ago.

“We had a strong suspicion that we had found the causal gene, but we needed confirmation and for that, we needed to identify additional families,” she said. “That took some time.

Bezzina described the collaboration with Frohman as “critical,” as she and Lahrouchi had been struggling to set up the PLD1 enzymatic assay in their lab, without any success. Lahrouchi identified Frohman as a leading expert in the study of PLD1 and the team reached out to him.

His work was instrumental in determining the effect of the mutations on the enzymatic activity of PLD1, Bezzina explained.

The timing in connecting with Frohman proved fortuitous, as Frohman had been collaborating with Michael Airola, Assistant Professor in the Department of Biochemistry & Cell Biology at Stony Brook University, on the structure of the PLD1 catalytic domain.

“Together, they immediately saw that the mutations found in the patients were located primarily in regions of the protein that are important for catalysis and this provided detailed insight into why the mutations caused the PLD1 enzyme to become non-functional,” Bezzina wrote.

These findings have implications for reproductive counseling, the scientists suggested.

A couple with an affected child who has a recessive variation of PLD1 could alert parents to the potential risk of having another child with a similar defect.

One of the variants the scientific team identified occurs in about two percent of Ashkenazi Jews, which means that 1 in 2,500 couples will have two carriers and a quarter of their conceptions will be homozygous recessive, which virtually guarantees congenital heart disease. This, however, is about three times less frequent than Tay-Sachs. “This has, in our view, clinical implications for assessing the risk of congenital heart defects among individuals of this ancestry,” said Bezzina.

The mutation probably arose among Ashkenazi Jews around 600 to 800 years ago. There are about 20 known disease mutations like Tay-Sachs in this population that are found only rarely in other groups.

Lahrouchi and Bezzina specialize in the genetics of congenital heart disease, which occurs worldwide in 7 out of every 1,000 live births.

With 56 coauthors, Frohman said this publication had the largest number of collaborators he’s ever had in a career that includes about 200 papers. While this is unusual for him, it’s not uncommon among papers in clinical research.

The lead researchers believed a comprehensive report with a uniform presentation of clinical data and biochemical analysis would provide a better resource for the field, so they brought together research from The Netherlands, the Czech Republic, Israel, France, Italy and the United States.

Previous research that involved Frohman revealed other patterns connected to the PLD1 gene. 

About a dozen years ago, Frohman helped discover that mice lacking the PLD1 gene, or that were inhibited by a drug that blocked its function, had platelets that are less easily activated, which meant they were less able to form large blood clots.

These mice had better outcomes with strokes, heart attacks and pulmonary embolisms.

The small molecule inhibitor was protective for these conditions before strokes, but only provided a small amount of protection afterwards. Technical reasons made it difficult to use this inhibitor in clinical trials.

The primary work in Frohman’s lab explores the link between PLD1 and cancer. He has shown that loss of PLD1 decreases breast cancer tumor growth and metastasis.

As for what’s next, Frohman said he has a scientific focus and a translational direction. On the scientific front, he would like to know why the gene is required for heart development. He is launching into a set of experiments in which he can detect what might go wrong in animal models early in the development of the heart. 

Clinically, he hopes to explore how one bad copy of the PLD1 gene combines with other genes that might contribute to cause enough difficulties to challenge the survival of a developing heart.

A resident of Old Field, Frohman lives with his wife Stella Tsirka, who is in the pharmacology department and is Vice Dean for Faculty Affairs in the Renaissance School of Medicine. The couple has two children, Dafni, who is a first-year medical student at Stony Brook and Evan, who is a lawyer clerking with a judge in Philadelphia.

Outside of work, Frohman, who earned MD and PhD degrees, enjoys hikes in parks, kayaking and biking.

Having a medical background helped him learn a “little bit about everything,” which gave him the opportunity to prepare for anything new, which included the medical implications of mutations in the PLD1 gene.

Bezzina hopes to continue to work with Frohman, on questions including how the mutation type affects disease severity. “An interplay with other predisposing genetic factors is very interesting to explore as that could also help us in dissecting the disease mechanism further,” she wrote.

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Photo from SBUH

In response to an easing of state regulations and their approach to patient care, area hospitals are relaxing restrictions about patient visitors.

Cheryl Miranda, director of Patient Experience at Huntington Hospital, has been planning the new visitation policy since the beginning of the month. Photo from Huntington Hospital

Starting this past Monday, Huntington Hospital will allow patients who do not have COVID-19 to have one visitor per day, between 2 p.m. and 6 p.m. St. Charles and St. Catherine of Siena hospitals also allow one COVID-19 negative visitor per day during those same hours.

Huntington Hospital is responding to the medical, emotional and personal need its patients have for the support of family and friends during whatever health challenges they face.

“There is nothing like having your loved one at your bedside, holding your hand,” said Cheryl Miranda, director of Patient Experience at Huntington Hospital, which is a part of Northwell Health.

Family also provides helpful information, helping medical professionals know whether a patient’s behavior is different from normal

“As a nurse, I’ve always felt that family is part of the caregiving circle,” Miranda said. “The family knows their loved one better than anyone. They will help us provide better care.”

St. Charles Hospital and St. Catherine of Siena started allowing one hospital visitor per COVID-negative patient per day starting about four weeks ago.

Stony Brook is making several changes to its visitation policy.

As of April 1, the hospital is allowing two visitors for patients in labor and delivery, for pediatric patients and for patients in end-of-life situations. This will increase from one to two.

Patients receiving same day surgical procedures will also be allowed a patient visitor until a procedure begins. The visitor is required to wait outside during the procedure and then can return during the patient’s release from the hospital.

Inpatient child psychiatry will also allow a visitor, as will cancer center and outpatient offices.

Approved visitors to Stony Brook must wear a mask that covers their nose and mouth the entire time, will have symptom checks, including thermal scanning, will not be allowed outside the patient’s room, must maintain six feet of distance and must wash their hands on entering and leaving the room.

Hospitals had generally restricted most or all patient visitors over various periods in the last year amid the pandemic to limit the spread of COVID-19. Nurses throughout Long Island and the world have used tablets, phones and other technology to help their patients connect with family members, enabling them to see spouses, siblings, children, grandchildren and friends from hospital beds that often had them feeling isolated during their health battles.

Allowing visitors, who are still required to wear masks, will help hospitalized patients feel more normal and receive the kind of support that can brighten their day while shortening their hospital visit.

A hospital employee will screen patients on their way into the hospital, asking them questions about any possible symptoms and taking their temperature.

Visitors who are COVID-19 positive can’t enter. Additionally, visitors who come in from out of the state or whom they believe necessitates a screening will have a rapid swab.

“We are not asking everyone to be tested,” Miranda said.

The hospital is spreading the word about its new patient visitor policy by changing its on-hold messages, is sharing information on TV sets and is telling families directly during virtual visits that one person at a time can come to the hospital.

Patients can determine who visits, which includes family members and friends.

“There is nothing like having your loved one at your bedside, holding your hand.”

— Cheryl Miranda

Miranda said the medical staff is well-prepared for an increase in visitors through the hospital.

“I don’t have to tell anybody in this building to follow precautions,” Miranda said. “We’ve all been through this for 13 months now and there isn’t anyone” who needs reminding about personal protective equipment, hand washing or social distancing.

Initially, Huntington Hospital workers will escort visitors to patient rooms, reminding them about safety policies.

During visits, patients and visitors are expected to wear masks. If a family member comes during mealtime or brings food, the patient can eat, but should do so at a safe distance.

Miranda, who has been at Huntington Hospital for 20 years, realizes the suffering patients and their families have endured during the pandemic.

“To tell someone they can’t be here is an awful, awful thing,” Miranda said. “My heart goes out to the families that haven’t been allowed to be here” and to the patients who “haven’t been able to have their loved ones at their side.”

Miranda has been planning this new visitation policy since the beginning of the month.

The hospital has learned numerous lessons about health care, including by providing virtual support for patients.

In addition to bereavement support groups, which have been particularly busy as families mark the one-year anniversary of the loss of a loved one, the hospital is adding a long-haul support group.

Starting on Thursday, April 8 at 2 p.m., Huntington Hospital will offer support to people who have a lingering cough, ongoing debilitating fatigue, body aches, joint pain, shortness of breath, loss of taste and smell, difficulty sleeping, headaches and brain fog.

People interested in joining that group can email Kacey Farber at [email protected].

Dr. Jean Cacciabaudo, associate medical director at Huntington Hospital and a cardiologist, will sit on the long haulers support meeting. Cacciabaudo, who had COVID-19 and has some long haulers symptoms, will attend not just for herself, but to provide the physician’s perspective.

Miranda said the bereavement support groups have helped family members amid a loss.

“It’s the beauty of humanity, when we reach out and help each other,” Miranda said. “There’s no magic solution for grief and loss. For some people, it’s just about remembering all the wonderful things they had when they had that person and sharing that with other people. It’s about not being isolated. That’s a big key.”

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Bananas are rich in potassium. METRO photo
Most Americans don’t consume enough potassium

By David Dunaief, M.D.

Dr. David Dunaief

With all the focus on reducing sodium in our diets, the importance of consuming potassium gets short shrift. 

More than 90 percent of people consume far too much sodium, with salt being the primary culprit (1). Sodium is insidious; it’s in foods that don’t even taste salty. Bread products are among the primary offenders. Other foods with substantial amounts of sodium are cold cuts and cured meats, cheeses, pizza, poultry, soups, pastas and, of course, snack foods. Processed foods and those prepared by restaurants are where most of our consumption occurs (2).

On the flip side, only about two percent of people get enough potassium from their diets (3). According to one study, we would need to consume about eight sweet potatoes or 10 bananas each day to reach appropriate levels. 

Why is it important to reduce sodium and increase potassium? A high sodium-to-potassium ratio increases the risk of cardiovascular disease by 46 percent, according to the study, which looked at more than 12,000 Americans over almost 15 years (4). In addition, both may have significant impacts on blood pressure and cardiovascular disease.

To improve our overall health, we need to shift the sodium-to-potassium balance so that we consume more potassium and less sodium. Let’s look at the evidence.

Reduce your sodium

Two studies illustrate the benefits of reducing sodium in high blood pressure and normotensive (normal blood pressure) patients, ultimately preventing cardiovascular disease, including heart disease and stroke.

The first used the prestigious Cochrane review to demonstrate that blood pressure is reduced by a significant mean of −4.18 mm Hg systolic (top number) and −2.06 mm Hg diastolic (bottom number) involving both normotensive and hypertensive participants (5). When looking solely at hypertensive patients, the reduction was even greater, with a systolic blood pressure reduction of −5.39 mm Hg and a diastolic blood pressure reduction of −2.82 mm Hg.

This was a meta-analysis (a group of studies) that evaluated data from randomized clinical trials, the gold standard of studies. There were 34 trials reviewed with more than 3,200 participants. Salt was reduced from 9 to 12 grams per day to 5 to 6 grams per day. These levels were determined using 24-hour urine tests. The researchers believe there is a direct linear effect with salt reduction. In other words, the more we reduce the salt intake, the greater the effect of reducing blood pressure. The authors concluded that these effects on blood pressure will most likely result in a decrease in cardiovascular disease.

In the second study, a meta-analysis of 42 clinical trials, there was a similarly significant reduction in both systolic and diastolic blood pressures (6). This study included adults and children. Both demographics saw a reduction in blood pressure, though the effect was greater in adults. Interestingly, an increase in sodium caused a 24 percent increased risk of stroke incidence but, more importantly, a 63 percent increased risk of stroke mortality. The risk of mortality from heart disease was increased as well, by 32 percent.

In an epidemiology modeling study, the researchers projected that either a gradual or instantaneous reduction in sodium would save lives (7). For instance, a modest 40 percent reduction over 10 years in sodium consumed could prevent 280,000 premature deaths. These are only projections, but in combination with the above studies may be telling. The bottom line: decrease sodium intake by almost half and increase potassium intake from foods.

Increase your potassium

When we think of blood pressure, not enough attention is given to potassium. The typical American diet doesn’t contain enough of this mineral.

In a meta-analysis involving 32 studies, results showed that as the amount of potassium was increased, systolic blood pressure decreased significantly (8). When foods containing 3.5 to 4.7 grams of potassium were consumed, there was an impressive −7.16 mm Hg reduction in systolic blood pressure with high blood pressure patients. Anything more than this amount of potassium did not have any additional benefit. Increased potassium intake also reduced the risk of stroke by 24 percent. This effect was important.

The reduction in blood pressure was greater with increased potassium consumption than with sodium restriction, although there was no head-to-head comparison done. The good news is that potassium is easily attainable in the diet. Foods that are potassium-rich include bananas, sweet potatoes, almonds, raisins and green leafy vegetables such as Swiss chard.

Lowering sodium intake may have far-reaching benefits, and it is certainly achievable. First, consume less and give yourself a brief period to adapt — it takes about six weeks to retrain your taste buds, once you cut your sodium. You can also improve your odds by increasing your dietary potassium intake, which also has a substantial beneficial effect, striking a better sodium-to-potassium balance.

References:

(1) Am J Clin Nutr. 2012 Sep;96(3):647-657. (2) www.cdc.gov. (3) Am J Clin Nutr. 2012 Sep;96(3):647-657. (4) Arch Intern Med. 2011;171(13):1183-1191. (5) BMJ. 2013 Apr 3;346:f1325. (6) BMJ. 2013 Apr 3;346:f1326. (7) Hypertension. 2013; 61: 564-570. (8) BMJ. 2013; 346:f1378.

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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From left, Councilman Ed Smyth, Councilman Mark Cuthbertson, Supervisor Chad A. Lupinacci, Carlos Ortiz (Regional VP for Suffolk County, Sun River Health), Lisa Santeramo (Assistant Secretary for Intergovernmental Affairs, Governor Cuomo's office)

UPDATE: Supervisor Chad A. Lupinacci, Councilman Ed Smyth and Councilman Mark Cuthbertson were joined by Lisa Santeramo of Governor Andrew Cuomo’s office and Carlos Ortiz of Sun River Health for the opening day of a pop-up COVID-19 vaccination site, on March 22, where 600 doses of the Moderna vaccine will be administered by appointment only at the Town of Huntington Senior Center.  

“We are pleased to be able to offer a large, safe vaccination site at the Town’s Senior Center, something we have been working on with the Governor’s office for some time now,” said Supervisor Chad A. Lupinacci. “We look forward to the day we can reopen this community facility to our senior residents and end the isolation many continue experiencing for over a year now: these vaccinations are getting us one step closer to normal.” 

Councilman Ed Smyth stated, “I encourage everyone to get a vaccine at the earliest possible date. I understand many people are anxious about it. Many people have reservations about vaccines based on medical concerns, historical concerns, or religious concerns.  If you have concerns, please speak directly with your doctor, community and religious leaders. Please don’t substitute an internet search for actual medical advice.” 

Councilman Mark Cuthbertson stated, “Today and tomorrow 600 seniors will be vaccinated at our Senior Center, we are hopeful that NYS will allocate more vaccines so we can continue to vaccinate our residents.” 

“Sun River Health is proud to partner with the Governor’s Office, the Town of Huntington, and the Huntington Senior Center to continue the important work that will finally bring an end to the COVID-19 pandemic,” said Anne Kauffman Nolon, MPH, Sun River Health CEO. “Thank you to all our dedicated staff and partners providing vaccines to members of the Huntington community this week.” 

Rodney Nichols, Huntington resident, was very happy to receive the vaccine on March 22.

In coordination with the Governor’s office, the Town of Huntington is hosting a pop-up COVID-19 vaccination site for New York residents ages 60+ by appointment only at the Town’s Senior Center on Monday, March 22 & Tuesday, March 23 between 9AM and 3PM for 600 doses of the Moderna COVID-19 vaccine to be administered by Sun River Health (2nd doses to be administered on Monday, April 19 & Tuesday, April 20).  

In January, Supervisor Chad A. Lupinacci sent a letter signed by the entire Town Board to the Governor’s office offering the Town of Huntington Senior Center facility as a potential COVID-19 vaccination site, due to the space, parking and refrigeration facilities available. 

The Lupinacci administration had previously conducted an in-house analysis of space under its jurisdiction that would accommodate the basic needs of a vaccine point of distribution. 

The administration determined that the Senior Center (423 Park Avenue, Huntington), largely vacant due to COVID-19, would provide the State with a complement of amenities including, but not limited to a spacious cafeteria, numerous classrooms, bathrooms, refrigerators, heating and air-conditioning, and plentiful parking spaces. 

The Senior Center’s close proximity to NYS Route 110, NYS Route 25A and Park Avenue is conducive to easy access from all points of the Town. Furthermore, the facility is situated between Jackson Avenue and Park Avenue, which would provide flexible traffic control options. 

 

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Osteoarthritis osteoarthritis affects joints in your hands, knees, hips and spine. METRO photo

By David Dunaief

Dr. David Dunaief

Osteoarthritis most commonly affects the knees, hips and hands. If you suffer from it, you know it can be painful to perform daily tasks or to get around. There are some surgical solutions, such as joint replacements of the hips or knees, as well as medical approaches with pain medications. The most commonly used first-line medications are acetaminophen and nonsteroidal anti-inflammatory drugs, such as ibuprofen. Unfortunately, while medications treat the immediate symptoms of pain and inflammation, they don’t slow osteoarthritis’ progression, and they do have side effects, especially with long-term use.

Here, we’ll focus on nonpharmacologic approaches you can use to ease pain — and perhaps slow worsening of your osteoarthritis.

Does dairy help or hurt?

With dairy, specifically milk, there is conflicting information. Some studies show benefits, while others show that it may contribute to the inflammation that makes osteoarthritis feel worse.

In the Osteoarthritis Initiative study, an observational study of over 2,100 patients, results showed that low-fat (1 percent) and nonfat milk may slow the progression of osteoarthritis in women (1). The researchers looked specifically at joint space narrowing that occurs in those with affected knee joints. Compared to those who did not drink milk, patients who did saw significantly less narrowing of knee joint space over a 48-month period.

Osteoarthritis affects joints in your hands, knees, hips and spine. METRO photo

The result curve was interesting, however. For those who drank from fewer than three glasses a week up to 10 glasses a week, the progression of joint space narrowing was slowed. However, for those who drank more than 10 glasses per week, there was less beneficial effect. There was no benefit seen in men or with the consumption of higher fat products, such as cheese or yogurt.

However, the study had significant flaws. First, the patients were only asked about their milk intake at the study’s start. Second, patients were asked to recall their weekly milk consumption for the previous 12 months before the study began — a challenging task. Third, confounding factors, such as orange consumption, were not examined.

On the flip side, a study of almost 39,000 participants from the Melbourne Collaborative Cohort Study found that increases in dairy consumption were associated with increased risk of total hip replacements for men with osteoarthritis (2).

Getting more specific, a recently published analysis of the Framingham Offspring Study found that those who consumed yogurt had statistically significant lower levels of interleukin-6 (IL-6), a marker for inflammation, than those who didn’t eat yogurt, but that this was not true with milk or cheese consumption (3).

We are left with more questions than answers. Would I recommend consuming low-fat or nonfat milk or yogurt? Not necessarily, but I may not dissuade osteoarthritis patients from yogurt.

Vitamin D

Over the last decade, the medical community has gone from believing that vitamin D was potentially the solution to many diseases to wondering whether, in some cases, low levels were indicative of disease, but repletion was not a change-maker. Well, in a randomized controlled trial (RCT), the gold standard of studies, vitamin D had no beneficial symptom relief, nor any disease-modifying effects (4). This two-year study of almost 150 men and women raised blood levels of vitamin D on average to 36 ng/ml, which is considered respectable. Researchers used MRI and X-rays to track their results.

Weight loss

This could not be an article on osteoarthritis if I did not talk about weight. In a study involving 112 obese patients, there was not only a reduction of knee symptoms in those who lost weight, but there was also disease modification, with reduction in the loss of cartilage volume around the medial tibia (5).

On the other hand, those who gained weight saw the inverse effect. A reduction of tibial cartilage is potentially associated with the need for knee replacement. The relationship was almost one-to-one; for every 1 percent of weight lost, there was a 1.2 mm3 preservation of medial tibial cartilage volume, while the exact opposite was true with weight gain.

Exercise and diet

In a study, diet and exercise trumped the effects of diet or exercise alone (6). Patients with osteoarthritis of the knee who lost at least 10 percent of their body weight experienced significant improvements in function and a 50 percent reduction in pain, as well as reduction in inflammation, compared to those who lost 5 to 10 percent and those who lost less than 5 percent. This study was a well-designed, randomized controlled single-blinded study with a duration of 18 months.

Researchers used biomarker IL6 to measure inflammation. The diet and exercise group and the diet-only group lost significantly more weight than the exercise-only group, 23.3 pounds and 19.6 pounds versus 4 pounds. The diet portion consisted of a meal replacement shake for breakfast and lunch and then a vegetable-rich, low-fat dinner. Low-calorie meals replaced the shakes after six months. The exercise regimen included one hour of a combination of weight training and walking with alacrity three times per week.

Therefore, concentrate on lifestyle modifications if you want to see potentially disease-modifying effects. These include both exercise and diet. In terms of low-fat or nonfat milk, the results are controversial at best. For yogurt, the results suggest it may be beneficial for osteoarthritis, but stay on the low end of consumption. And remember, the best potential effects shown are with weight loss and with a vegetable-rich diet.

References:

(1) Arthritis Care Res online. 2014 April 6. (2) J Rheumatol. 2017 Jul;44(7):1066-1070. (3) Nutrients. 2021 Feb 4;13(2):506. (4) JAMA. 2013;309:155-162. (5) Ann Rheum Dis. 2015 Jun;74(6):1024-9. (6) JAMA. 2013;310:1263-1273.

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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Long Island Jewish Medical Center nurse Sandra Lindsay’s historic first Pfizer-BioNTech vaccine will now be part of National Museum of American History Collections

When Northwell Health nurse manager Sandra Lindsay received the first injection of the Pfizer-BioNTech COVID-19 vaccine last December, the nation tuned in to watch a turning point in the pandemic. That milestone moment turned out to be historic. Northwell today announced that the items used as part of the first FDA-approved COVID-19 vaccine in the United States have been donated to the Smithsonian’s National Museum of American History, where they will join the museum’s medical collection.

Northwell donated materials documenting the first doses, which took place on December 14, 2020, at Long Island Jewish (LIJ) Medical Center, as well as objects related to vaccine distribution and efforts to encourage the vaccination of frontline health care staff. The donation includes the now empty Pfizer-BioNTech vial that contained the first doses of approved vaccine administered in the U.S., Ms. Lindsay’s original vaccination record card along with her scrubs worn at the event and employee identification badge. Ms. Lindsay, director of critical care services at the hard-hit hospital, was the first person known to receive the vaccine. 

“December 14 was a historic moment for all: the day the very first COVID-19 vaccine was administered in the United States,” said Michael Dowling, president and CEO of Northwell Health. “It was our first real sign of hope after so many dark months in the fight against the global pandemic. Northwell was prepared to put shots in arms as soon as the vaccine arrived, not to make history but to protect our frontline workers battling COVID-19 as quickly as possible. But when Sandra Lindsay rolled up her sleeve, we weren’t just showing our team members the safety and efficacy of this groundbreaking vaccine – we were telling the world that our country was beginning a new fight back to normalcy. It was an extraordinary moment, and I thank the Smithsonian for preserving this important milestone.”

As New York State’s largest health system, no provider handled more COVID-positive patients and LIJ stood at the epicenter of the first surge in March and April. Ms. Lindsay was one of thousands of frontline workers who heroically soldiered on and saved countless lives despite personal fears and an unending caseload.

“Having lived through the devastation and suffering created by the virus, I knew I wanted to be part of the solution to put an end to COVID-19,” said Ms. Lindsay. “I hope that when people visit the museum and see all these items that they stop to honor the lives of people who did not make it and remember the loved ones they left behind. I hope it will inspire some discussion and education for future generations.”

In April 2020, the museum formed a rapid-response collecting task force to address the COVID-19 pandemic and document the scientific and medical events as well as the effects and responses in the areas of business, work, politics and culture. Due to health and safety protocols, the museum is only able to bring in a limited number of artifacts into the building. Additional artifacts related to the pandemic will be brought in and processed when the museum returns to full operation.

The Northwell acquisition includes additional vials from doses of the Pfizer-BioNTech and Moderna vaccines administered at Northwell, as well as the supplies needed to prepare, inject and track the vaccinations, such as diluent, syringes and vaccination-record cards. Northwell also donated shipping materials that document the enormous effort required to support vaccine distribution and preserve vaccine potency, such as a specialized vaccine “shipper” that monitors and maintains temperature.

“The urgent need for effective vaccines in the U.S. was met with unprecedented speed and emergency review and approval,” saidAnthea M. Hartig, Ph.D, the museum’s Elizabeth MacMillan Director. “These now historic artifacts document not only this remarkable scientific progress but represent the hope offered to millions living through the cascading crises brought forth by COVID-19.”

Northwell’s donation joins the museum’s medicine and science collections that represent nearly all aspects of health and medical practice. Highlights include a penicillin mold from Alexander Fleming’s experiments, Jonas Salk’s original polio vaccine, early genetically engineered drugs and an 1890s drugstore. The museum is working on a signature 3,500-square-foot exhibition, “In Sickness and in Health,” that will explore efforts to contain, control and cure illnesses over the centuries, thereby shaping the nation’s history. The exhibition will feature artifacts from 19th-century vaccination tools and diagnostic instruments to cardiac implants, imaging technologies and objects from the global smallpox eradication campaign and the COVID-19 pandemic.

Among the museum’s resources related to vaccines and the role of antibodies is a website, “The Antibody Initiative,” and a March 2 virtual program with Dr. Anthony S. Fauci, the director of the National Institute of Allergy and Infectious Diseases. Fauci was presented with the museum’s signature honor, the Great Americans medal, and donated his personal 3D model of the SARS-CoV-2 virion to help represent his pandemic work in the national collections. The program featuring a conversation with Smithsonian Regent David M. Rubenstein can be accessed at https://greatamericans.si.edu.

Through incomparable collections, rigorous research and dynamic public outreach, the National Museum of American History seeks to empower people to create a more just and compassionate future by examining, preserving and sharing the complexity of our past. All Smithsonian museums continue to be closed to support the effort to contain the spread of COVID-19.  For more information, visithttp://americanhistory.si.edu.

The museum’s staff also canvassed the nation, asking what it should collect to document this pandemic. The public can continue to make suggestions at [email protected] and share their Stories of 2020 at a site that will serve as a digital time capsule for future generations. The portal, open through April, will accept stories in English or Spanish and photos or short video.

Photos courtesy of Northwell Health

 

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Pal-O-Mine Equestrian, Inc. in Islandia, a private, not for profit organization providing a comprehensive therapeutic equine program using horses to facilitate growth, learning and healing for children and adults with disabilities, has announced that it is opening up its Frontline Heroes Wellness Program, initially developed for medical professionals and first responders, to all Long Islanders grappling with the impacts of the pandemic. 

Photo from Pal-O-Mine

This includes those who have lost a loved one and anyone who could benefit from participating in some of the program’s various well-being activities.

The Frontline Heroes Wellness Program, which was introduced in May 2020 at the height of the pandemic in New York, includes both virtual and in-person wellness sessions at Pal-O-Mine’s 13-acre working farm. These sessions include reiki, mindfulness, and a wide range of experiences with Pal-O-Mine’s horses and other animals that live on the farm. All sessions are facilitated by licensed social workers, reiki masters and certified equine specialists. The sessions are free through April 30, 2021.

“The benefits of being in nature have been well-documented and include reduced stress and an imparting of calm, connection and solace. It also has been proven that animals and nature together help lower heart rate, blood pressure and muscle tension,” said Pal-O-Mine Founder and CEO Lisa Gatti. “We are proud to be able to support our fellow Long Islanders as, together, we all strive for a return to normal and well-being.”

For more information on Pal-O-Mine or this Grief Program, visit:www.pal-o-mine.org or call, JoAnn Woodruff, Office Manager, at 631-348-1389. 

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By Nancy Marr

Climate change is the most important threat we face, as one of the three greatest threats imperiling the Earth, in addition to the loss of biodiversity and global pollution. Reducing the carbon dioxide that we release into the atmosphere into the atmosphere is critical. The mantra — reduce, reuse, recycle — has become more important as incomes rise and consumption increases, particularly in urbanizing communities where local government must find ways to deal with the waste stream. 

Leftover food is a major component of landfill waste. It has been estimated that only 40% of the food that is produced is consumed, due partly to overproduction on farms and poor distribution methods. The EPA estimates that food waste comprises about 22% of our entire waste stream.

In 2022 the Food Donation and Food Scraps/Recycling Law will take effect in New York State. It will require businesses that generate an average of two tons of excess edible food per week to donate it to food banks and charities. All remaining food scraps, if the business is within 25 miles of an organics recycler, must be recycled instead of ending up in a landfill. 

One method is feeding it to an anaerobic digester, in which microorganisms break down organic materials in a closed space where there is no air (or oxygen). The material that is left over following the anaerobic digestion process, called digestate, can be made into soil amendments and fertilizers, improving soil characteristics and facilitating plant growth. 

Biogas, which is produced throughout the anaerobic digestion process, is a renewable energy source that can be used in a variety of ways, depending on its quality. Biogas treated to meet pipeline quality standards can be distributed through the natural gas pipeline and used in homes and businesses.  However, on the controversial side of this positive energy gain, remains the fact that anaerobic digesters generate an inordinate amount of methane (CH4), an enemy in our effort to combat climate change. 

Our waste stream includes packaging materials and paper goods. Bill S1185 has been introduced by Senator Todd Kaminski and it will be followed by A5801, to be introduced by Assemblyman Steve Englebright. They require producers and manufacturers to finance the recycling of their packaging materials and plastics, with incentives for finding ways of making recycling easier. Within three years of the bill’s implementation, producers will have to comply with the provisions of the bill or work with a producer responsibility organization. 

Very good news is that agronomists have found that improved soil management can reduce the carbon that is released into the atmosphere and can increase the amount of carbon that is drawn down into the soil through photosynthesis. Led by Suffolk County Cooperative Extension, many farmers are using the methods of no-till farming, cover crops, and natural fertilizers, recognizing the importance of the biodiversity of the soil. Farming can transition from a net carbon emitter to a carbon sink.

In order to reduce the amount of methane coming from landfills, New York State passed a law in 1990 that prohibited municipalities from retaining household waste in their landfills.  (Construction and yard waste and recyclables can remain.)  

In the case of Brookhaven Town, which built a landfill in 1974 in Yaphank, the waste is currently transported to a waste-to-energy facility in Hempstead for incineration. The ash by-product is then returned to Brookhaven (along with the ash from four other  municipalities) to be deposited in the Brookhaven landfill, which will be closed in 2024.  There is a question of how that ash will be stored, recycled, or disposed of. Until we can get to zero waste that question will remain. Can we do so in a timely way? Can we do so at all?

The League of Women Voters of New York State supports policies that protect food production and distribution while diverting food waste from landfills, incinerators and other waste treatment facilities. 

One thing we already know: we will only achieve zero waste conditions when everyone participates.   Look for ways to make easy changes at home – using imperfect fruits and vegetables and organizing your pantry can help reduce waste. Plan to re-use and repair your goods, recycle, and compost your food waste.  Regenerative farming methods will improve the soil in suburban gardens and lawns as well as farms.  Let your state legislators know that you support the EPR bill to require end-of-life recycling by producers.

Nancy Marr is vice-president of the League of Women Voters of Suffolk County, a nonprofit nonpartisan organization that encourages the informed and active participation of citizens in government and influences public policy through education and advocacy. Visit www.lwv-suffolkcounty.org or call 631-862-6860.

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