Health

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NSAIDS con contribute to kidney damage

By David Dunaief, M.D.

Dr. David Dunaief

Last week, I wrote that the CDC estimates as many as 15 percent of U.S. adults have chronic kidney disease (CKD) and that roughly 90 percent of them don’t know they have it (1). This includes about 50 percent of people with a high risk of kidney failure in the next five years.

How is this possible? CKD is tricky because it tends to be asymptomatic, initially. Only in the advanced stages do symptoms become distinct, although there can be vague symptoms in moderate stages such as fatigue, malaise and loss of appetite. Those at highest risk for CKD include patients with diabetes, high blood pressure and those with first-degree relatives who have advanced disease. But those are only the ones at highest risk.

Why does CKD matter?

Your kidneys function as efficient little blood filters. They remove wastes, toxins and excess fluid from the body. In addition, they play roles in controlling blood pressure, producing red blood cells, maintaining bone health, and regulating natural chemicals in the blood. When they’re not operating at full capacity, the consequences can be heart disease, stroke, anemia, infection and depression — among others. According to the U.S. Preventive Services Task Force and the American College of Physicians, those who are at highest risk should be screened including patients with diabetes or hypertension (2)(3).

Slowing CKD progression

Fortunately, there are several options available, ranging from preventing CKD with specific exercise to slowing the progression with lifestyle changes and medications.

Exercise helps – even walking

The results of a study show that walking reduces the risk of death and the need for dialysis by 33 percent and 21 percent respectively (4). Even more intriguing, those who walked more often saw greater results. So, the participants who walked one-to-two times a week had a significant 17 percent reduction in death and a 19 percent reduction in kidney replacement therapy, while those who walked at least seven times per week experienced a more impressive 59 percent reduction in death and a 44 percent reduction in the risk of dialysis. There were 6,363 participants with an average age of 70, and they were followed for an average of 1.3 years.

How much protein to consume?

When it comes to CKD, more protein is not necessarily better, and it may even be harmful. In a meta-analysis of 17 Cochrane database studies of non-diabetic CKD patients who were not on dialysis, results showed that the risk of progression to end-stage kidney disease, including the need for dialysis or a kidney transplant, was reduced 36 percent in those who consumed a very low-protein diet, rather than a low-protein or normal protein diet (5).

Reducing sodium consumption

Good news! In a study, results showed that a modest sodium reduction in our diet may be sufficient to help prevent proteinuria (protein in the urine) (6). Here, less than 2000 mg was shown to be beneficial, something all of us can achieve.

Medications have a place

We routinely give certain medications, ACE inhibitors or ARBs, to patients who have diabetes to protect their kidneys. What about patients who do not have diabetes? ACEs and ARBs are two classes of anti-hypertensives — high blood pressure medications — that work on the kidney systems responsible for blood pressure and water balance (7). Results of a study show that these medications reduced the risk of death significantly in patients with moderate CKD. Most of the patients were considered hypertensive.

However, there was a high discontinuation rate among those taking the medication. If you include the discontinuations and regard them as failures, then all who participated showed a 19 percent reduction in risk of death, which was significant. However, if you exclude discontinuations, the results are much more robust with a 63 percent reduction. To get a more realistic picture, this result, including both participants and dropouts, is probably close to what will occur in clinical practice unless the physician is a really good motivator or has very highly motivated patients.

Should you be taking NSAIDs?

Non-steroidal anti-inflammatory drugs (NSAIDs), which include ibuprofen and naproxen, have been associated with CKD progression and with kidney injury in those without CKD (1). For those on ACE inhibitors or ARBs, NSAIDs can also interfere with their effectiveness. Talk to your doctor about your prescription NSAIDs and any other over-the-counter medications you are taking.

Takeaways

You don’t necessarily have to rely on drug therapies to protect your kidneys, and there is no down-side to lifestyle modifications. Lowering sodium modestly, walking frequently, and lowering your protein consumption may all be viable options, with or without medication. Discuss with your physician whether you need regular screening. High-risk patients with hypertension and diabetes should definitely be screened; however, those with vague symptoms of lethargy, aches and pains might benefit from screening, as well.

References: (1) cdc.gov/kidneydisease (2) uspreventiveservicestaskforce.org (3) aafp.org. (4) Clin J Am Soc Neph-rol. 2014;9(7):1183-9. (5) Cochrane Database Syst Rev. 2020;(10):CD001892. (6) Curr Opin Nephrol Hypertens. 2014;23(6):533-540. (7) J Am Coll Cardiol. 2014;63(7):650-658.

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.

Mehdi Damaghi. Photo from Stony Brook Hospital

By Daniel Dunaief

Do the birds on the Galapagos Islands, with their unique coloration, differently shaped beaks and specific nesting places, have anything to do with the cancer cells that alter the course of human lives?

For Mehdi Damaghi, Assistant Professor in the Department of Pathology at the Renaissance School of Medicine at Stony Brook University, the answer is a resounding, “Yes.”

Damaghi uses the same principles of evolutionary biology to understand how cancer, which resides within human genes, works to adapt, as it tries to win the battle to survive.

“What we try to understand is the Darwinian principals of cancer,” said Damaghi. Cancer “adapts and reprograms themselves” to their environment to survive.

Damaghi, who arrived at Stony Brook four months ago from Moffitt Cancer Center, plans to address numerous questions related to cancer. He recently received a $4 million grant from the Physical Science in Oncology program (PSON) through the National Institutes of Health/ National Cancer Institute. Working with cancer biologists, clinicians, and computational scientists, he plans to define and understand cancer’s fitness.

“We are trying to study the core evolution of cancer cells and the normal stroma around them,” said Damaghi. “We are looking at the evolution of the tumor and some of the host cells.”

Cancer biologists are trying to build mathematical and theoretical models to explore the playbook cancer uses when confronted with threats, either in the form of a body’s natural defenses against it or from therapies against which it can, and often does, develop resistance.

Treating cancer could involve using adaptive therapy, which could enable people to control and live with cancer longer, Damaghi suggested.

In studying cancer’s phenotype, or the way the disease is expressed and survives, he hopes to understand factors in the microenvironment. Many cancers, he reasons, become more problematic as people age. Indeed, centuries ago, cancer wasn’t as prevalent as it is today in part because life expectancy was shorter.

Damaghi also has an evolutionary model to explore metastasis, in which cancer spreads from one organ or system to other parts of the body. He is looking at the earliest stages of breast cancer, to see what factors some of these cancers need or take from the environment that enables them not only to develop into breast cancer, but also to spread to other systems.

Through the microenvironment, he is looking for biomarkers that might signal a potential tumor development and metastasis long before a person shows signs of an aggressive form of the disease.

“We look at the tumor as a part of a whole ecosystem that can have different niches and habitats,” he said. “Some can be hypoxic and oxidative, and others can be like a desert on Earth, where not much grows and then cancer evolves.”

Damaghi challenges cells in a culture or organoids, which are miniature, three-dimensional live models of human cells, with different microenvironmental conditions to see how they respond. He exposes them to hormones, immune cells, and hypoxic conditions.

“We try to understand what is the adaptation mechanism of cancer to this new microenvironment and how can we push them back to the normal phenotype,” he said.

Like other scientists, Damaghi has demonstrated that many of these cancer cells use sugar. Removing sugar caused some of the cancer to die.

Increasing the survival for patients could involve knowing what kinds of micro-environments cancer uses and in what order. Deprived of sugars, some cancers might turn to amino acids, dairy or other sources of food and energy.

Damaghi thinks researchers and, eventually, doctors, will have to approach cancer as a system, which might have a patient-specific fingerprint that can indicate the resources the disease is using and the progression through its various diseased stages.

Choosing Stony Brook

Damaghi appreciates the depth of talent in cancer sciences at Stony Brook University. He cited the work of Laufer Center Director Ken Dill and Cancer Center Director Yusuf Hannun. He also suggested that the Pathology Department, headed by Ken Shroyer, was “very strong.”

For their part, leaders at Stony Brook were pleased to welcome, and collaborate with, Damaghi. Hannun suggested Stony Brook recruited Damaghi because his research “bridges what we do in breast cancer and informatics.”

Shroyer, meanwhile, has already started collaborating with Damaghi and wrote that his new colleague’s focus on breast cancer “overlaps with my focus on pancreatic cancer.”

To conduct his research, Damaghi plans to look at cells in combination by using digital pathology, which can help reveal tumor ecosystems and niches.

He also appreciated the work of Joel Saltz, the Founding Chair in the Department of Biomedical Informatics. “In the fight against cancer, we all need to unite against this nasty disease,” Damaghi said. “From looking at it at different angles, we can understand it first and then design a plan to defeat it.”

Originally from Tehran, Iran, Damaghi is the oldest of five brothers. He said his parents encouraged them to explore their curiosity.

Damaghi, whose wife Narges and two daughters Elissa and Emilia are still in Tampa and hope to join him before long, has hit the ground running at Stony Brook, where he has hired three postdoctoral researchers, a lab manager, four PhD students, two master’s candidates, and three undergraduates.

Damaghi is inspired to conduct cancer research in part because of losses in his family. Two grandparents died from cancer, his aunt has breast cancer, and his cousin, who had cancer when he was 16, fought through the disease and is a survivor for 20 years.

Damaghi bicycles and plays sports including soccer. He also enjoys cooking and said his guests appreciate his Persian kebobs.

As for his arrival in Stony Brook, he said it was “the best option for me. It’s a great package and has everything I need.”

Commack resident Theodore Wawryk, above, recently received shockwave intravenous lithotripsy at Huntington Hospital. Photo from Wawryk

Theodore Wawryk, a resident of Commack who performs maintenance work at the Bronx Gardens nursing home, had six stents placed in his heart in 2005.

One of the doctors performing the procedure was Dr. Gaurav Rao. Photo from Rao

This past February, Wawryk, 52, had a buildup of calcium behind some stents at their edges, which could lead to restenosis, or a narrowing of the arteries again.

The patient came to Huntington Hospital, where his cardiologist, Dr. Raj Patcha, director of the Cardiac Catheterization Laboratory, couldn’t initially get through the blockage.

Patcha reached out to Dr. Gaurav Rao, director of Interventional Cardiology at Huntington Hospital, to see if Wawryk might be a candidate to become the first Huntington Hospital patient to receive shockwave intravascular lithotripsy, also known as IVL.

Rao had used the shockwave treatment, which uses pressure waves to create fractures in the calcium, for over a year at other hospitals and was prepared to introduce the procedure at Huntington Hospital.

Other options for breaking through the calcium, such as orbital or rotational atherectomies, which act more like miniature jackhammers breaking up the calcium in the arteries, are off label when a stent is nearby because it can shave off the metal in the stent, leading to other complications, Rao said.

Additionally, placing another stent in the area without modifying the calcium leads to stent failure.

Rao and Patcha performed the procedure in early February.

“This is a much safer” approach, Rao said. “It’s revolutionary in the way we deliver classic cardiac care.”

Shockwave IVL enables the placement of stents by creating fractures in the calcium that allow doctors to put in functional and durable stents, Rao explained.

Other area hospitals have used shockwave IVL for circulatory issues as well. Stony Brook Hospital, for example, uses shockwaves for peripheral arteries. Huntington Hospital also uses shockwaves to treat peripheral vascular disease.

While every surgical procedure includes risks, Rao cited studies that indicate that the possibility of a dissection, or a tear in the wall of the aorta, for heart-focused IVL is 0.3% for shockwave IVL, which is substantially lower than the 3.4% rate for orbital atherectomy and 3% for rotational atherectomy.

Rao said about 70% of patients who are coming in for stents are eligible for IVL, while the remainder are still candidates for atherectomy.

Extremely long lesions or lesions where the entry point is small so that doctors can’t deliver an IVL balloon make atherectomies, with their front cutting abilities, the preferred approach, he said.

So far at Huntington Hospital, the growing number of patients eligible for shockwave IVL have chosen to have this approach.

“No one has shied away from shockwave therapy,” Rao said.

Patient experience

As for the patient experience, Wawryk recalled how the operation, felt “a little weird.”

Wawryk described how the doctors told him he’d feel a “little zap” inside his body.

Indeed, Rao said the procedure uses an electrical pulse that can cause the heart rate, particularly for someone with a resting pulse below 60 per minute, to accelerate for about 10 seconds.

Intravenous lithotripsy, which uses a low energy pressure wave of about 8 to 10 nanojoules and involves inserting a tube through the arm or leg, is generally “well-tolerated” Rao said. Many patients don’t feel the effect of the procedure.

Even with the slight shockwave, Wawryk said he would recommend the procedure to other patients considering it.

Wawryk, whose father died of a heart attack at the age of 46, is grateful for the cardiac care he received. He appreciates the time he gets to spend with his wife Nydia and his 19-year-old son Michael.

The Commack resident spent a day at the hospital, as the procedure started at 7 a.m. and he was heading home by 7 p.m. that night. He said he felt like the staff treated him as if he were at a “five-star resort.”

Rao is pleased to offer this interventional cardiac approach at Huntington Hospital, which makes it possible for residents nearby to receive the treatment and head home, without a longer ride back from a hospital further away.

Stock photo

Town of Huntington Supervisor Ed Smyth, Huntington American Legion Post #360 and the Halesite Fire Department will hold back-to-back blood drives with New York Blood Center on Thursday, April 21 and Friday, April 22 in response to the emergency blood shortage.

“Our hospitals need the public’s help with the emergency blood shortage we are facing,” said Supervisor Ed Smyth. “One blood donation can save up to three lives — please donate share this life-saving gift.”

“Donating the American Legion to host a blood drive is just one element of our national mission statement, we are happy to do what we can for our community,” said Glenn Rodriguez of the Huntington American Legion Post #360.

“Coming out of the COVID-19 pandemic, the need for blood donations is at an all-time high,” said Halesite Fire Department Chief Dom Spada. “The Halesite Fire Department will be holding an additional blood drive on Friday, April 22nd — please register online and donate the gift of life.”

Appointments are preferred however walk-ins will be welcomed if space permits. Please remember to eat, drink and bring your donor ID card or ID with name and photo. Masks are required for all donors regardless of vaccination status. For full list of COVID-19 safety protocols, please visit nybc.org/coronavirus.

Thursday, April 21 

Supervisor Ed Smyth, the Town of Huntington and Huntington American Legion Post #360 will host a blood drive at the American Legion, 1 Mill Dam Road, Halesite on Thursday, April 21 3:30 to 8 p.m. To make an appointment, please contact: Ryen Hendricks at [email protected] or register online at: https://donate.nybc.org/donor/schedules/drive_schedule/292863  

Friday, April 22 

Halesite Fire Department will host a blood drive at the Halesite Fire House in the large meeting room upstairs at 1 N. New York Avenue, Halesite on Friday, April 22 from 3:30 to 8 p.m. All donors are asked to park in the municipal parking lot behind the fire department building, not in the area immediately around the building, as those spots are needed for fire department members, and enter through the back door of the building. To make an appointment, please register online at: https://donate.nybc.org/donor/schedules/drive_schedule/299416

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A daily quarter-teaspoon increase in sodium can affect kidney function

By David Dunaief, M.D

Dr. David Dunaief

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 CDC (1).

Early-stage CKD is associated with a 40 percent increased risk of developing cardiovascular events, such as heart attacks (2). 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 (3). Ultimately, it can progress to end-stage renal (kidney) disease, requiring dialysis and potentially a kidney transplant, so it’s important to identify and treat it.

However, 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 you 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. eGFR is a calculation, and while the other two indices have varying ranges depending on the laboratory used, a patient with an eGFR of 30 to 59 is considered to have mild disease. The eGFR and the kidney function are inversely related, meaning as eGFR declines, the severity of chronic kidney disease increases.

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.

Does Allopurinol help?

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 (4). 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.

A 2018 study published in the Journal of the American Medical Association, concluded that allopurinol at a dose of 300 mg or higher reduced the risk of developing stage 3 kidney disease, but less than 300 mg did not (5). However, there is a much smaller 2020 study that shows allopurinol does not help to slow the progression of CKD stage 3 patients (6). This study was very small, but it does raise a question about whether allopurinol truly works.

Diet’s impact

Fruits and vegetables may play a role in helping patients with CKD. In a one-year study with 77 patients, 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. Animal products tend to cause an acidic environment.

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, a difference of approximately a quarter-teaspoon of sodium 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. After one month of lifestyle modifications, his eGFR improved by 9 points to 63, 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 lifestyle modifications to manage and reverse early-stage CKD. If you have common risk factors, such as diabetes, smoking, obesity or high blood pressure, or if you are over 60 years old, talk to your doctor about testing. 

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) N Engl J Med. 2004;351:1296-1305. (3) Circulation. 2004;109:320–323. (4) Clin J Am Soc Nephrol. 2010 Aug;5:1388-1393. (5) JAMA Intern Med. 2018;178(11):1526-1533. (6) N Engl J Med 2020; 382:2504-2513. (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. 

 

Dr. Adam Bitterman. Photo from Huntington Hospital

Huntington Hospital has appointed Adam Bitterman, DO, chair of orthopedic surgery. Dr. Bitterman is a board-certified orthopedic surgeon and an assistant professor of orthopedic surgery at the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell. He is a foot and ankle specialist and has a focus in treating conditions of the lower leg. 

“Dr. Bitterman has the experience, demeanor and dedication needed to lead Huntington Hospital through its growth as a premier destination for orthopedics,” said Nick Fitterman, MD, executive director of Huntington Hospital. “I am confident he will set a vision and strategy well suited to support the orthopedic needs of residents in Huntington and Suffolk County.”

A native of Commack, Dr. Bitterman’s clinical interests include arthritis of the foot and ankle, deformity correction, Achilles’ tendon disorders, and sports-related injuries to the ankle and foot. He is highly skilled in arthroscopic, minimally invasive, and open approaches for various conditions surrounding the lower foot and ankle.

“The Department of Orthopedics at Huntington Hospital has enjoyed a rich history, and now with Dr. Bitterman as chair, we look forward to continuing to advance the highest quality patient-centric musculoskeletal care in our region,” said Nicholas Sgaglione, MD, senior vice president and executive director of Northwell Health Orthopedics. “I look forward to watching the department continue to grow under Dr. Bitterman’s leadership.”

“I am excited about continuing to raise the bar at Huntington Hospital, from clinical growth to the enhancement of efficiency and safety,” said Dr. Bitterman. “I’ve been fortunate to work at Huntington Hospital for six years and I look forward to continuing to build on the achievements we’ve made and I’m excited for what we will create in the future.”

Many doctors are suggesting people learn to live with the virus and begin returning to usual activities such as going to the movies. Photo from Pixabay

Dr. Gregson Pigott went to the movies this week.

While the activity would be considered mundane in 2019, the decision to go to the theater to catch a flick is yet another example of how local doctors, or, in this case, commissioner of the Suffolk County Department of Health Services, is practicing what he preaches.

“We need to learn to live with the virus,” said Pigott, who has also been to a few Brooklyn Nets basketball games. Pigott, who is not using a mask except in situations where it is required, such as on a plane or on public transit, suggested people are “trying to resume life as it was pre-COVID.”

While the percentage of positive tests has risen, the numbers haven’t raised any alarm bells.

The percentage of COVID positive tests increased to a seven-day average of 2.6% as of April 2, according to figures from the New York State Department of Health.

That figure is higher than it had been in the weeks prior, when the percentage dipped below 2%.

“I certainly expected this,” Dr. Sean Clousten, associate professor of Public Health at Stony Brook University explained in an email. “I suspect this increase is due to unmasking at public schools because many kids who are infected are asymptomatic or the symptoms are different.”

Pigott said the current symptoms for the newer variant of omicron, called BA.2, which is becoming the dominant strain across the country and through much of the world, includes stuffy noses, scratchy throat and a slight cough.

Clousten added that the symptoms can also appear more like a bad stomach bug.

Second booster

Recently, the Food and Drug Administration approved a second booster for people over 50 and for those who are immunocompromised and who had a first booster more than four months ago.

Pigott said he would urge people who are over 65 or those who are immunocompromised to consider getting another jab.

“Most of the general population is fine with the three-shot regimen,” Pigott said. “Your body will recognize any kind of COVID infection and deal with it quickly.”

Dr. Sharon Nachman, chief of the Division of Pediatric Infectious Diseases at Stony Brook Children’s Hospital, indicated in an email that Stony Brook has been “advocating for switching vaccines.”

Switching vaccines could mean triggering a different response to the shot for the second booster, Nachman added.

Data about a second booster shows that the shot provides “good protection” against serious COVID, Nachman said. “Will it protect against any infection (meaning you might get a runny nose, cough or upper respiratory infection)? Not really.”

Nachman urged people to consult with their primary care doctor to decide whether to take a booster. What people are doing and where they are going can and should affect that decision.

Finally, daily activities such as going back to a crowded office or starting to take New York City transit could be “excellent reasons” to get a booster, she said.

Nachman plans to get a booster, although she is working on the best timing for another shot.

“Before I travel abroad is key to making sure I have my booster and am protected,” Nachman added.

Conferences

Nachman is encouraged that people are returning to in-person conferences and other activities.

“It will be great to have people starting to get back to routine living, and that means being with other people,” she explained in an email.

She urged people to stay at home if they don’t feel well.

“Now is not the time to push to go to that meeting or get together with extended family, since you might just be responsible for getting someone else sick,” she explained.

She suggested people should be patient and understanding of others who choose to wear masks or continue to practice social distancing.

“Don’t shame anyone who is wearing a mask,” Nachman advised. “If that is what it takes to get them together with you in public, go for it.”

In another sign of a return to a pre-pandemic life, Pigott suggested that the Health Department was planning to direct more resources to tracking illnesses like Lyme disease.

Precision Pilates

Amy Hirsch, founder and owner of Precision Pilates and Wellness, LLC, a boutique Pilates Studio, invites the community to celebrate the grand opening of their new location at 110 Lake Avenue South, Suite #45, Nesconset on April 9 from 11 a.m. to 1 p.m. The newly renovated Precision Pilates and Wellness is located in the Lake Industrial Park at 110 Lake Ave South, Suite #45, Nesconset. 

The studio will be offering tours, unveiling new equipment and fitness amenities. Attendees will enjoy refreshments and nibbles, along with raffles, giveaways, and sale of up to 20% off fitness wear and more. Special discounts on intro packages and individual Pilates sessions will also be offered at the event.

“We are thrilled to introduce and share our new state of the art Pilates Health and Wellness Facility,” said Hirsch. 

“For the past 9 years, we have truly enjoyed helping our clients energize their lives and improve their overall health and wellness, strength, posture, and flexibility by offering affordable, personalized Classical Pilates instruction. Now with our expansion and the opening of Precision Pilates, we are excited to offer many mor class options, beyond Reformer Pilates, including Tower, Equipment, Mat and Privates based on the original work of Joseph Pilates.”

The event is FREE to the public and all ages and fitness levels are welcome. Attendees are encouraged to wear fitness attire and be ready to try out the new space. RSVP via email at [email protected] or visit https://smithtownpilates.com/open-house/ to schedule a tour. For more information, class schedules, or to reserve classes online visit www.SmithtownPilates.com.

Pixabay photo
Most Americans underconsume potassium   

By David Dunaief, M.D.

Dr. David Dunaief

Most of us know we need to lower our sodium intake. Still, more than 90 percent of us consume far too much sodium (1). Even if we don’t have hypertension, the impact of sodium on our health can be dramatic.

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 include cold cuts and cured meats, cheeses, pizza, poultry, soups, pastas, sauces 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).

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. And if you struggle with high blood pressure, this approach could help you win the battle. Let’s look at the evidence.

Why do we always harp on 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 34 randomized clinical trials, totaling more than 3,200 participants. Salt reduction from 9 to 12 grams per day to 5 to 6 grams per day, determined using 24-hour urine tests, had a dramatic effect. 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 recommend further reduction to 3 grams per day as a long-term target for the population and concluded that the 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 both 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 alongside an increase in sodium, 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, they may be telling.

Why is potassium important?

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 this was not a head-to-head comparison. The good news is that potassium is easily attainable in the diet. Foods that are potassium-rich include bananas, almonds, raisins, sweet potato and green leafy vegetables such as Swiss chard.

The bottom line: decrease your sodium intake by almost half and increase potassium intake from foods. 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. 

File photo/TBR News Media

Mather Hospital in Port Jefferson has been awarded a $25,000 Innovation Grant Award from the Katz Institute for Women’s Health (KIWH) to pilot an Integrative Oncology Program that will focus on both the physical and mental pain of cancer patients.

“Pain management is cited by the American Cancer Society as a top priority for oncology patients, as the physical attributes of the diagnosis and treatment of cancer are amplified by emotional and spiritual suffering,” KIWH stated in awarding the grant. 

The Community Integrative Care Oncology program aims to expand community access to evidence-based integrative care modalities for women with an oncology/hematology diagnosis.

“We will be providing acupuncture, meditation, reiki, nurse coaching, aromatherapy, etc. to women with an active cancer diagnosis or women who are survivors of cancer,” said Marie O’Brien, NP, Coordinator and Nurse Practitioner for Mather Hospital’s Integrative Pain Management Program. Nurses in the program include Patricia Dodd, NP, Maria Rubino, NP, and Margaret Scharback, RN. 

Patients will register through Patient Access for the services, which will be offered at the hospital. The services will be offered free of charge to participants.

O’Brien said the staff has received additional training and plans to launch the clinic in April.