Nicole Hoefler, director for cardiac cath services at Mather Hospital in the new cardiac catheterization lab.
Photo by Julianne Mosher
It’s finally here.
Mather Hospital announced this week its new cardiac catheterization lab is completed and is ready to serve patients — as soon as it receives its final Department of Health inspection and approval in the upcoming weeks.
According to Nursing Director for Cardiac Cath Services Nicole Hoefler, Mather Hospital in Port Jefferson is joining the few places on Long Island in hosting a cardiac catheterization lab to provide less invasive heart-related services to patients who need it.
“We’re here to basically help prevent serious heart attacks,” Hoefler said. “And prevent heart attacks that might be evolving.”
The labs specialize in using X-ray guided catheters to help open blockages in coronary arteries or repair the heart in minimally invasive procedures. These range from stenting to angioplasty and bypass surgery — that are less traumatic to the body and speed recovery.
Photo by Julianne Mosher
“Sometimes, if a patient had a positive stress test, they’ll come in here so we can see what’s causing that pain they might have been having,” she noted. “Sometimes they need to have it for surgery clearance, like if they saw something on their EKG.”
The two new state-of-the-art rooms were approved by Northwell Health last year, alongside three other Northwell facilities. Construction began on the new spaces in August 2020, completing and turning over to the clinical staff on April 19.
By adding the two labs into Mather, Hoefler said they can help save a life.
“Every minute that passes when you’re having a heart attack slows your heart muscle,” she said. “So not having to transfer the patient out, and just bring them in from upstairs will be life changing.”
Both rooms will be able to accommodate approximately 20 patients per day with the 12 hours the labs are open.
The addition of the more than 3,000 square foot space is just another space that Mather can now provide patients better.
“I think the community just loves Mather,” Hoefler said. “Having this service
is just another reason to come here.”
Melville-based Allied Physicians Group, an independent provider of comprehensive family health care services for both children and adults, held a “Start of Construction Ceremony” for its new Rocky Point office located at 346 Route 25A, Rocky Point, on April 6.
Local dignitaries and elected officials, including Town of Brookhaven Supervisor Edward P. Romaine and Town Councilwoman Jane Bonner, joined Allied physicians and executives at the ceremony.
The 5,500 sq. ft., state-of-the-art pediatric office will have eight employees, including 2 pediatricians and medical practitioners. Services for patients and families will include wellness care, vaccinations, sick care, a new parent helpline, breastfeeding support, telehealth services, social work access, nutrition assistance, asthma control education and community education (webinars, CPR classes). The build-out will be by the Klinger Construction Corporation, based in Coram.
The Rocky Point office will also feature new health safety focused enhancements to protect patients from the spread of COVID-19 and other illnesses. Design elements include separated sick and well areas and a state-of-the-art HVAC system with UV lighting to improve air quality.
“Allied Physicians Group is a physician led organization committed to quality, personalized health care. Our doctors know every one of our patients and their families, this is critical for providing the highest quality of care and exceptional patient experiences. Today, we mark the start of construction of our 24th Long Island independent Allied Physician Group office. This location will bring much needed care to Rocky Point and the surrounding communities,” said Dr. Kerry Fierstein, CEO Allied Physicians Group.
“Allied Physicians Group’s new pediatric practice here in Rocky Point is an important new medical practice in our community. We have a growing number of families with young children in the area and as is the case with children, they need regular checkups as well as medical care. This new office will be convenient for families living here in Rocky Point and the surrounding area,” said Supervisor Romaine.
“Rocky Point is a community with numerous young families and children who will be well served by this new facility from Allied Physicians Group,” said Councilwoman Bonner. “This is another great addition to the Rocky Point community, and I look forward to their grand opening.”
Pictured from left, Brianne Chidichimo, Director of Marketing; Valentin Staller, VP of Staller Associates; Councilwoman Bonner; Kevin Edwards, Sr. Vice President of Business Development; Jason Halegoua, Allied Partner Pediatrician; Andrew Phillips, Director of Operations; Kerry Fierstein, CEO of Allied Physicians Group; Robert Creaven, Chief Operating Officer; Gary Mirkin, President of Allied Physicians Group; and Supervisor Romaine.
Visit www.alliedphysiciansgroup.com for more information.
Chest pain remains the most common symptom in both men and women
By David Dunaief, M.D.
Dr. David Dunaief
When we refer to heart disease, it is an umbrella term; heart attacks are one component.
Fortunately, the incidence of heart attacks has decreased over the last several decades, as have deaths from heart attacks. However, there are still 790,000 heart attacks every year, and almost three-quarters of these are first heart attacks (1).
If you think someone is having a heart attack, call 911 as quickly as possible and have the patient chew an adult aspirin (325 mg) or four baby aspirins. While the Food and Drug Administration does not recommend aspirin for primary prevention of a heart attack, the use of aspirin here is for treatment of a potential heart attack, not prevention.
Heart attack symptoms
The main symptom is chest pain, which most people don’t have trouble recognizing. However, there are a number of other, more subtle, symptoms such as discomfort or pain in the jaw, neck, back, arms and epigastric, or upper abdominal areas. Others include nausea, shortness of breath, sweating, light-headedness and tachycardia (racing heart rate). One problem is that less than one-third of people know these other major symptoms (2). About 10 percent of patients present with atypical symptoms — without chest pain — according to one study (3).
It is not only difficult for the patient but also for the medical community, especially the emergency room, to determine who is having a heart attack. Fortunately, approximately 80 to 85 percent of chest pain sufferers are not having a heart attack. More likely, they have indigestion, reflux or other non-life-threatening ailments.
There has been a raging debate about whether men and women have different symptoms when it comes to heart attacks. Several studies speak to this topic.
Men vs. women
There is data showing that, although men have heart attacks more commonly, women are more likely to die from a heart attack (4). In a Swedish prospective (forward-looking) study, after having a heart attack, a significantly greater number of women died in hospital or near-term when compared to men. The women received reperfusion therapy, artery opening treatment that consisted of medications or invasive procedures, less often than the men.
However, recurrent heart attacks occurred at the same rate, regardless of sex. Both men and women had similar findings on an electrocardiogram; they both had what we call ST elevations. This was a study involving approximately 54,000 heart attack patients, with one-third of them being women.
One theory about why women are treated less aggressively when first presenting in the ER is that they have different and more subtle symptoms — even chest pain symptoms may be different. Women’s symptoms may include pain in the lower portion of the chest or upper portion of the abdomen, and they may have significantly less severe pain that could radiate or spread to the arms. But, is this true? Not according to several studies.
In one observational study, results showed that, though there were some subtle differences in chest pain, on the whole, when men and women presented with this main symptom, it was of a similar nature (5). There were 34 chest pain characteristic questions used to determine if a difference existed. These included location, quality or type of pain and duration. Of these, there was some small amount of divergence: The duration was shorter for a man (2 to 30 minutes), and pain subsided more for men than for women. The study included approximately 2,500 patients, all of whom had chest pain. The authors concluded that determination of heart attacks with chest pain symptoms should not factor in the sex of patients.
This trial involved an older population; patients were a median age of 70 for women and 59 for men, with more men having had a prior heart attack. The population difference was a conspicuous weakness of an otherwise solid study, since age and previous heart attack history are important factors.
In the GENESIS-PRAXY study, another observational study, but with a younger population, the median age of both men and women was 49. Results showed that chest pain remained the most prevalent presenting symptom in both men and women (6). However, of the patients who presented without distinct chest pain and with less specific EKG findings (non-ST elevations), significantly more were women than men. Those who did not have chest pain symptoms may have had some of the following symptoms: back discomfort, weakness, discomfort or pain in the throat, neck, right arm and/or shoulder, flushing, nausea, vomiting and headache.
If the patients did not have chest pain, regardless of sex, the symptoms were diffuse and nonspecific. The researchers were looking at acute coronary syndrome, which encompasses heart attacks. In this case, independent risk factors for disease not related to chest pain included both tachycardia (rapid heart rate) and being female. The authors concluded that there need to be better ways to calibrate non-chest pain symptoms.
Some studies imply that as much as 35 percent of patients do not present with chest pain as their primary complaint (7).
Let’s summarize
So what have we learned about heart attack symptoms? The simplest lessons are that most patients have chest pain, and that both men and women have similar types of chest pain. However, this is where the simplicity stops and the complexity begins. The percentage of patients who present without chest pain seems to vary significantly depending on the study — ranging from less than 10 percent to 35 percent.
Non-chest pain heart attacks have a bevy of diffuse symptoms, including obscure pain, nausea, shortness of breath and light-headedness. This is seen in both men and women, although it occurs more often in women. When it comes to heart attacks, suspicion should be based on the same symptoms for both sexes. Therefore, know the symptoms, for it may be your life or a loved one’s that depends on it.
Dr. David Dunaief is a speaker, author and local lifestyle medicine physician focusing on the integration of medicine, nutrition, fitness and stress management. Visit www.medicalcompassmd.com.
From left, Dr. Maurie McInnis, President Of Stony Brook University, Wolfie and Dr. Margaret McGovern, Stony Brook Medicine Vice President for Health System Clinical Programs and Strategy, thank healthcare workers giving their time to help vaccinate Long Island. Photo from Stony Brook Medicine
In the race to get Long Island vaccinated against COVID-19, StonyBrook University hit a major vaccine milestone, celebrating its 200,000th shot today. The mark was reached at the state-run mass vaccination site established by Governor Cuomo, located in the Innovation & Discovery Building (IDC) in the University’s Research and Development (R&D) Park. StonyBrook’s IDC Point of Distribution (POD) has been up-and-running since January 18. In total, StonyBrook Medicine (SBM) has administered 350,000 vaccines at PODs all across Long Island.
Photo from Stony Brook Medicine
“I am so proud of the critical contribution StonyBrook University is making in the battle to stop the spread of this disease and bring the COVID crisis to an end,” says Maurie McInnis, President of StonyBrook University. “Today’s vaccine milestone is a profound testament to the dedication, expertise and resources we’ve been able to provide to the lives of those in our community and beyond.”
StonyBrook Medicine has also played a critical role in vaccinating residents on the East End of Long Island. SBM’s other state-run vaccination site located at StonyBrook’s Southampton campus opened on March 19 and has since distributed 30,000 vaccines. In addition, 20,000 shots have been distributed through PODs facilitated by StonyBrook Southampton Hospital in Southampton and StonyBrook Eastern Long Island Hospital in Greenport. Another 100,000 COVID-19 vaccines were administered at StonyBrook University Hospital.
Dr. Margaret McGovern, Vice President for Health System Clinical Programs and Strategy, StonyBrook Medicine, who oversees vaccine distribution, said, “StonyBrook Medicine has administered more than 350,000 vaccines at our various PODs, including StonyBrook University Hospital, the StonyBrook Union, StonyBrook Advanced Specialty Care in Commack, StonyBrook Southampton and multiple locations throughout the East End of Long Island, serviced by StonyBrook Southampton Hospital and StonyBrook Eastern Long Island Hospital.
“Today’s milestone of administering 200,000 COVID-19 vaccinations at the R&D Park, in partnership with New York State, demonstrates our responsiveness, capabilities and determination to protect the Long Island community. We will keep doing our part to vaccinate as many people as possible,” added Dr. McGovern.
To further serve its patients across the island, SBM worked with the state to successfully develop community PODs as pop-up sites in underserved communities on Long Island, to reach communities of color and the elderly, as well as help build trust.
Huntington Hospital scored a five-star rating from the U.S. Centers for Medicare & Medicaid Services in its annual 2021 hospital rankings.
The hospital, which is the only one in Suffolk County to achieve a five-star rating this year, has climbed the rankings over the last year, with three stars in 2019 and four stars in 2020.
“This is a reflection of the dedication of all the staff here,” said Huntington Hospital Executive Director Nick Fitterman. “What it means for the community is that they can get great care in their backyard.”
The top 13.56 percent of hospitals nationwide received five stars in 2021, according to the CMS website.
The rating measures five qualities, including mortality, safety, readmission, patient experience and timely and effective care. The first four categories receive a 22 percent weighting, while timely and effective care receives 12 percent.
The star rating encompasses over 100 measures CMS publicly reports, including the death rate for heart attack patients, surgical site infections for colon surgery, percentage of health care workers given influenza vaccinations, and the percentage of patients receiving appropriate recommendations for follow-up screening colonoscopy, among other measures.
“The five-star quality rating system is ultimately grounded in helping patients and their families make informed care decisions,” a CMS spokesman said in a statement. The ratings provide a general indication or what to expect in the future based on how a facility performed in the past.
Fitterman suggested that the rating reflects the hospital’s dedication to its mission, rather than focusing on achieving a specific rating.
Delivering excellence in clinical care is “the best and only strategy,” Fitterman said. “We don’t perseverate on what the rating agencies are looking for: we perseverate on what we think we’re doing for our patient.”
The improvements over the last few years have been incremental in numerous areas, including in neurosurgery and stroke care, cardiovascular care, and orthopedic care, which is ranked in the top 50 in the country, Fitterman said.
Fitterman praised the nursing staff, which he described as “first class,” and suggested that their culture is “contagious.”
While Huntington Hospital, which is part of Northwell Health System, doesn’t negotiate independently as a hospital, he said companies and payers “want to align themselves with high quality institutions and providers in their networks, because good [care] equates to less expensive care.”
After Fitterman received the news last week about the five stars, he walked through the hospital, high-fiving and fist pumping everyone from valets to engineers, to the food and nutrition workers and the doctors and the nurses.
“There was such excitement and jubilation and everyone realizes the hard work, the blood, sweat and tears, that go into the job,” the executive director said. “They put their heart into what they do. To get that public recognition was outstanding.”
Fitterman said he walks the halls each day, thanking staff for what they do and reminding them that they don’t just do their own task. They are all “helping relieve the suffering of others.”
Rite Aid announced on April 30 it is now administering the COVID-19 vaccine at all locations, spanning more than 2,500 stores in 17 states. Following the latest guidance from the Biden Administration, all those aged 16 years or older are now eligible for vaccination, and Rite Aid encourages everyone to schedule an appointment as soon as possible.
While scheduling appointments in advance is recommended to reduce wait time and guarantee availability of the vaccine, Rite Aid is now also accommodating walk-in vaccines on a limited basis in every store. Enabling walk-in appointments supports customers that may not have access to internet while also meeting the need for flexibility for customers. People interested in a walk-in appointment are encouraged to visit their local Rite Aid to confirm availability.
“The availability of vaccines in every Rite Aid location is a major milestone in our ongoing effort to fight COVID-19. We’ve been on the front lines since the beginning of the pandemic, working across our store footprint to bring testing and vaccines directly to local communities,” said Jim Peters, chief operating officer, Rite Aid. “Vaccine availability is improving every day, and our pharmacists are ready to administer vaccines safely and efficiently, providing the benefits of pharmacist-administered vaccines in a safe and sterile environment right in your neighborhood. Also, in addition to the grassroots efforts we’ve undertaken with our community partners, the availability of these walk-in appointments provides another way for those with limited or no technology access to more easily obtain COVID vaccines. We encourage everyone to make an appointment, or walk-in, today.”
Through its participation in the Federal Retail Pharmacy Program and as an Official COVID-19 Vaccination Program Provider, Rite Aid has accelerated its COVID-19 immunization efforts as allocation has expanded. Rite Aid’s certified immunizing pharmacists are administering the Moderna, Pfizer-BioNTech and Johnson & Johnson (Janssen) vaccines.
Individuals ages 18 and over can schedule appointments using the Rite Aid scheduling tool found at www.RiteAid.com/covid-19. Those ages 16 and 17 can schedule an appointment with guardian consent at any store administering the Pfizer vaccine by contacting the store’s pharmacy directly. Those stores can be found here.
For more information about Rite Aid’s COVID-19 vaccine efforts, please visit www.RiteAid.com/covid-19.
Long-term proton pump inhibitor use may have serious side effects
By David Dunaief, M.D.
Dr. David Dunaief
Reflux (GERD) disease, sometimes referred to as heartburn, though this is more of a symptom, is one of the most commonly treated diseases. In line with this, proton pump inhibitors (PPIs) have become one of the top-10 drug classes prescribed or taken in the United States.
The class of drugs called PPIs includes Prevacid (lansoprazole), Prilosec (omeprazole), Nexium (esomeprazole), Protonix (pantoprazole) and Aciphex (rabeprazole). Several of these medications are now available over-the-counter, rather than by prescription. When they were first approved, they were touted as having one of the cleanest side-effect profiles. This may still be true, if we use them correctly. They are intended to be used only for the short term. This can range from 7 to 14 days for over-the-counter PPIs to 4 to 8 weeks for prescription PPIs.
Dangers of long-term use
While PPI pre-approval trials were short-term, not longer than a year, many physicians put patients on these medications for decades. And the longer people are on them, the more complications arise. Among potential associations with long-term use are chronic kidney disease, dementia, bone fractures and Clostridium difficile, a bacterial infection of the gastrointestinal tract.
Though PPIs may increase the risk of a number of complications, keep in mind that none of the data are from randomized controlled trials (RCTs), which are the gold standard of studies, but mostly observational studies that suggest an association, not a link.
Chronic kidney disease
In two separate studies, results showed that there was an increase in chronic kidney disease with prolonged PPI use (1). All of the patients started the study with normal kidney function based on glomerular filtration rate (GFR). In the Atherosclerosis Risk in Communities (ARIC) study, there was a 50 percent increased risk of chronic kidney disease, while the Geisinger Health System cohort study found there was a modest 17 percent increased risk.
The first study had a 13-year duration, and the second had about a six-year duration. Both demonstrated modest, but statistically significant, increased risk of chronic kidney disease. But as you can see, the medications were used on a chronic basis for years. In an accompanying editorial to these published studies, the author suggests that there is overuse of the medications or that they are used beyond the resolution of symptoms and suggests starting with diet and lifestyle modifications as well as a milder drug class, H2 blockers (2).
Dementia
Stock photo
A German study looked at health records from a large public insurer and found there was a 44 percent increased risk of dementia in the elderly who were using PPIs, compared to those who were not (3). These patients were at least age 75. The authors surmise that PPIs may cross the coveted blood-brain barrier and potentially increase beta-amyloid levels, markers for dementia. With occasional use, meaning once every 18 months for a few weeks to a few months, there was a much lower increased risk of 16 percent.
The researchers also suggested that PPIs may be significantly overprescribed in the elderly. Unfortunately, there were confounding factors that may have conflated the risk. Researchers also did not take into account family history of dementia, high blood pressure or excessive alcohol use, all of which have effects on dementia occurrence.
Bone fractures
In a meta-analysis of 18 observational studies, results showed that PPIs can increase the risk of hip fractures, spine fractures and any-site fractures (4). Interestingly, when it came to bone fractures, it did not make a difference whether patients were taking PPIs for more or less than a year.
They found increased fracture risks of 58, 26 and 33 percent for spine, hip and any site, respectively. It is not clear what may potentially increase the risk; however, it has been proposed that it may have to do with calcium absorption through the gut. PPIs reduce acid, which may be needed to absorb insoluble calcium salts. In another study, seven days of PPIs were shown to lower the absorption of calcium carbonate supplements when taken without food (5).
Need for magnesium
PPIs may have lower absorption effects on several electrolytes including magnesium, calcium and B12. In one observational study, PPIs combined with diuretics caused a 73 percent increased risk of hospitalization due to low magnesium (6). Diuretics are commonly prescribed for high blood pressure, heart failure and swelling.
Another study confirmed these results. In this second study, which was a meta-analysis of nine studies, PPIs increased the risk of low magnesium in patients by 43 percent, and when researchers looked only at higher quality studies, the risk increased to 63 percent (7). The authors note that a significant reduction in magnesium could lead to cardiovascular events.
The bottom line is that it’s best if you confer with your doctor before starting PPIs. You may not need PPIs, but rather a milder medication, such as H2 blockers (Zantac, Pepcid). Even better, start with lifestyle modifications including diet, not eating later at night, raising the head of the bed, losing weight and stopping smoking, if needed, and then consider medications (8).
If you do need medications, know that PPIs don’t give immediate relief and should only be taken for a short duration: 7 to 14 days, according to the FDA, without a doctor’s consult, and 4 to 8 weeks with one (9).
Dr. David Dunaief is a speaker, author and local lifestyle medicine physician focusing on the integration of medicine, nutrition, fitness and stress management. Visit www.medicalcompassmd.com.
The Three Village Dads Foundation recently signed an official pledge with Stony Brook Children’s Hospital to donate $100,000 over the next 5 years to the Child Life Services program. A check in the amount of $10,000 was presented on April 21 in partnership with Jeff Hendel of Hendel Wealth Management.
Photo from TVDF
“Two years ago when our Foundation began it’s local philanthropic efforts, the Children’s Hospital was actually our very first recipient. What initially was supposed to be a small Three Village Dads group BBQ where I figured we could perhaps raise a few dollars for a great local cause, turned into something so much more. That event was wildly successful as we were able to raise $12,000 which opened our eyes to the effectiveness us Dads could have on our community,” said David Tracy, Three Village Dads Foundation President & Chairman.
“When we established that relationship with Stony Brook’s Child Life program we immediately felt as connected and dedicated to their mission as their wonderful staff do. To now be in a position where we are able to deliver so much more to this great organization truly means a lot to myself, my board members, and our amazing donors. Jeff Hendel of Hendel Wealth Management joined as a co-donor with this presentation. It is generous donors such as Mr. Hendel that have enabled us to do the good we strive to do in Three Village,” he said.
Pictured from left, Elisa Ruoff, Development Officer of Advancement at Stony Brook Hospital; Michael Attard, Child Life Specialist at Stony Brook Children’s Hospital; Vince DiCarlo, Three Village Dads Foundation board member; David Tracy, Three Village Dads Foundation President & Chairman; Jeff Hendel, Hendel Wealth Management President & CEO; and Three Village Dads Foundation board members Chris Carson and David Bitman.
Clinical Assistant Professor of Medicine at Stony Brook Medicine, Dr. Miguel Saldivar, wants residents to make vaccine decisions based on scientific information, rather than Internet speculation. Saldivar, who joined Stony Brook just months before the pandemic hit Long Island, sees improvement in the overall infection numbers, which have declined in recent weeks to about two to three percent from closer to five to six percent. In a wide-ranging interview (which can be seen online at tbrnewsmedia.com), Saldivar answered a host of questions.
TBR: Do you have any concerns about the number or percentage of people who are not lining up for vaccination?
Saldivar: In general, what we are more concerned about is the amount of misinformation that is out there. If you go on social media — if you go just on the internet, period — there’s a lot of people who are spreading lot of information that is really frankly inaccurate.
TBR: What are Stony Brook and others trying to do to counter misinformation?
Saldivar: There are a number of things we hear fairly frequently, probably the more common one I personally have heard, because Pfizer and Moderna are based on mRNA technology, everybody hears the term RNA and is worried that it’s going to change my genetic code and turn me into a mutant or cause a disease down the line. The first thing to understand about that, the way both of those vaccines work, it’s a set of instructions being given to the body cells, the moment it’s been delivered, the mRNA dissolves. It has no way of getting into the deeper part of the cells to change your genetic code.
TBR: Black and brown communities have a distrust of the federal government after some well known problems regarding Tuskegee Experiment and other issues. Is there broader acceptance now compared with a month or two ago?
Saldivar: Statistically, if you compare how this disease has affected minority communities, the risk of a severe outcome, hospitalization intubation and death is almost universally higher among minority communities. That has a number of factors, not just the disease itself. It’s also the fact that within those communities, it is more frequent to find some of the risk factors, meaning diabetes, obesity, preexisting pulmonary disease so on and so forth … What I have been personally involved with is reaching out to the community, we have found a lot of community centers have been very ready and willing to engage in a conversation. We have found places of worship to be wonderful places to have that conversation
TBR: What does the data tell you about the pandemic?
Saldivar: The last numbers I heard from the meeting this morning were between two to three percent positivity. We’ve been there for a week. Before that, we were staying pretty stable at like five to six percent or thereabouts. It looks like finally, this may be the effect of the vaccine, the numbers are finally starting to little by little trend their way down. We’ve been cautiously optimistic. There seems to be a little bit of a light at the end of the tunnel.
TBR: You have a bachelor’s degree in classical guitar performance. How did you wind up in infectious disease?
Saldivar: Through the nonprofit circle, I landed a job with the medical center at UCLA. That’s where I met a very, very good friend and mentor. She was key to helping me shape the path. I feel incredibly lucky to be part of this profession.
The prevalence of osteoporosis is increasing, especially as the population ages. Why is this important? Osteoporosis may lead to increased risk of fracture due to a decrease in bone strength (1). That is what we do know. But what about what we think we know?
For decades we have been told that if we want strong bones, we need to drink milk. This has been drilled into our brains since we were toddlers. Milk has calcium and is fortified with vitamin D, so milk could only be helpful, right? Not necessarily.
The data is mixed, but studies indicate that milk may not be as beneficial as we have been led to believe. Even worse, it may be harmful. The operative word here is “may.” We will investigate this further. Vitamin D and calcium are good for us. But do supplements help prevent osteoporosis and subsequent fractures? Again, the data are mixed, but supplements may not be the answer for those who are not deficient.
Does milk help or hurt?
The results of a large, observational study involving men and women in Sweden showed that milk may be harmful (2). When comparing those who consumed three or more cups of milk daily to those who consumed less than one, there was a 93 percent increased risk of mortality in women between the ages of 39 and 74. There was also an indication of increased mortality based on dosage.
For every one glass of milk consumed there was a 15 percent increased risk of death in these women. There was a much smaller, but significant, three percent per glass increased risk of death in men. Women experienced a small, but significant, increased risk of hip fracture, but no in-creased risk in overall fracture risk. There was no increased risk of fracture in men, but there was no benefit either. There were higher levels of biomarkers that indicate oxidative stress and inflammation found in the urine.
This study was 20 years in duration and is eye-opening. We cannot make any decisive conclusions, only associations, since it is not a randomized controlled trial. But it does get you thinking. The researchers surmise that milk has high levels of D-galactose, a simple sugar that may increase inflammation and ultimately contribute to this potentially negative effect, whereas other foods have many-fold lower levels of this substance.
Ironically, the USDA recommends that, from 9 years of age through adulthood, we consume three cups of dairy per day (3). This is interesting, since the results from the previous study showed the negative effects at this recommended level of milk consumption. The USDA may want to rethink these guidelines.
Prior studies show milk may not be beneficial for preventing osteoporotic fractures. Specifically, in a meta-analysis that used data from the Nurses’ Health Study for women and the Health Professionals Follow-up Study for men, neither men nor women saw any benefit from milk consumption in preventing hip fractures (4).
Does calcium help?
Stock photo
Unfortunately, it is not only milk that may not be beneficial. In a meta-analysis involving a group of observational studies, there was no statistically significant improvement in hip fracture risk in those men or women ingesting at least 300 mg of calcium from supplements and/or food on a daily basis (5).
The researchers did not differentiate the types of foods containing calcium. In a group of randomized controlled trials analyzed in the same study, those taking 800 to 1,600 mg of calcium supplements per day also saw no increased benefit in reducing nonvertebral fractures. In fact, in four clinical trials the researchers actually saw an increase in hip fractures among those who took calcium supplements. A weakness of the large multivaried meta-analyses is that vitamin D baseline levels, exercise and phosphate levels were not taken into account.
What about vitamin D?
Finally, though the data is not always consistent for vitamin D, when it comes to fracture prevention, it appears it may be valuable. In a meta-analysis (involving 11 randomized controlled trials), vitamin D supplementation resulted in a reduction in fractures (6). When patients were given a median dose of 800 IUs (ranging from 792 to 2,000 IUs) of vitamin D daily, there was a significant 14 percent reduction in nonvertebral fractures and an even greater 30 percent reduction in hip fractures in those 65 years and over. However, vitamin D in lower levels showed no significant ability to reduce fracture risk.
Just because something in medicine is a paradigm does not mean it’s correct. Milk may be an ex-ample of this. No definitive statement can be made about calcium, although even in randomized controlled trials with supplements, there seemed to be no significant benefit. Of course, the patients in these trials were not necessarily deficient in calcium or vitamin D.
In order to get benefit from vitamin D supplementation to prevent fracture, patients may need at least 800 IUs per day, which is the Institute of Medicine’s recommended amount for a relatively similar population as in the study.
Remember that studies, though imperfect, are better than tradition alone. Prevention and treatment therefore should be individualized, and deficiency in vitamin D or calcium should usually be treated, of course. Please, talk to your doctor before adding or changing any supplements.
References:
(1) JAMA. 2001;285:785-795. (2) BMJ 2014;349:g6015. (3) health.gov (4) JAMA Pediatr. 2014;168(1):54-60. (5) Am J Clin Nutr. 2007 Dec;86(6):1780-1790. (6) N Engl J Med. 2012 Aug. 2;367(5):481.
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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