Health

Micronutrients are vitamins and minerals needed by the body in very small amounts. METRO photo
Micronutrient focus may reduce cravings

By David Dunaief, M.D.

Dr. David Dunaief

If we needed any more proof, this past year has been a good reminder that many things influence our eating behavior, including food addictions, boredom, lack of sleep and stress. This can make weight management or weight loss very difficult to achieve.

Unfortunately, awareness of a food’s caloric impact doesn’t always matter, either. Studies assessing the impact of nutrition labeling in restaurants gave us a clear view of this issue: knowing an item’s calories either doesn’t alter behavior or encourages higher calorie purchases (1, 2).

Does this mean we are doomed to acquiesce to temptation? Actually, no: It is not solely about willpower. Changing diet composition is more important.

How can we alter the dynamic? In my clinical experience, increasing the quality of food has a tremendous impact. Foods that are the most micronutrient dense, such as plant-based foods, rather than those that are solely focused on macronutrient density, such as protein, carbohydrates and fats, tend to be the most satisfying. In a week to a few months, one of the first things patients notice is a significant reduction in cravings. But don’t take my word for it. Let’s look at the evidence.

Examining refined carbohydrates

Many of us know that refined carbohydrates are not beneficial. Worse, however, a randomized control trial showed refined carbohydrates may cause food addiction (3). Certain sections of the brain involved in cravings and reward are affected by high-glycemic foods, as shown by MRI scans of trial subjects.

Study participants consumed a 500-calorie shake with either a high-glycemic index or a low-glycemic index. They were blinded (unaware) as to which they were drinking. The ones who drank the high-glycemic shake had higher levels of glucose in their blood initially, followed by a significant decline in glucose levels and increased hunger four hours later. The region of the brain that is related to addiction, the nucleus accumbens, showed a spike in activity with the high-glycemic intake.

According to the authors, this effect may occur regardless of the number of calories consumed. Granted, this was a very small study, but it was well designed. High-glycemic foods include carbohydrates, such as white flour, sugar and white potatoes. The conclusion: Everyone, but especially those trying to lose weight, should avoid refined carbohydrates. Calorie composition matters.

Comparing macronutrients

We tend to focus on macronutrients when looking at diets. These include protein, carbohydrates and fats, but are these the elements that have the greatest impact on weight loss? In an RCT, when comparing different macronutrient combinations, there was very little difference among groups, nor was there much success in helping obese patients reduce their weight (4, 5). Only 15 percent of patients achieved a 10 percent reduction in weight after two years.

The four different macronutrient diet combinations involved overall calorie restriction. In addition, each combination had either high protein, high fat; average protein, high fat; high protein, low fat; or low protein, low fat. Carbohydrates ranged from low to moderate (35 percent) in the first group to high (65 percent) in the last group. This was another well-designed study, involving 811 participants with an average BMI of 33 kg/m², which is classified as obese.

Again, focusing primarily on macronutrient levels and calorie counts did very little to improve results.

Adding micronutrients

In an epidemiological study looking at National Health and Nutrition Examination Survey data, results demonstrate that those who are overweight and obese tend to be lacking in micronutrients (6). These include carotenoids, such as lutein, zeaxanthin, beta-carotene, alpha-carotene and beta-cryptoxanthin, as well as vitamin B12, folate and vitamins C, E and D.

Unfortunately, taking supplements won’t solve the problem; supplements don’t compensate for missing micronutrients. Quite the contrary, micronutrients from supplements are not the same as those from foods. With a few exceptions, such as vitamin D and potentially B12, most micronutrient levels can be raised without supplementation, by adding variety to your diet. Please ask your doctor.

Lowering cortisol levels

The good news is that once people lose weight, they may be able to continue to keep the weight off. In a prospective (forward-looking) study, results show that once obese patients lose weight, the levels of cortisol metabolite excretion decrease significantly (7).

Why is this important? Cortisol is a glucocorticoid, which means it raises the level of glucose and is involved in mediating visceral or belly fat. This type of fat has been thought to coat internal organs, such as the liver, and result in nonalcoholic fatty liver disease. Decreasing the level of cortisol metabolite may also result in a lower propensity toward insulin resistance and may decrease the risk of cardiovascular mortality. This is an encouraging preliminary, yet small, study involving women.

Controlling or losing weight is not solely about willpower or calorie-counting. While calories have an impact, the nutrient density of the food may be more important. Thus, those foods high in a variety of micronutrients may also play a significant role in reducing cravings, ultimately helping to manage weight.

References:

(1) Am J Pub Health 2013 Sep 1;103(9):1604-1609. (2) Am J Prev Med.2011 Oct;41(4):434–438. (3) Am J Clin Nutr Online 2013;Jun 26. (4) N Engl J Med 2009 Feb 26;360:859. (5) N Engl J Med 2009 Feb 26;360:923. (6) Medscape General Medicine. 2006;8(4):59. (7) Clin Endocrinol.2013;78(5):700-705.

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. 

Photo from Deposit Photos

Looking back on the response to the COVID-19 pandemic, Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, expressed his frustration with the reaction to recommended safety measures.

“Public health issues got entangled in the profound divisiveness in our society,” Fauci said in a public discussion with the College of William & Mary president, Katherine Rowe, last week. “When you’re dealing with a common enemy, which is the virus, it is very counterproductive to be divisive over virtually everything you do.”

Fauci was frustrated that wearing a mask became a political statement, calling that “ridiculous” and suggesting that it “accounted for a less-than-optimal response that this country had.”

“I believe we’re going to get there within this calendar year.”

— Dr. Anthony Fauci

The disagreements were based “not on facts and science, but on political differences,” he said. In the next year, however, Fauci expressed hope that the country would have the virus under control and that it would eventually no longer threaten public health.

“I believe we’re going to get there within this calendar year,” Fauci said on the William & Mary call. “The problem is that a global pandemic requires a global response and if we don’t participate as [have] the other developed nations in the EU and in the U.K. and Canada and Australia, if we don’t participate in a program, in COVAX, that helps provide vaccines for the developing world … our problem will never go away.”

Indeed, last week, President Joe Biden (D) pledged $4 billion to the COVAX program at the G7 meeting.

Fauci pushed an initial estimate back for the time when vaccines for the virus would be available broadly to the United States population.

“One of the disappointments, which made me change [the] estimate, the Johnson & Johnson vaccine, which we anticipated would be coming in significant quantities in March and April, we learned that they will not have significant quantities until likely May and June,” Fauci said.

Reacting to a question from William & Mary Student Assembly president, Anthony Joseph, Fauci said, “Somebody like yourself, a young person, will likely have to wait until May.”

In response to a question about whether a vaccinated individual could be a carrier for COVID-19, Fauci said it is a “theoretical possibility — how likely that is, we do not know.”

The vaccination might prevent someone from showing clinical signs of the disease, but it might not keep someone from being a carrier.

He recommends people who have received the vaccine continue to wear a mask when they’re in the presence of people who have not been vaccinated, to prevent the possibility of infecting someone else.

New York State vaccinations

Snowstorms throughout the country this winter have disrupted the process of distributing vaccines.

New York State Department of Health said facilities where people scheduled appointments will connect with them before and during storms.

“As has been the case for past postponements, if any vaccine appointments at state-run sites are impacted by winter weather, they will be rescheduled over the following seven days,” a DOH spokesman said in a statement. “New Yorkers with appointments scheduled will receive an email or text message to reschedule their vaccination.”

Each resident who received a first dose at a state-run site will get a reminder email 24 hours before their second dose appointment.

When residents of the Empire State receive their first shot, they are required to schedule a second dose during that appointment.

Anyone who missed their appointment for a second shot should contact the call center to reschedule, if possible.

The state is required to keep a second dose on hand up to 42 days after a first shot, even though people who receive the Pfizer vaccine should get their second dose three weeks after the first shot and those who get the Moderna vaccine should return four weeks later. After 42 days, the state site can give the vaccine to someone else.

New York State requires all providers to keep a daily list of standby eligible people, in the event that an appointment opens up.

“As soon as providers are aware that there are more doses than people to be vaccinated, standby eligible individuals should be called, or other steps must be taken to bring additional eligible recipients to the facility or clinic before the acceptable use period expires,” the Health Department said in a statement.

Recognizing that the vaccination process can go awry during storms, providers can administer the vaccine to other public facing employees if extra doses remain at the end of a clinic and no one from a priority population can arrive before the doses expire.

As an example, the DOH suggested that commercial pharmacists who had already vaccinated eligible residents can offer the vaccine to members of the pharmacy department, store clerks, cashiers, stock workers and delivery staff.

“This exception is only for the purpose of ensuring vaccine is not wasted,” the spokesman said.

In remarks on Feb. 9, Gov. Andrew Cuomo (D) indicated that the supply of vaccines continues to lag well behind the demand.

“We now have about 10 million New Yorkers waiting on 300,000 doses,” Cuomo said. “The supply will only increase when and if Johnson & Johnson is approved. The Pfizer and Moderna vaccines are ramping up but the ramp-up is relatively slow, so we won’t see a major supply increase from Pfizer and Moderna, nowhere near what we would need to make rapid progress against the 10 million.”

Stony Brook vaccinations

Stony Brook University, meanwhile, announced that it reached a milestone last week when it distributed its 25,000th vaccine, exactly a month after the site started administering the vaccine. That means the university has vaccinated more than one person per minute for each of the 11 hours it’s been providing shots.

In a statement, President Maurie McInnis said she was “proud of the milestone” and called the effort by the university and Stony Brook Medicine “excellent work.”

SBU Hospital is also assisting in developing point-of-distribution sites in underserved communities on Long Island.

Photo from BNL

COVID-19 needs no introduction. Scientists fighting it do.

John Hill leads the COVID-19 Science and Technology Working Group at the U.S. Department of Energy’s (DOE) Brookhaven National Laboratory. He also represents Brookhaven in a DOE consortium—the National Virtual Biotechnology Laboratory—which includes all 17 national laboratories working to address key challenges in responding to COVID-19.

The COVID-19 working group Hill leads at Brookhaven comprises experts in biology, nanoscience, computation, and other areas of science. They and their collaborators are leveraging world-class capabilities to study the structure of viral components, narrow the search for drugs, track research efforts, model the disease’s spread, and more.

Hill will give a virtual talk about the impacts of Brookhaven’s multifaceted COVID-19 research on Thursday, Feb. 25. The event, held from 6:30 to 7:30 p.m., will also include an interactive Q&A session, when audience members can submit questions for Hill and two of his colleagues:

How to join the event—and ask a question

This event will stream live on Twitter, Facebook, and YouTube. During the Q&A session, audience members can ask questions, using those streaming platforms’ chat functions.

You don’t need an account with Twitter, Facebook, or Google to watch the talk. You do need an account to ask questions via chat. Or you can email questions to [email protected] before the talk.

About the speakers

John Hill is the Deputy Associate Laboratory Director for Energy and Photon Sciences, and Director of the National Synchrotron Light Source II (NSLS-II), a DOE Office of Science User Facility at Brookhaven Lab. He previously served as leader for the X-ray Scattering group in the Lab’s Condensed Matter Physics and Materials Science Department. He is recognized as a world leader in x-ray scattering techniques for studying condensed matter systems.

Hill joined Brookhaven Lab as a postdoc in 1992, after earning a Ph.D. in physics from the Massachusetts Institute of Technology. He earned a bachelor’s degree in physics from Imperial College in London in 1986.

Kerstin Kleese van Dam is Director of the Computational Science Initiative (CSI) at Brookhaven Lab. CSI leverages computational science expertise and investments across multiple programs to tackle big-data challenges at the frontiers of scientific discovery. Kleese van Dam and collaborators at Brookhaven and Stony Brook University have applied simulations, machine learning, and other artificial intelligence tools in the fight against COVID-19.

Sean McSweeney is the Director of the Laboratory for BioMolecular Structure (LBMS) at Brookhaven. LBMS is home to state-of-the-art cryo-electron microscopes and other equipment for researchers to study the building blocks of all living organisms. Most of the data McSweeney and his group collected for COVID-19 research was done at NSLS-II.

Brookhaven National Laboratory is supported by the U.S. Department of Energy’s Office of Science. The Office of Science is the single largest supporter of basic research in the physical sciences in the United States and is working to address some of the most pressing challenges of our time. For more information, visit https://energy.gov/science.

Follow @BrookhavenLab on Twitter or find us on Facebook.

From right, 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 who are giving their time to help vaccinate Long Island.

Stony Brook University reached a major milestone in the COVID-19 vaccine distribution process on Thursday, February 18 when it administered the 25,000th vaccine at its state-run mass vaccination site. The site, established under the leadership of Governor Cuomo, opened on January 18. As the continued demand for COVID-19 vaccinations grows, Stony Brook University and Stony Brook Medicine have responded to the community’s need. Playing a critical role in carrying out New York State’s vaccination plans and contributing its R&D Park as an on-campus point of distribution (POD), staff went to work alongside the State to bring peace of mind to many people in an array of at-risk groups.

From left, Stony Brook University President Maurie McInnis, Stony Brook Medicine Vice President for Health System Clinical Programs and Strategy Dr. Margaret McGovern, 25,000 COVID-19 Vaccine recipient and Southampton resident Veronica Lang with her husband James, Wolfie, and Lisa Santeramo, assistant secretary for intergovernmental affairs.

“I am so proud of the milestone Stony Brook University, under Governor Cuomo’s leadership, has reached today in administering its 25,000th COVID-19 vaccine. This comes just one month after we opened the mass vaccination site at the University’s R&D Park on January 18. The efficient and effective administration of the vaccine is an example of the excellent work the University and Stony Brook Medicine have been doing to help stop the spread of COVID-19 and bring this pandemic to an end,” says President Maurie McInnis.

Widely regarded as a flagship campus for the State University of New York (SUNY) system, Stony BrookUniversity is bringing the full strength of its leadership, expertise, resources and quality care to further New York State’s goal of delivering life-saving vaccines to those who need it most.

The State also turned to Stony Brook University Hospital to assist in successfully developing 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, recognizing that the vaccine is one of the best ways to protect ourselves, our families and our communities from this serious infectious disease.

Stony Brook Medicine Vice President for Health System Clinical Programs and Strategy Dr. Margaret McGovern adds, “Our success in administering vaccines at Stony Brook is a testament to our robust COVID-19 response activities, talent and expertise that are hallmarks of this University and premier academic medical center. It exemplifies how quickly and well we can coordinate our resources to best serve our community, on campus and off. We are continuing to administer as many doses of the COVID-19 vaccine as possible based on New York State eligibility requirements, distribution guidelines and vaccine supplies, and we will continue to lead all efforts we can to help ensure the health, safety and well-being of our local communities.”

To mark this occasion, Stony Brook University’s very own Wolfie joined public officials to show appreciation to all of the frontline workers manning the mass vaccination site.

Photos courtesy of Stony Brook University. 

VIDEO: Please see link to B-Roll here. Video courtesy of Stony Brook University. 

Yoga can improve balance and strength, which are risk factors for falls. METRO photo
Fear of falling can lead to greater risk

By David Dunaief, M.D.

Dr. David Dunaief

Earlier in life, falls usually do not result in significant consequences. However, once we reach middle age, falls become more substantial. Even without icy steps and walkways, falls can be a serious concern for older patients, where consequences can be devastating. They can include brain injuries, hip fractures, a decrease in functional ability and a decline in physical and social activities (1). Ultimately, a fall can lead to loss of independence (2).

Contributors to fall risk

Many factors contribute to fall risk. A personal history of falling in the recent past is the most prevalent. But there are many other significant factors, such as age and medication use. Some medications, like antihypertensive medications used to treat high blood pressure and psychotropic medications used to treat anxiety, depression and insomnia, are of particular concern. Chronic diseases can also contribute.

Circumstances that predispose us to falls also involve weakness in upper and lower body strength, decreased vision, hearing disorders and psychological issues, such as anxiety and depression (3).

Simple fall prevention tips

Of the utmost importance is exercise. But what do we mean by “exercise”? Exercises involving balance, strength, movement, flexibility and endurance all play significant roles in fall prevention (4).

Many of us in the Northeast are also low in vitamin D, which may strengthen muscle and bone. This is an easy fix with supplementation. Footwear also needs to be addressed. Nonslip shoes are crucial indoors, and outside in winter, footwear that prevents sliding on ice is a must. Inexpensive changes in the home, like securing area rugs, can also make a big difference.

Medication side-effects

There are a number of medications that may heighten fall risk. As I mentioned, psychotropic drugs top the list. But what other drugs might have an impact?

High blood pressure medications have been investigated. A propensity-matched sample study (a notch below a randomized control trial in terms of quality) showed an increase in fall risk in those who were taking high blood pressure medication (5). Those on moderate doses of blood pressure medication had the greatest risk of serious injuries from falls, a 40 percent increase.

While blood pressure medications may contribute to fall risk, they have significant benefits in reducing the risks of cardiovascular disease and events. Thus, we need to weigh the risk-benefit ratio in older patients before considering stopping a medication. When it comes to treating high blood pressure, lifestyle modifications may also play a significant role in treating this disease (6).

How exercise helps

All exercise has value. A meta-analysis of a group of 17 trials showed that exercise significantly reduced the risk of a fall (7). If the categories are broken down, exercise led to a 37 percent reduction in falls that resulted in injury and a 30 percent reduction in those falls requiring medical attention. Even more impressive was a 61 percent reduction in fracture risk.

Remember, the lower the fracture risk, the more likely you are to remain physically independent. Thus, the author summarized that exercise not only helps to prevent falls but also fall injuries.

Unfortunately, those who have fallen before, even without injury, often develop a fear that causes them to limit their activities. This leads to a dangerous cycle of reduced balance and increased gait disorders, ultimately resulting in an increased risk of falling (8).

What types of exercise?

Tai chi, yoga and aquatic exercise have been shown to have benefits in preventing falls and injuries from falls.

A randomized controlled trial showed that those who did an aquatic exercise program had a significant improvement in the risk of falls (9). The aim of the aquatic exercise was to improve balance, strength and mobility. Results showed a reduction in the number of falls from a mean of 2.00 to a fraction of this level — a mean of 0.29. There was also a 44 percent decline in the number of exercising patients who fell during the six-month trial, with no change in the control group.

If you don’t have a pool available, Tai Chi, which requires no equipment, was also shown to reduce both fall risk and fear of falling in older adults in a randomized control trial of 60 male and female participants (10).

Another pilot study used modified chair yoga classes with a small assisted living population (11). Participants were those over 65 who had experienced a recent fall and had a resulting fear of falling. While the intention was to assess exercise safety, researchers found that participants had less reliance on assistive devices and three of the 16 participants were able to eliminate their use of mobility assistance devices.

Thus, our best line of defense against fall risk is prevention. Does this mean stopping medications? Not necessarily. But for those 65 and older, or for those who have arthritis and are at least 45 years old, it may mean reviewing your medication list with your doctor. Before considering changing your blood pressure medications, review the risk-to-benefit ratio with your physician.

References:

(1) MMWR. 2014; 63(17):379-383. (2) J Gerontol A Biol Sci Med Sci. 1998;53(2):M112. (3) JAMA. 1995;273(17):1348. (4) Cochrane Database Syst Rev. 2012;9:CD007146. (5) JAMA Intern Med. 2014 Apr;174(4):588-595. (6) JAMA Intern Med. 2014;174(4):577-587. (7) BMJ. 2013;347:f6234. (8) Age Ageing. 1997 May;26(3):189-193. (9) Menopause. 2013;20(10):1012-1019. (10) Mater Sociomed. 2018 Mar; 30(1): 38–42. (11) Int J Yoga. 2012 Jul-Dec; 5(2): 146–150.

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. 

Stony Brook University's COVID-19 testing site. Photo by Matthew Niegocki
Updated February 18, 2021
The COVID-19 testing site at Stony Brook University’s South P-lot will be closing at 1 p.m. on February 18 due to the snowstorm. There is an anticipated delayed opening Tomorrow, February 19 with timing yet to be determined.
For further updates and more information about Stony Brook’s coronavirus drive-through testing, click here.
New York State has partnered with Stony Brook University to provide drive-through testing for the coronavirus at Stony Brook University’s South P Lot off Stony Brook Road. Walk-ins are accepted, but appointments are strongly encouraged and can be made by phone at 888-364-3065 or online at covid19screening.health.ny.gov.

 

Beginning Sunday, February 14, the COVID-19 testing site at Stony Brook University’s South P-lot will be operating from 8 a.m. to noon  on Sundays.

Operating hours are now:
Monday through Friday, 8 a.m. to 6 p.m.
Saturday, 8 a.m. to 3 p.m.
Sunday, 8 a.m. to noon.

Anyone who believes they’re at risk should call the Department of Health Hotline, 888-364-3065, and talk to experts to determine if and how they should be tested.

Test results are not provided by Stony Brook University Hospital. They can be obtained through BioReference at bioreference.com/patient-portal or by calling the New York State DOH Hotline at 888-364-3065.

Click here for a map and directions to the testing site.

Coronavirus Hotline

Updated January 8, 2021
For people who have questions about symptoms, testing, vaccines and more, Stony Brook Medicine’s coronavirus phone line is here as a resource for you:

Coronavirus Hotline
(631) 638-1320

Staffed by registered nurses, the hotline is available daily from 8 am to 4:30 pm. Callers will be evaluated and directed to the appropriate healthcare setting for assistance, as needed.

Stock photo

Building heart-healthy habits improves the likelihood we’ll be around for those we love

By David Dunaief, M.D.

Dr. David Dunaief

This February, we celebrate both Valentine’s Day, an opportunity to celebrate those we love, as well as American Heart Month, a chance for us to build awareness of heart-healthy habits.

The good news is that heart disease is on the decline due to a number of factors, including better awareness in lay and medical communities, improved medicines, earlier treatment of risk factors and lifestyle modifications. We are headed in the right direction, but we can do better. Heart disease is something that is eminently preventable.

Reducing our risks

Risk factors for heart disease include obesity, high cholesterol, high blood pressure, smoking and diabetes. Unfortunately, both obesity and diabetes are on the rise. For patients with type 2 diabetes, 70 percent die of cardiovascular causes (1). However, high blood pressure, high cholesterol and smoking have declined (2).

Inactivity and the standard American diet, rich in saturated fat and calories, also contribute to heart disease risk (3). The underlying culprit is atherosclerosis, fatty streaks in the arteries.

Another potential risk factor is a resting heart rate greater than 80 beats per minute (bpm). In one study, healthy men and women had 18 and 10 percent increased risks of dying from a heart attack, respectively, for every increase of 10 bpm over 80 (4). A normal resting heart rate is usually between 60 and 100 bpm. Thus, you don’t have to have a racing heart rate, just one that is high-normal. All of these risk factors can be overcome.

When medication helps reduce risk

Cholesterol and blood pressure medications have been credited to some extent with reducing the risk of heart disease. The compliance with blood pressure medications has increased over the last 10 years from 33 to 50 percent, according to the American Society of Hypertension.

In terms of lipids, statins have played a key role in primary prevention. Statins are effective at not only lowering lipid levels, including total cholesterol and LDL — the “bad” cholesterol — but also inflammation levels that contribute to the risk of cardiovascular disease. The Jupiter trial showed a 55 percent combined reduction in heart disease, stroke and mortality from cardiovascular disease in healthy patients — those with a slightly elevated level of inflammation and normal cholesterol profile — with statins.

The downside of statins is their side effects. Statins have been shown to increase the risk of diabetes in intensive dosing, compared to moderate dosing (5).

Unfortunately, many on statins also suffer from myopathy (muscle pain). I have had a number of patients who have complained of muscle pain and cramps. Their goal when they come to see me is to reduce and ultimately discontinue their statins by following a lifestyle modification plan involving diet and exercise. Lifestyle modification is a powerful ally.

Making lifestyle changes

The Baltimore Longitudinal Study of Aging, a prospective (forward-looking) study, investigated 501 healthy men and their risk of dying from cardiovascular disease. The authors concluded that those who consumed five servings or more of fruits and vegetables daily with <12 percent saturated fat had a 76 percent reduction in their risk of dying from heart disease compared to those who did not (6). The authors theorized that eating more fruits and vegetables helped to displace saturated fats from the diet. These results are impressive and, to achieve them, they only required a modest change in diet.

The Nurses’ Health Study shows that these results are also seen in women, with lifestyle modification reducing the risk of sudden cardiac death (SCD). Many times, this is the first manifestation of heart disease in women. The authors looked at four parameters of lifestyle modification, including a Mediterranean-type diet, exercise, smoking and body mass index. There was a decrease in SCD that was dose-dependent, meaning the more factors incorporated, the greater the risk reduction. There was as much as a 92 percent decrease in SCD risk when all four parameters were followed (7). Thus, it is possible to almost eliminate the risk of SCD for women with lifestyle modifications.

Monitoring your risk of heart disease

To determine your progress, we use cardiac biomarkers, including inflammatory markers like C-reactive protein, blood pressure, cholesterol and body mass index. 

In a cohort study of high-risk participants and those with heart disease, patients implemented extensive lifestyle modification: a plant-based, whole foods diet accompanied by exercise and stress management. The results showed an improvement in biomarkers, as well as in cognitive function and overall quality of life. The best part is the results occurred over a very short period to time — three months from the start of the trial (8). Many patients I have seen have had similar results.

Ideally, if patient needs to use medications to treat risk factors for heart disease, it should be for the short term. For some patients, it may be appropriate to use medication and lifestyle changes together; for others, lifestyle modifications may be sufficient, as long as patients take an active role.

By focusing on developing heart-healthy habits, we can improve the likelihood that we – and those we love – will be around for a long time.

References:

(1) Diabetes Care. 2010 Feb; 33(2):442-449. (2) JAMA. 2005;293(15):1868. (3) Lancet. 2004;364(9438):93. (4) J Epidemiol Community Health. 2010 Feb;64(2):175-181. (5) JAMA. 2011;305(24):2556-2564. (6) J Nutr. March 1, 2005;135(3):556-561. (7) JAMA. 2011 Jul 6;306(1):62-69. (8) Am J Cardiol. 2011;108(4):498-507.

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. 

Photo by Pixabay

By Leah S. Dunaief

Leah Dunaief

Last Saturday I received my first of the required two vaccines against COVID-19. The inoculation itself was painless. The person who administered the shot was a broad-shouldered young man with curly black hair, deep brown eyes and prominent cheekbones that led to a white-tooth smile. He pinched the skin of my arm just below my left shoulder, and I knew the deed was done only when he discarded the needle into the red can. I think you can see why the entire experience was painless.

As you, who have tried undoubtedly know, it was not easy to get an appointment for the vaccine. My family and friends and the children of my friends were all on the phone or on their computer keyboards for hours trying over and over again to make contact with the right person in a reasonably close location to schedule the vaccination. Finally, the daughter of a close friend secured a time slot for me at the Javitz Center in New York City, and then my son found one sooner at Jones Beach.

I know that some people are passing up the opportunity to get vaccinated. They are concerned, among other reasons, that it has not been tested sufficiently since it was developed with unprecedented speed. What will the long term effects of the vaccine be? No one knows because there has not been a long term so far; we do know that the immediate effects have been studied for the short term in thousands of patients in clinical trials. The results and the efficacy have been excellent. So I decided that I would risk any unknown long term negative effects from the vaccine against the already known long-haul negative consequences from the disease and go for it.

I had heard that after-effects were not uncommon during the 24 hours following the vaccination, and indeed I did experience a couple. Two or three hours after I returned home, and after my dinner, I suddenly was enormously fatigued. I managed to climb the stairs to the bedroom, despite feeling light-head, and I slid into bed, where I then spent the night and enjoyed a sound sleep. I awoke to an aching arm, but that wasn’t the main problem. When I tried to walk, my right leg was, I thought, in spasm. I assumed I had slept in an awkward position and that I could walk it off, but the pain intensified. As the day went by, I endured only with the help of repeated Tylenol capsules, vitamins, a banana and ultimately the distraction of the big football game.

The next day, little more than 24 hours later, I felt perfectly fine. I was timid about walking, but there was no problem. Do I know that the leg pain was the after effect of the shot? I don’t, of course. 

I do have a date for the second shot, which is scheduled for early next month, and apparently there is a dose reserved for me to receive at that time. Will the vaccine protect me? From what I have read and been told, it takes about two weeks before the body develops any immunity, and with the one shot, that is perhaps only 50 or 60 percent. The second vaccination brings the immune system to about 94 percent — or so the evidence has shown. Now, with the new mutations that are freely developed by the viruses with each reproduction in new victims, the scientists are not sure. Vaccinations are racing against viral reproduction.

There can be many minute mutations of the viruses’ genetic sequences. More worrisome is recombination. That means the coronavirus mixes large chunks of its genome upon reproduction, and that is common and surely happening. Recombination might enable different tiny variants to combine and make the virus more potent inside a victim’s body.

The question is, will the vaccine hold these newly minted intruders off? Scientists are studying variants and recombination, but they don’t yet know. So far, so good.

A 42-year-old pastor from Long Island gets a special thank you from a New York Jets legend after battling COVID-19 at Stony Brook University Hospital (SBUH).

At the height of the pandemic, Doug Jansson organized prayer parades with his church, Living Word Church, at a few locations on Long Island, including Stony Brook University Hospital, where his mother-in-law was being treated for COVID-19 back in March. Doug, his wife Kelly and members of their church would drive around the hospital, signs and all, and stop to pray for staff and the patients they were treating. Their kindness didn’t stop there as they even organized grocery donations and drop-offs across Long Island.

Things came full circle on December 12, 2020 when Doug was admitted to SBUH after testing positive for COVID-19. Doug wound up in the ICU and on Christmas Eve he was intubated and placed on life support. The people he had been praying for were now caring for him.

Led by Dr. Paul Strachan and Dr. Allison McLarty, staff from nearly every division and department at SBUH helped care for Doug. Teams in pulmonary, CT surgery, ID, Medicine, Psychiatry/palliative care, GI, Hematology, Cardiology, Vascular and more helped on his road to recovery.

Doug was taken off ECMO on December 29 and extubated on January 5, 2021 before being discharged on February 3, 2021. He and his wife say the staff of every unit became like family and it seemed that the entire hospital was involved and routing for his recovery.

“The staff at Stony Brook were fighting for Doug and rooting him on. They were so encouraging to us. I am speechless over the care we’ve received,” said Kelly Jansson.

Rob Nocito, a resident in Emergency Medicine at SBUH, was one of the physicians who assisted in taking Doug off the ventilator. Nocito noticed Jansson was a hardcore New York Jets fan from the team’s memorabilia hanging in his room. Nocito happens to be good friends with Erik Coleman, a former defender on the Jets. He gave Coleman a call and he quickly agreed to talk to Jansson.

“My job is to make people feel better, and that doesn’t always mean medicine,” said Nocito.

Jansson was speechless as he met the NFL star via FaceTime. Coleman wished Jansson well and thanked him for everything he has done. See the moment here.

His wife Kelly couldn’t believe somebody would be so kind and do this for him. “We are so grateful to the staff at Stony Brook. They go above and beyond every single day,” she said.

As Doug was discharged, staff lined the hallways to wish him well.

Doug now looks forward to returning home to his wife and three children as well as getting back to the work he loves with his church.

Photos courtesy of SBUH

As we continue to deal with the COVID-19 crisis, the need for blood donations has hit a crisis level due to the lack of donors.  To help assist the New York Blood Center (NYBC) increase their blood supply, Senator Mario R. Mattera (2nd Senate District) is sponsoring a blood drive on Sunday, February 14, at the Smith Haven Mall in Lake Grove.  This donation drive will take place from noon to 6 p.m. in the mall’s Center Court.

With nearly 2,000 donations needed every day in New York and New Jersey alone, the current shortage has the potential to have a real effect on those who need blood transfusions.  Every single donation can save up to three lives.

Those most in need of blood include cancer patients, accident, burn, or trauma victims, newborn babies as well as mothers delivering babies, transplant recipients, surgery patients, chronically transfused patients suffering from sickle cell disease or thalassemia, and many more.

Potential donors are required to meet certain criteria including:
• Bring NYBC Blood Donor Card or ID with signature or photo.
• Minimum weight 110 lbs. or more.
• Eligible ages are 16 to 75.  Anyone donating who is 16 years old must have parental permission and anyone who is age 76 and over is required to supply a doctor’s note.
• No tattoos for past 3 months

All donors will receive a New York Blood Center t-shirt and a coupon for Auntie Annie’s pretzels.  Additionally, the NYBC will be doing free COVID anti-body testing for anyone who participates in the blood drive with results being provided via mail.

The entire donation process takes less than an hour and appointments are recommended to ensure minimal waiting time.  To schedule an appointment or for more information, residents should visit Senator Mattera’s website at mattera.nysenate.gov and click on the link on the home page or call the NYBC at 800-933-2566.

Donors with O-negative blood type, or “universal donors,” are especially encouraged to donate, as their blood is essential in emergency situations.  Any potential donor with questions concerning medical eligibility is asked to call 1-800-688-0900.  It is recommended that those donating eat well and drink plenty of fluids prior to their appointment.

“The ongoing crisis is causing a very real and extremely serious shortage of blood supply and it is my hope that all residents who are eligible to donate will join us on Valentine’s Day to show some heart for their fellow Long Islanders.  Each donation has potential to save three lives and all donors will be a Valentine’s Day hero to everyone in our community in need of life saving assistance,” stated Senator Mattera.

Residents are urged to visit Senator Mattera’s website at mattera.nysenate.gov for more information and to make an appointment.