Port Jefferson middle and high schools will be closing Nov. 12 after a middle school student tested positive for COVID-19. Photo by Elana Glowatz
*Update* The Port Jefferson School District announced it was reopening the middle and high schools for Friday, Nov. 13 for in-person learning.
“Since the positive case had not been in school since last week, we were fortunate that students and staff were not exposed and did not have to quarantine,” the district said in a message on its website. “As the holidays approach, please remain vigilant with social distancing, proper hand hygiene and masks. These mitigation strategies will keep our schools open for our students.”
The Port Jefferson School District is closing its middle and high schools for Thursday, Nov. 12 and going full remote for both buildings after officials announced a middle school student tested positive for COVID-19.
The district said in a notice to parents Wednesday that since the Suffolk County Department of health is closed due to Veterans Day, and the district is unable to yet talk to officials about starting contact tracing.
All staff and students will be doing remote work, and only a few clerical, custodial and administrators will be reporting into the buildings.
“Although the student has not been in school this week, we would like official information regarding exposures from the Department of Health,” the district said in its message.
This post will be updated when more information becomes available.
Decorations on a house in Rocky Point reminding people to wear masks. Photo by Kyle Barr
The percentage of positive tests for the coronavirus that causes COVID-19 has increased in the last week, particularly among younger residents.
Positive tests over the last seven days increased to 2.17%, which is up from 1.41% in the prior week, according to County Executive Steve Bellone (D).
“COVID cases are surging in Suffolk County,” Bellone said on a conference call with reporters Nov. 10. “We are seeing what other places in other communities have been experiencing for some time now.”
Indeed, the increase in cases is likely occurring even at gatherings that are following the state-mandated limit of 50 people at any gathering.
On Monday, the positivity rate was 3.8%, which is the first time since May 25 that the rate was above 3%.
Given when these positive tests occurred, Bellone said they are “exactly when we would expect to see cases spiking” from Halloween gatherings.
The majority of the positive tests are among people who are under 65, said Dr. Gregson Pigott, Commissioner of the Suffolk County Department of Health Services, with 27% of the cases among people 25 to 40 and 31% for people who are 41 to 65.
“If we continue to see this surge in positive cases throughout Suffolk County, how long before it gets into that more vulnerable population?” Bellone said.
Bellone urged families to take precautions at gatherings during Thanksgiving by limiting the number of people coming together for the holiday, opening windows when possible, and, if necessary in smaller spaces, wearing masks.
“The current spike we are seeing is clearly related to gatherings,” Bellone said. These gatherings do not violate limits, which is a warning sign. “We have to take precautions to prevent these surges.”
Gov. Andrew Cuomo (D) also expressed alarm in a press conference Monday about the spike in COVID cases nationwide, saying we’re likely to have “a long two months.”
Bellone said the county is planning to increase its contact tracers over the next week in response to the increase in positive tests. The county currently has 50 contact tracers and plans to double that to 100 over the next few days, at which point it will double that again.
The number of hospitalizations which, like the testing percentage is not close to where it was during the worst of the pandemic, current stands at 60, which is also a rise from recent weeks, when the number of people hospitalized with the virus hovered between the 20s and 40s.
In recent months, hospitals haven’t seen the “real, real sick COVID patients they were seeing in March,” Pigott said. Residents are typically coming in for a day or two and then are continuing their recovery at home.
In addition to the public health threat an increase in cases poses for a county that had been the epicenter for the pandemic in the U.S. in the spring, the rise in positive tests presents a potential threat to the fragile economy, which is still recovering after an extended lockdown and slow, phased reopening.
“If these trends continue, that could result in certain rollbacks of the economic recovery,” Bellone said.
Bellone urged people in the county to pay close attention to their own symptoms. He recommended that residents stay home when they are not feeling well and get tested.
Testing has become much more widely available in Suffolk County and throughout the state. Information on the location of testing sites is available at suffolkcountyny.gov/Covid19. A list of testing sites is located half way down the screen, in a blue box on the left hand side.
“If you don’t have insurance, the test is free throughout the county,” Bellone said. “Get tested. That will help us get a handle on the surge that is happening right now. Those numbers are concerning, they are disturbing.”
The county needs to keep the numbers under control to keep the virus from threatening the economic recovery, he added.
Out of every 100 American men, about 13 will get prostate cancer during their lifetime. METRO photo
What you consume may have a dramatic effect on your risk
By David Dunaief, M.D.
Dr. David Dunaief
Happy “Movember!” The Movember Foundation is in its 17th year of raising awareness and research money for men’s health issues (1). What better time to discuss prostate cancer prevention?
The best way to avoid prostate cancer is through lifestyle modifications. There are a host of things that may increase your risk and others that may decrease your likelihood of prostate cancer, regardless of family history.
What may increase the risk of prostate cancer? Contributing factors include obesity, animal fat and supplements, such as vitamin E and selenium. Equally as important, factors that may reduce risk include vegetables, especially cruciferous, and tomato sauce or cooked tomatoes.
Vitamin E and selenium
In the SELECT trial, a randomized clinical trial (RCT), a dose of 400 mg of vitamin E actually increased the risk of prostate cancer by 17 percent (2). Though significant, this is not a tremendous clinical effect. It does show that vitamin E should not be used for prevention of prostate cancer. Interestingly, in this study, selenium may have helped to reduce the mortality risk in the selenium plus vitamin E arm, but selenium trended toward a slight increased risk when taken alone. I would not recommend that men take selenium or vitamin E for prevention.
Obesity and aggressive disease risk
Obesity showed conflicting results, prompting the study authors to analyze the results further. According to a review of the literature, obesity may slightly decrease the risk of nonaggressive prostate cancer, however increase risk of aggressive disease (3). The authors attribute the lower incidence of nonaggressive prostate cancer to the possibility that it is more difficult to detect the dis-ease in obese men, since larger prostates make biopsies less effective. What the results tell us is that those who are obese have a greater risk of dying from prostate cancer when it is diagnosed.
Animal fat and meat intake
It seems there is a direct effect between the amount of animal fat we consume and incidence of prostate cancer. In the Health Professionals Follow-up Study, a large observational study, those who consumed the highest amount of animal fat had a 63 percent increased risk, compared to those who consumed the least (4).
Here is the kicker: It was not just the percent increase that was important, but the fact that it was an increase in advanced or metastatic prostate cancer. Also, in this study, red meat had an even greater, approximately 2.5-fold, increased risk of advanced disease. If you are going to eat red meat, I recommend decreased frequency, like lean meat once every two weeks or once a month.
In another large, prospective observational study, the authors concluded that red and processed meats increase the risk of advanced prostate cancer through heme iron, barbecuing/grilling and nitrate/nitrite content (5).
Unexpected Omega-3 findings
When we think of omega-3 fatty acids or fish oil, we often think “protective” or “beneficial.” However, these may increase the risk of prostate cancer, according to one epidemiological study (6). This study, called the Prostate Cancer Prevention Trial, involving a seven-year follow-up period, showed that docosahexaenoic acid (DHA), a form of omega-3 fatty acid, increased the risk of high-grade disease 2.5-fold. This finding was unexpected.
If you choose to eat fish, salmon or sardines in water with no salt are among the best choices.
Lycopene from tomato sauce
Tomato sauce has been shown to potentially reduce the risk of prostate cancer. However, uncooked tomatoes have not shown the same beneficial effects. It is believed that lycopene, which is a type of carotenoid found in tomatoes, is central to this benefit. Tomatoes need to be cooked to release lycopene (7).
In a prospective study involving 47,365 men who were followed for 12 years, the risk of prostate cancer was reduced by 16 percent with higher lycopene intake from a variety of sources (8). When the authors looked at tomato sauce alone, they saw a reduction in risk of 23 percent when comparing those who consumed at least two servings a week to those who consumed less than one serving a month. The reduction in severe, or metastatic, prostate cancer risk was even greater, at 35 per-cent. There was a statistically significant reduction in risk with a very modest amount of tomato sauce.
In the Health Professionals Follow-Up Study, the results were similar, with a 21 percent reduction in the risk of prostate cancer (9). Again, tomato sauce was the predominant food responsible for this effect.
Although tomato sauce may be beneficial, many brands are loaded with salt. I recommend to patients that they either make their own sauce or purchase a sauce made without salt.
Cruciferous vegetables
Vegetables, especially cruciferous vegetables, reduce the risk of prostate cancer significantly. In a case-control study, participants who consumed at least three servings of cruciferous vegetables per week, versus those who consumed less than one per week, saw a 41 percent reduction in prostate cancer risk (10). What’s even more impressive is the effect was twice that of tomato sauce, yet the intake was similarly modest. Cruciferous vegetables include broccoli, cauliflower, bok choy, kale and arugula, to name a few.
When it comes to preventing prostate cancer, lifestyle modification, including making dietary changes, can reduce your risk significantly.
References:
(1) www.movember.com. (2) JAMA. 2011; 306: 1549-1556. (3) Epidemiol Rev. 2007;29:88. (4) J Natl Cancer Inst. 1993;85(19):1571. (5) Am J Epidemiol. 2009;170(9):1165. (6) Am J Epidemiol. 2011 Jun 15;173(12):1429-1439. (7) Exp Biol Med (Maywood). 2002; 227:914-919. (8) J Natl Cancer Inst. 2002;94(5):391. (9) Exp Biol Med (Maywood). 2002; 227:852-859; Int. J. Cancer. 2007;121: 1571–1578. (10) J Natl Cancer Inst. 2000;92(1):61.
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.
The Miller Place School District closed its middle and high schools mid-morning on Monday due to two positive COVID-19 tests from students, officials said.
Miller Place dismissed classes for the high school at 10:45 a.m. and 11:30 a.m. for the middle school Monday, Nov. 1. Superintendent Marianne Cartisano said in a letter posted to the district website that a student at the North County Road Middle School and a student at Miller Place High School both tested positive for COVID-19 Sunday. The students were described as family members and were both a part of Cohort 2. The two students were in school Friday, Oct. 30.
In addition, officials said the COVID-positive students were with friends from Cohorts 1 and 2 this past weekend.
Officials said they were in contact with the Suffolk County Department of Health for contact tracing, and the district warned that some students may have to quarantine in the future. The students who tested positive will not be permitted to return to school until they are released by SCDOH.
“The health and safety of our students and staff remains a priority of our district,” Cartisano said in the letter.
The district maintained that the high and middle school are open for polling Tuesday, Nov. 3. No staff is having to quarantine, according to the SCDOH. Secondary level buildings were closed Nov. 3 as it was scheduled as a Superintendents Conference Day and only required staff to report.
Miller Place High School and North Country Road Middle School will have their typical virtual instruction day on Wednesday, Nov. 4, and will be open for Cohort 2 in-person instruction Thursday, Nov. 5.
Shoreham-Wading River High School is located at 250A Route 25A in Shoreham. File photo by Kevin Redding
*Update* The Shoreham-Wading River school district announced it was closing the high school through Nov. 11, and planned to reopen Thursday Nov. 12.
Shoreham-Wading River school district officials have quarantined 110 students plus eight staff members after two students were tested positive for COVID-19. Officials said those positive tests came after a recent get-together among students.
SWR Superintendent Gerard Poole released a letter to parents Thursday, Oct. 29 informing them that the three students “all attended a weekend social gathering of students.” The district was notified about the positive tests Wednesday night.
Officials closed the high school, and later that day announced the building would also be closed Friday, Oct. 30. The school will continue learning using online distance learning, and students are required to log into their teacher’s Google Classroom at the start of each period to join the class and click on the Google Meet code. The schedule can be found in the Distance Learning plan which is posted in the Re-Opening section of the District webpage.
“What students do over the weekend and after school matters,” Poole wrote in his letter to parents. “As we have found out, it impacts our ability to remain open daily for all students.”
The district worked with the Suffolk County Department of Health to conduct contact tracing. Any student that has tested positive is currently under quarantine as well as their family members, which would include school age children as well.
With the additions of the 118 quarantined, the district said there are now a full 125 students and staff members asked to isolate themselves. The New York State School Report Card, which tracks the number of positive cases in districts, reads there have been a total of five positive tests in the district since it opened in September.
Students who tested positive are not allowed to return to school until the DOH gives the go-ahead, Pooles letter stated.
“With the Halloween weekend approaching, children may need an additional reminder about the importance of implementing COVID-19 health precautions at all times and the importance of avoiding large social gatherings,” the superintendent said in his letter. “In order for our schools to remain open and for the health of all students, it is my hope that any large social gatherings that may have been planned for the upcoming weekend are canceled.”
Chronic stress can cause wear and tear on your mind and body. METRO photo
Cortisol resistance can increase susceptibility to viruses and infection
By David Dunaief, M.D.
Dr. David Dunaief
This has been a tough year, where many of us have been under continual stress. While some stress is valuable to help motivate us and keep our minds sharp, high levels of constant stress can have detrimental effects on the body.
Nowhere is the mind-body connection clearer: although stress may start in the mind, it can lead to acute or chronic disease promotion. It can also play a role with your emotions, causing irritability and outbursts of anger and possibly leading to depression and anxiety.
Stress symptoms can include stiff neck, headaches, stomach upset and difficulty sleeping. Stress may also be associated with cardiovascular disease, with an increased susceptibility to infection from viruses causing the common cold, and with cognitive decline and Alzheimer’s (1).
A stress steroid hormone, cortisol, is released from the adrenal glands and can have beneficial effects in small bursts. We need cortisol in order to survive. Some of its functions include raising glucose (sugar) levels when they are low and helping reduce inflammation and stress levels (2). However, when cortisol gets out of hand, higher chronic levels may cause inflammation, leading to disorders such as cardiovascular disease, as research suggests.
Let’s look at the evidence.
Inflammation
Inflammation may be a significant contributor to more than 80 percent of chronic diseases. In a meta-analysis (a group of two observational studies), high levels of C-reactive protein (CRP), a biomarker for inflammation, were associated with increased psychological stress (3).
A study of over 73,000 adults found that with CRP higher than 3.0 there was a greater than twofold increase in depression risk. The researchers suggest that CRP may heighten stress and depression risk by increasing levels of inflammatory communicators among cells (4).
In one study, results suggested that stress may influence and increase the number of hematopoietic stem cells (those that develop all forms of blood cells), resulting specifically in an increase in inflammatory white blood cells (5). The researchers suggest that this may lead to these white blood cells accumulating in atherosclerotic plaques in the arteries, which ultimately could potentially increase the risk of heart attacks and strokes. Chronic stress overactivates the sympathetic nervous system — our “fight or flight” response — which may alter the bone marrow where the stem cells are found. This research is preliminary and needs well-controlled trials to confirm these results.
Infection
Stress may increase the risk of colds and infection. Over the short term, cortisol is important to help suppress the symptoms of colds, such as sneezing, cough and fever. These are visible signs of the immune system’s infection-fighting response. However, the body may become resistant to the effects of cortisol, similar to how a type 2 diabetes patient becomes resistant to insulin.
In one study of 296 healthy individuals, participants who had stressful events and were then exposed to viruses had a higher probability of catching a cold. It turns out that these individuals also had resistance to the effects of cortisol. This is important because those who were resistant to cortisol had more cold symptoms and more proinflammatory cytokines (6).
Lifestyle changes can reduceeffects of stress
Lifestyle plays an important role in stress at the cellular level, specifically at the level of the telomere, which determines cell survival. The telomeres are to cells as the plastic tips are to shoelaces; they prevent them from falling apart. The longer the telomere, the slower the cell ages and the longer it survives.
In a one-year study of women aged 50 to 65, those who followed a healthy lifestyle — one standard deviation over the average lifestyle — were able to withstand life stressors better since they had longer telomeres (7). This healthy lifestyle included regular exercise, a healthy diet and a sufficient amount of sleep. On the other hand, the researchers indicated that those who had poor lifestyle habits lost substantially more telomere length than the healthy lifestyle group.
In another study, chronic stress and poor diet (high sugar and high fat) together increased metabolic risks, such as insulin resistance, oxidative stress and central obesity, more than a low-stress group eating a similar diet (8). The high-stress group members were caregivers, specifically those caring for a spouse or parent with dementia. This is a good reminder that it’s especially important to eat a healthy diet when under stress.
Interestingly, in terms of sleep, the Evolution of Pathways to Insomnia Cohort (EPIC) study shows that those who deal directly with stressful events are more likely to have good sleep quality. Using medication, alcohol or, most surprisingly, distractors, such as television watching or other activities, to deal with stress all resulted in insomnia after being followed for one year (9). Cognitive intrusions or repeat thoughts about the stressor also resulted in insomnia.
The most important message from this study is that how a person reacts to and deals with stressors may determine whether they suffer from insomnia.
We need to recognize the effects of constant stress. If it’s not addressed, it can lead to suppressed immune response or increased levels of inflammation. To address chronic stress and lower CRP, it is important to adopt a healthy lifestyle that includes sleep, exercise and diet modifications. Good lifestyle habits may also be protective against the effects of stress on cell aging.
References:
(1) Curr Top Behav Neurosci. 2014 Aug. 29. (2) Am J Physiol. 1991;260(6 Part 1):E927-E932. (3) JAMA Psychiatry. 2013;70:176-184. (4) Chest. 2000;118:503-508. (5) Nat Med. 2014;20:754-758. (6) Proc Natl Acad Sci U S A. 2012;109:5995-5999. (7) Mol Psychiatry Online. 2014 July 29. (8) Psychoneuroendocrinol Online. 2014 April 12. (9) Sleep. 2014;37:1199-1208.
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.
Orange juice is fortified with vitamin D. METRO photo
Daylight saving time ends on Nov. 1, making the days shorter and providing fewer hours to access vitamin D from natural sunlight. That’s why Northwell Health-GoHealth Urgent Care is encouraging New Yorkers to ask their doctors to check their vitamin D levels.
This year, with COVID-19 still present in the region, it’s especially important to make sure everyone gets enough vitamin D, as research continues to emerge showing that those with low vitamin D levels may be more susceptible to catching the coronavirus.
“Half of Americans are deficient in vitamin D, with much higher rates seen in African Americans, Hispanics, and individuals living in areas where it is difficult to get enough sun exposure in winter,” said Dr. Neal Shipley, the Medical Director for Northwell Health-GoHealth Urgent Care.
“People who are deficient in vitamin D may be at higher risk of contracting COVID-19 than those with sufficient levels, according to the results of a new retrospective study,” he said.
That study, “Association of Vitamin D Status and Other Clinical Characteristics With COVID-19 Test Results,” was published in early September in JAMA Network Open.
“Individuals with untreated vitamin D deficiency were nearly twice as likely to test positive for COVID-19 relative to their peers with adequate vitamin D levels,” Dr. Shipley added. “These findings appear to support a role of vitamin D status in COVID-19 risk.”
There are a host of benefits to gain by having adequate vitamin D levels.
“Vitamin D is important to the function of the immune system and vitamin D supplements have previously been shown to lower the risk of viral respiratory tract infections,” Dr. Shipley said. “This study suggests this may be true for the COVID-19 infection.”
People can find out if they are deficient through a simple blood test by their physician, who may recommend a vitamin D supplement if levels are low. But people should not take a supplement without first speaking with their doctor, warned Christine Santori, Program Manager Center for Weight Management for Northwell Health System at Syosset Hospital.
“There’s no benefit for supplemental vitamin D if a deficiency isn’t there,” she said. “If you’re taking too much and you don’t need it, there could be concerns of toxicity levels.”
Still, those who are deficient in vitamin D may not realize it, including people who spend the majority of their days outside, Ms. Santori said. With no one-size-fits-all, a physician will prescribe the dosage needed.
There are a myriad of ways to absorb vitamin D, besides sunshine. Fatty fish – including salmon, tuna, trout and cod – eggs, yogurt, other dairy and mushrooms are also sources, as are fortified products such as soy and almond milk, juice and cereals.
But sunlight, a primary vitamin D source, offers other benefits, including helping to regulate mood disorders, enhance bone strength and boost immunity. And new findings continue to emerge, helping medical experts gain a better understanding of vitamin D and its impact on COVID-19.
“Since Vitamin D is inexpensive, safe, widely available, and easy to take, it’s evident that we need to do randomized clinical trials to see whether interventions among groups at increased risk of vitamin D deficiency and COVID-19 could reduce COVID-19 cases,” said Dr. Shipley.
The challenge this Halloween will be adhering to guidelines while trick or treating. Stock photo
By Rob Calarco
In 1918, as the United States dealt with the Spanish Flu pandemic, cities across the country called on their residents to have a different kind of Halloween. At that time, the holiday was more of an opportunity for adults to have costume parties and for boys and young men to pull pranks and commit vandalism. During the pandemic, cities banned or discouraged these traditions and called on residents to be respectful of those who might be sick or have lost a loved one. Overall people observed these restrictions knowing that what they were doing was for the benefit of the community. The Buffalo Express reported on that year’s Halloween, saying “Hallowe’en revels lack the spirit of previous affairs.”
Rob Calarco
This year we are again asking Americans to be safe as they celebrate Halloween. COVID-19 is still with us, and while our infection rates do remain low, there is still a risk to us all. That does not mean we cannot celebrate all things spooky this year. We can still find creative ways to enjoy the day and take precautions to minimize potential spread of the virus.
The U.S. Centers for Disease Control and Prevention has characterized traditional trick-or-treating, where treats are handed to children who go door to door, as a high-risk activity. To avoid this risk consider participating in one-way trick-or-treating. This is when individually wrapped goodie bags are lined up for families to grab and go while continuing to social distance. Try to avoid placing large bowls of treats where children have to grab out of the same container. These treats can be placed at the end of a driveway or at the edge of a yard. You can communicate whether you are participating in the festivities by placing a sign on your yard. Also if you are wearing a costume mask, remember that it is not a replacement for a cloth mask. Instead consider incorporating a cloth mask into your costume this year.
If you are looking for a safe outdoor adventure, consider heading over to Southaven County Park in Yaphank, which has been taken over by Gateway’s Haunted Playhouse in partnership with Suffolk County. The Gateway has created a drive-through haunted trail experience called “The Forgotten Road,” which includes sounds and sights outside the car as well as a narrative that can be listened to over your car’s sound system. Additionally the Patchogue-Medford Library is offering a Halloween Story Walk. This is a self-guided quest for the entire family. You can pick up your map at the Children’s Department Information Desk during library hours or print your map and story questions from home at any time to navigate your way through Patchogue Village by following a story. Those who complete the quest will receive a Halloween surprise at the end.
With a different kind of Halloween celebration this year, it is going to take us all working together to keep each other safe. There are plenty of precautions to make sure that we all have fun while not contributing to the spread of COVID-19. By following these easy guidelines and doing more socially distanced activities, we can all do our part and stay safe.
Rob Calarco (D) is the presiding officer of the Suffolk County Legislature.
Veggies such as broccoli , cauliflower, cabbage and brussel sprouts provide easily absorbable nutrients needed to support the pancreas. METRO photo
Lifestyle changes can reduce your risk
By David Dunaief, M.D.
Dr. David Dunaief
Acute pancreatitis is the most frequent gastrointestinal cause for patients to be admitted to a hospital (1). Typically, severe abdominal pain is what compels patients to go to the emergency room.
A rudimentary definition of pancreatitis is an inflammation of the pancreas. There are both acute and chronic forms. Acute pancreatitis, which is what we will address, is abrupt and of short duration. Acute types are characterized as mild, moderately severe and severe. Those with the mild type don’t experience organ failure or local complications, while those with moderately severe acute pancreatitis experience short-term or transient (less than 48 hours) organ failure and/or local complications. Those with the severe type have persistent organ failure (2).
Symptoms of acute pancreatitis
To diagnosis this disease, the American College of Gastroenterology guidelines suggest that two of three symptoms be present. The three symptoms include severe abdominal pain; enzymes (amylase or lipase) that are at least three times greater than normal; and radiologic imaging that shows characteristic disease findings (3). Most of the time, the abdominal pain is in the central upper abdomen near the stomach, and it may also present with pain in the right upper quadrant of the abdomen (4). Approximately 90 percent of patients also experience nausea and vomiting (5). In half of patients, there is also pain that radiates to the back.
Risk factors
Acute pancreatitis risk factors include gallstones, alcohol, obesity and, to a much lesser degree, drugs. Gallstones and alcohol may cause up to 75 percent of the cases (2). Many other cases of acute pancreatitis are considered idiopathic (of unknown cause). Although medications are potentially responsible for between 1.4 and 5.3 percent of cases, making it rare, the number of medications implicated is diverse (6, 7). These include certain classes of diabetes therapies, some antibiotics — metronidazole (Flagyl) and tetracycline — and immunosuppressive drugs used to treat ailments like autoimmune diseases. Even calcium may potentially increase risk.
Obesity’s role
In a study using the Swedish Mammography Cohort and the Cohort of Swedish Men, results showed that central obesity is an important risk factor, not body mass index or obesity overall (8). In other words, it is the fat in the belly that is very important, since this may increase risk more than twofold for the occurrence of a first-time acute pancreatitis episode. Those who had a waist circumference of greater than 105 cm (41 inches) experienced this significantly increased risk compared to those who had a waist circumference of 75 to 85 cm (29.5 to 33.5 inches). The association between central obesity and acute pancreatitis occurred in both gallbladder-induced and non-gallbladder-induced disease.
A more recent meta-analysis of 19 studies including almost 10,000 patients showed a direct association between BMI and acute pancreatitis severity and mortality (9). Those with a BMI over 25 had an almost three-fold increased risk of severe acute pancreatitis, when compared with those who had a normal BMI, and a BMI over 30 was associated with a three-times greater risk of mortality than those with a BMI under this threshold.
Diabetes risks
The pancreas is a critical organ for balancing glucose (sugar) in the body. In a meta-analysis (24 observational trials), results showed that more than one-third of patients diagnosed with acute pancreatitis went on to develop prediabetes or diabetes (10). Within the first year, 15 percent of patients were newly diagnosed with diabetes. After five years, the risk of diabetes increased 2.7-fold. By reducing the risk of pancreatitis, we may also help reduce the risk of diabetes.
Surgical treatments
Gallstones and gallbladder sludge are major risk factors, accounting for 35 to 40 percent of acute pancreatitis incidences (11). Gallstones are thought to cause pancreatitis by temporarily blocking the duct shared by the pancreas and gallbladder that leads into the small intestine. When the liver enzyme ALT is elevated threefold (measured through a simple blood test), it has a positive predictive value of 95 percent that it is indeed gallstone-induced pancreatitis (12).
If it is gallstone-induced, surgery plays an important role in helping to resolve pancreatitis and prevent recurrence. In a retrospective study with 102 patients, results showed that surgery to remove the gallbladder was better than medical treatment when comparing hospitalized patients with this disease (13). Surgery trumped medical treatment in terms of outcomes, complication rates, length of stay in the hospital and overall cost for patients with mild acute pancreatitis.
Can diet have an impact?
The short answer is: Yes. What foods specifically? In a large, prospective observational study, results showed that there was a direct linear relationship between those who consumed vegetables and a decreased risk of non-gallstone acute pancreatitis (14). For every two servings of vegetables, there was 17 percent drop in the risk of pancreatitis. Those who consumed the most vegetables — the highest quintile (4.6 servings per day) — had a 44 percent reduction in disease risk, compared to those who were in the lowest quintile (0.8 servings per day). There were 80,000 participants involved in the study with an 11-year follow-up. The authors surmise that the reason for this effect with vegetables may have to do with their antioxidant properties, since acute pancreatitis increases oxidative stress on the pancreas.
References:
(1) Gastroenterology. 2013 Jun; 144(6): 1252–1261. (2) Gastroenterol. 2013 Sep; 108(9):1400-1415. (3) Am Fam Physician. 2014 Nov 1;90(9):632-639. (4) JAMA. 2004;291:2865-2868. (5) Am J Gastroenterol. 2006;101:2379-2400. (6) Gut. 1995;37:565-567. (7) Dig Dis Sci. 2010;55:2977-2981. (8) Am J Gastroenterol. 2013;108:133-139. (9) World J Gastroenterol. 2019 Feb 14; 25(6): 729–743. (10) Gut. 2014;63:818-831. (11) Gastroenterology. 2007;132:2022-2044. (12) Am J Gastroenterol. 1994;89:1863-1866. (13) Am J Surg online. 2014 Sept. 20. (14) Gut. 2013;62:1187-1192.
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. Anthony Fauci, Director of the National Institute of Allergy and Infectious Diseases, raised a red flag about the safety of annual family gatherings during Thanksgiving last week on an interview on CBS.
People may have to “bite the bullet and sacrifice that social gathering unless you’re pretty certain that the people that you’re dealing with are not infected,” Fauci told CBS.
Richard Gatteau, SBU Dean of Students. Photo from SBU Website
Doctors at area hospitals and officials at Stony Brook University are offering guidance to residents and students over a month before an annual holiday that often brings people from several generations, cities and states together.
Before they send some of the 4,200 on campus students at SBU home, the university plans to test them for the presence of the virus that causes COVID-19.
The week of Nov. 16, “every resident will be tested,” said Dean of Students Richard Gatteau. “Any positive cases would remain on campus” until the university knew they were negative.
Students remaining on campus would receive meals and would get the same level of care through the holidays that students would normally get if they tested positive during the semester.
Stony Brook expects the student population to decline after Thanksgiving, when all classes and final exams will be remote through the end of the semester.
For the students who plan to return to campus, Stony Brook realizes the logistical challenges of requiring viral tests during the short holiday and will provide tests in the first two days after these students return to their dormitories.
Even before the holiday, Stony Brook expects to increase the frequency of viral testing from bi-weekly to weekly.
Gatteau said the student government plans to educate students who plan to join family during the holiday about procedures to keep everyone safe. This guidance mirrors school policies, such as wearing masks inside when near other family members, keeping a distance of six feet inside and washing hands regularly.
The dean of students recently spoke with Dr. Deborah Birx, head of the White House’s coronavirus task force who visited Stony Brook to speak with officials about the school’s COVID response. Though Birx was pleased with the measures the university took, she was reportedly more worried about the behavior of extended family than with students during Thanksgiving.
“Her concern is with the older generation not following the rules,” Gatteau said. She wanted students to encourage their grandparents to follow the same procedures because “grandparents will listen to their grandkids.”
Types of Tests
Dr. Michael Grosso, Chief Medical Officer at Huntington Hospital, urged everyone to plan to get tested before coming together for Thanksgiving.
Dr. Grosso said two types of tests are available for students and parents. The first is an antigen test and the second is a PCR, for polymerase chain reaction, test. Grosso suggests that the PCR test is more reliable as the antigen test “misses more cases.”
The test technique is critical to its success. Some false negatives may result from inadequate specimen collection, Grosso said. The deep nasopharyngeal specimen “requires a little skill on the part of the person doing the test.”
Additionally, people getting tested before a family gathering need to consider the timing of the test. They may receive a negative test during a period of time in which the virus is developing in their bodies.
Active testing may have helped reduce the severity of the disease for people who contract it. People are coming to the hospital in some cases before the disease causes as much damage.
In addition to getting tested and monitoring possible symptoms, Grosso urged residents to continue to practice the new, healthier etiquette, even when they are with relatives during the holidays.
“Families need to have conversations” about how close they are prepared to get before they see each other, Grosso said. People need to “decide together what rules [they] are going to follow, and make sure everybody is comfortable with those.”
As for Thanksgiving in the Grosso home, the Chief Medical Officer said he and his wife have five children between them, two of whom will be coming for the annual November holiday. The others will participate, as has become the modern reality, at the other end of a zoom call. Typically, the entire family would come together.
Stony Brook’s Gatteau said he and his partner typically have 20 to 25 people over for Thanksgiving. This year, they are limited the guests to seven people. They plan to keep masks on in their house and will crack a window open so there is air flow.
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