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Health

A sign of the times outside Smithtown Town Hall. Photo courtesy of Smithtown Library

Even before some family gatherings provide a potential breeding ground for the coronavirus, Suffolk County residents have tested positive for COVID-19 at rates not seen since the worst of the first wave, in April.

In the last day, 501 people have tested positive for the coronavirus which is the highest number since April. That represents a 4 percent positive test rate, which is also the highest figure since May 18.

“It is unclear if we are plateauing or whether [these numbers] will continue to go up,” County Executive Steve Bellone (D) said on a conference call with reporters. He is concerned about “where we may go after the Thanksgiving holidays.”

Indeed, Dr. Shahida Iftikhar, Deputy Commissioner for the Department of Health, said the numbers were likely climbing as a result of smaller gatherings, which is what triggered an increase after the Halloween weekend.

Long Island surpassed 1,000 cases on Tuesday, according to officials. More communities on Long Island are close to being named so-called yellow zones by the state, which might mean more restrictions and the potential rolling back of the phased reopening seen earlier this year.

Gov. Andrew Cuomo (D) said during his Wednesday livestream the virus is being spread mainly by bars and restaurants that sell alcohol, gyms and small gatherings. New restrictions have been placed on all three earlier this month. Cuomo also said places like Monroe County, whose officials said cases were mainly due to small gatherings and not places like gyms, were outliers, and stressed people limit gatherings on Thanksgiving.

I give thanks for the intelligence of New Yorkers, but we have to stay safe, we have to keep the infection rate down through the thanksgiving holiday,” he said. ““Don’t be a turkey, wear a mask this Thanksgiving.”

Despite the move away from contact tracing in other regions with widespread community spread, Suffolk County continues to use contact tracers to call people who have received positive tests and to warn anyone they might have infected.

For those residents who have received a negative COVID test and plan to gather with family and friends, Dr. Gregson Pigott, Commissioner in the County Department of Health, cautioned that people can have a negative test and still transmit the virus after they are exposed.

There is a lot of “asymptomatic spread,” Pigott warned.

To limit the spread of the virus, Bellone urged people to follow state guidelines, limiting gatherings to 10 people, washing their hands, wearing face coverings where possible and keeping a distance of at least six feet, particularly from vulnerable members of the population.

In anticipation of gatherings, the Suffolk County Police Department has added patrols and will perform compliance checks with bars and restaurants to ensure that these businesses are adhering to the state requirements that they shut down indoor food and beverage service after 10 p.m.

The SCPD will not go from house to house counting cars, but they will respond to any reports of private residences that exceed the 10-person limit.

New York State has designated Riverhead and Hampton Bays as yellow zones. Bellone encouraged residents living within these zones to get tested. Residents can find testing sites at the web site suffolkcountyny.gov.

Cuomo said New York, among other states, has started adding field hospitals again, much like what was seen during the first wave of the pandemic. The first field hospital has been set up in Staten Island, though more be on the way.

Free testing sites, supported by New York State, are opening Monday at the Northwell Health Dolan Family Healthy Center in Huntington and on Tuesday at Sun River Health in Patchogue.

As the Board of Elections continues to count votes, Bellone said one of the people who worked for the elections tested positive. The county has tested 111 people who worked in the building, with eight people testing positive and 37 quarantined because of close contact.

On the positive side, Suffolk County’s testing in schools in Riverhead and Hampton Bays has demonstrated a low rate of infection. In Riverhead, 12 out of 524 people tested positive, while Hampton Bays had four positive tests out of 417 people tested.

“While we continue to monitor the rise in cases, we are not currently seeing community spread happening in our schools,” Bellone said. “As long as students and faculty are kept safe, schools should remain open.”

Additional reporting by Kyle Barr

METRO photo
Diet choices trump exercise for weight loss

By David Dunaief, M.D.

Dr. David Dunaief

To quash guilt about Thanksgiving meal indiscretions, many of us will resolve to exercise to burn off the calories from this seismic meal and the smaller, calorically dense aftershock meals, whether with a vigorous family football game or with a more modest walk.

Unfortunately, exercise without dietary changes may not actually help many people lose weight, no matter what the intensity or the duration (1). If it does help, it may only modestly reduce fat mass and weight for the majority of people. However, it may be helpful with weight maintenance. Ultimately, it may be more important to reconsider what you are eating than to succumb to the rationalization that you can eat with abandon during the holidays and work it off later.

Don’t give up on exercise just yet, though. There is very good news: Exercise does have beneficial effects on a wide range of conditions, including chronic kidney disease, cognitive decline, diabetes, cardiovascular disease, osteoporosis, fatigue, insomnia and depression.

Let’s look at the evidence.

Exercise for weight loss

The well-known weight-loss paradigm is that when more calories are burned than consumed, we will tip the scale in favor of weight loss. The greater the negative balance with exercise, the greater the loss. However, study results say otherwise. They show that in premenopausal women there was neither weight nor fat loss from exercise (2). This involved 81 women over a short duration, 12 weeks. All of the women were overweight to obese, although there was great variability in weight.

However, more than two-thirds of the women (55) gained a mean of 1 kilogram, or 2.2 pounds, of fat mass by the end of the study. There were a few who gained 10 pounds of predominantly fat. A fair amount of variability was seen among the participants, ranging from significant weight loss to substantial weight gain. These women were told to exercise at the American College of Sports Medicine’s optimal level of intensity (3). This is to walk 30 minutes on a treadmill three times a week at 70 percent VO2max — maximum oxygen consumption during exercise — or, in other words, a moderately intense pace.

The good news is that the women were in better aerobic shape by the end of the study. Also, women who had lost weight at the four-week mark were more likely to continue to do so by the end of the study. This was a preliminary study, so no definitive conclusions can be made.

Other studies have shown modest weight loss. For instance, in a meta-analysis involving 14 randomized controlled trials, results showed that there was a disappointing amount of weight loss with exercise alone (4). In six months, patients lost a mean of 1.6 kilograms, or 3.5 pounds, and at 12 months, participants lost 1.7 kilograms, or about 3.75 pounds.

Exercise and weight maintenance

However, exercise may be valuable in weight maintenance, according to observational studies. Premenopausal women who exercised at least 30 minutes a day were significantly less likely to regain lost weight (5). When exercise was added to diet, women were able to maintain 30 percent more weight loss than with diet alone after a year in a prospective study (6).

Exercise and disease

As just one example of exercise’s impact on disease, let’s look at chronic kidney disease (CKD), which affects 15 percent, or one in seven, adults in the United States, according to the Centers for Disease Control and Prevention (7).

Trial results showed that walking regularly could reduce the risk of kidney replacement therapy and death in patients who have moderate to severe CKD, stages 3-5 (8). Yes, this includes stage 3, which most likely is asymptomatic. There was a 21 percent reduction in the risk of kidney replacement therapy and a 33 percent reduction in the risk of death when walkers were compared to non-walkers.

Walking had an impressive impact; results were based on a dose-response curve. In other words, the more frequently patients walked during the week, the better the probability of preventing complications. Those who walked between one and two times per week had 17 and 19 percent reductions in death and kidney replacement therapy, respectively, while those who walked at least seven times per week saw 44 and 59 percent reductions in death and kidney replacement. These are substantial results. The authors concluded that the effectiveness of walking on CKD was independent of kidney function, age or other diseases.

Therefore, while it is important to enjoy the holidays, remember that food choices will have the greatest impact on our weight and body composition. However, exercise can help maintain weight loss and is extremely beneficial for preventing progression of chronic diseases, such as CKD.

So, by all means, exercise during the holidays, but also focus on more nutrient-dense foods. At a minimum, strike a balance rather than eating purely calorically dense foods. You won’t be able to exercise them away.

References:

(1) uptodate.com. (2) J Strength Cond Res. Online Oct. 28, 2014. (3) ACSM.org. (4) Am J Med. 2011;124(8):747. (5) Obesity (Silver Spring). 2010;18(1):167. (6) Int J Obes Relat Metab Disord. 1997;21(10):941. (7) cdc.gov. (8) Clin J Am Soc Nephrol. 2014 Jul;9(7):1183-1189.

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.

Suffolk County Executive Steve Bellone. File photo by Alex Petroski

On the night before Thanksgiving, high school and college students typically come together to reconnect, share stories and share a drink.

This year, as COVID-19 cases climb throughout the U.S., including in Suffolk County, County Executive Steve Bellone (D), along with the Suffolk County Police Department and local enforcement offices, are discouraging gatherings that might cause further spread of the virus.

Enforcement efforts will using social host laws, which fine residents for allowing underage drinking, and state-mandated gathering restrictions, which combined, could lead to “serious consequences,” Bellone said on a conference call with reporters Nov. 17.

“No matter where you are or what you are doing, social distancing and mask guidelines must be followed,” Bellone said. “We’ve come too far to go back now.”

With new state restrictions that limit the sale of alcohol after 10 p.m. through bars and restaurants, Bellone said enforcement efforts would be on the look out for gatherings at private residences. Some of these viral spreading events have occurred during smaller gatherings.

“The spread of COVID-19 at these types of parties is very, very real,” Bellone said. “We’ve seen it countless times. We all need to take personal responsibility,” which includes parents who need to comply with social host laws and the state’s gathering limits in homes.

Bellone announced a partnership between the Suffolk County Department of Health and the nonprofit Partners in Prevention, which is starting a social media campaign to inform the community about social host laws. Bellone called this information “critical” leading up to Thanksgiving celebrations.

While Suffolk County enforcement efforts will respond to calls about larger group gatherings, Bellone said police would use “common sense” and would not be “going door to door to check on the number of individuals in a house.”

As for the infection rates, the numbers continue to rise, returning to levels not seen in months.

“We expect our numbers [of positive tests] to be around 400 today,” Bellone said. The positivity rate is about 3.4 percent, while the number of people hospitalized with symptoms related to the virus approaching 100.

“We have not been above 100 since June 18,” Bellone said. In the last 24 hours, the number of people who have required hospitalization from the virus increased by 16.

While the virus has exhausted people physically and mentally, the county cannot “jeopardize our continued economic recovery” and the health of the population by stepping back from measures such as social distancing, mask wearing and hand washing that proved so effective in reducing the spread earlier this year, Bellone said.

“Now is the time to double down on common sense measures that work,” he added.

Some of the positive tests are coming from people in nursing homes, who are among the most vulnerable population.

“With the nursing homes, that is obviously a big concern,” Bellone said. The county is “making sure they have the PPE [personal protective equipment] they need.”

The Department of Health is staying in close contact with these facilities as cases continue to climb.

Bellone urged residents who dined at a Friendly’s restaurant in Riverhead on Nov. 5 or 6 to monitor their symptoms for the next two weeks. Six adults who worked at the restaurant have tested positive for the virus.

Anyone who is exhibiting symptoms of the virus, which include fever, a runny nose, lost of taste or smell, fatigue, shortness of breath, can find a testing site at suffolkcountyny.gov/covid19.

Separately, when asked about the possibility of schools closing in response to the increasing incidence of positive tests, Bellone urged schools to remain open at this testing level.

“We are not seeing the spread happening in the schools,” Bellone said. “The protocols being put in place and the execution in the schools has really worked.”

Suffolk County Executive Steve Bellone. Photo by Julianne Mosher

Just as many areas in the rest of the country are experiencing a rise in positive tests for the coroanvirus, Suffolk County has now completed a week in which the numbers have climbed quickly.

The seven-day moving average of new cases is over 300, compared with an average of 119 the prior week.

“For a full week, we’ve seen an alarming spike in new COVID-19 cases,” County Executive Steve Bellone (D) said on a conference call with reporters.

Gov. Andrew Cuomo (D) has issued new guidelines starting this evening for restaurants, bars and fitness centers. Starting at 10 pm, each of those businesses is required to close from 10 p.m. to 5 a.m. Restaurants are allowed to offer curbside dining for pick up only after 10 p.m., but they can’t serve alcohol after that time.

At the same time, gatherings are limited to 10 people, in part because smaller collections of people have contributed to the rise in positive tests.

Starting today, the county will also deploy six teams, consisting of one fire marshal and one staff member from consumer affairs to boost ongoing compliance.

These teams will speak with businesses about new restrictions. The first focus will be on gaining compliance and informing and educating the public. These new teams will have the authority to issue citations if they “detect or observe egregious violations,” Bellone said.

These new restrictions are the first in the county since the spring.

“We don’t want to see new restrictions take effect that will slow the recovery more,” Bellone said. “That will all be dependent on what we do in the next couple of weeks.”

The county has a “short window” in which to get these numbers under control, the county executive continued.

The county has activated 200 additional case investigators and has 1,000 contact traces following up on positive tests within the county.

The goal is to get index cases as quickly as possible within a 24-hour period, Bellone added, to reduce the spread of the virus.

Bellone urged people to avoid gatherings this weekend to the greatest extent possible.

“We are entering a dangerous period for this virus,” Bellone said. “We have long talked about the possibility of a second wave in the fall. It very much feels like that’s where we are.”

With two weeks left until Thanksgiving, Bellone reminded residents that the time to quarantine is limited.

People need to follow best practices, which includes social distancing, mask wearing and hand sanitizing, even as the weather gets colder and residents spend more time indoors.

“No one wants their Thanksgiving gathering to be the next super spreader event,” Bellone said.

Wading River resident Bill McGrath donates blood at the NYBC location in Terryville. Photo by Julianne Mosher

Local hospitals are in need of blood, and they are joining forces with New York Blood Center to get the word out that a donation could save a life. 

Dr. James Cassin, dental resident at St. Charles Hospital’s Dental Clinic, donating blood Nov. 10 at St. Charles Hospital’s Blood Drive. Photo from St. Charles

According to Andrea Cefarelli, senior executive director at New York Blood Center, because of the current pandemic, there is a huge shortage across the country with no sign of any more supplies incoming.

“This is a chronic deficit in blood donations so we’re trying to raise awareness,” she said. 

Cefarelli explained that before the pandemic, 75% of blood donations came from the community. 

“We came to you in your place of work, place of worship and schools,” she said. “It was super easy to donate blood.”

According to its Facebook page, NYBC provides lifesaving blood products and services to nearly 200 hospitals in New York, New Jersey, Long Island, the Hudson Valley, and parts of Connecticut and Pennsylvania. 

But because of COVID-19, people aren’t going out to donate, especially since blood drives at schools, colleges, offices and other community groups have been canceled. 

“Post-pandemic we’re running far fewer community blood drives and so it’s not quite as convenient,” Cefarelli said. “We have a deficit of 8,000 donations per month.”

According to NYBC, New York’s health care system requires 1,500 donations each day to treat patients ranging from trauma victims to newborns to cancer patients. The lack of blood donations is “particularly dangerous given the looming uncertainty surrounding the pandemic’s trajectory over the course of this winter,” she said.

Pre-pandemic, NYBC would host 550 community blood drives every month, but it is currently hosting just 280 blood drives per month.

To make up for lost blood, NYBC has teamed up with local and regional hospitals including Northwell Health and Catholic Health Services of Long Island to spread the word and ask people to donate. 

“The lack of blood donations has caused shortages of blood types to be available in our blood bank which provides lifesaving blood to all the patients we serve within the community,” said Jon Zenker, the administrative director of Huntington Hospital’s laboratory. “We urge all members of the community who are able to donate blood to help us overcome this critical shortage so that we can continue to serve our patients and provide them with the highest quality of care.”

Greg Slater, a spokesperson with Catholic Health Services, said they have taken extra safety precautions to make people feel comfortable during COVID times. 

“It takes a little bit of time to do, but it can be a lifesaving thing for someone else,” he said. 

Cefarelli said the lack of first-time donors is also down because of the lack of blood drives in school. She is encouraging young people to lend a helping hand. 

“If you bring a son or daughter who’s a first-time donor, who doesn’t have that school experience, we’re welcoming that,” she said. “Making it a fun and safe experience is super important to us.”

She’s also reminding people that blood drives are safe and can be hosted in a socially distanced fashion. 

“We have churches, businesses and even some schools realizing that we can host a blood drive that is safe and socially distant,” she said. “We want other organizations to consider hosting a drive.”

Right now, donors can make an appointment online at any NYBC blood collection center. Upon arrival, their temperatures are checked, and masks are required. 

Stony Brook University Hospital is also accepting blood donations at their own personal blood bank. According to Linda Pugliese, blood bank donor recruiter at the hospital, every day (except for Sunday) is a blood drive there. 

“All of the whole blood and platelets that are donated in the hospital blood bank, stay at the hospital, and help provide patients with the blood products they need,” she said. “Donating at the Stony Brook University Hospital Blood Bank is truly an example of community service.”

Since they are not affiliated with NYBC, SBUH’s blood supply is currently stable, but their demand has reached pre-COVID-19 levels. “There is a critical need to meet the challenges for blood donations created by the pandemic,” she said. 

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.

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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.

Stock photo

With the approaching emotions of the holidays, Suffolk County residents may face persistent and unwanted changes in their lives, from not seeing a cherished family member to remaining confined to the same house where they work, live, eat and study. Between now and the end of the year, TBR News Media will feature stories about the impact of the ongoing pandemic on mental health. The articles will explore how to recognize signs of mental health strain and will provide advice to help get through these difficult times. This week, the article focuses on youth.

In a normal year, when school is out, the number of referrals Dr. Sharon Skariah, Director of Child Adolescent Psychiatry at South Oaks Hospital in Amityville, declines during the summer.

Dr. Sharon Skariah says parents should recognize their own issues in order to help their children. Photo by Sharon Skariah

That’s not the case this year, as children continued to seek help for mental health challenges caused by the loss of a parent, the loss of financial or health security and the decline in social contact amid social distancing.

“We’ve been seeing significant anxiety and depression,” Skariah said. “Part of that is the prolonged time that [children] have been out of school.”

Skariah expects that the ongoing pandemic losses and restrictions will likely continue to cause those figures to increase.

Several mental health professionals shared their dos and don’ts for parents with grieving children.

Grieving Dos

For starters, Skariah suggests that parents should recognize their own anxiety and depression.

“If they find that they are themselves overwhelmed with the chaos of the pandemic, they should be aware that their own anxiety and mood can play a role in their children’s behavior,” she said.

Dr. Meghan Downey, clinical psychologist and Director of Northwell Health’s OnTrackNY, urged people to maintain a routine.

“Often, a holiday can exacerbate our stress levels,” Downey said. “Changes to our routine can increase stress. Continuing with the same sleep wake routine, normal eating and [finding time] for joy and relaxation provide a good foundation for managing grief.”

Based on prior group traumatic events, like the 9/11 terrorist attacks and the SARS virus, Skariah said the restoration of order happens over time and depends on personal and predisposing factors.

She urged families to be genuine and open and actively listen to what children say. Downey suggests children need to feel that they are allowed to mourn.

A support network can and should consider showing empathy, care and concern. Approaching people when they are calm, rather than in a distressed state, can provide some mental health relief.

People who are experiencing grief also can benefit from staying connected, even through holiday letters, phone calls, or a card, Downey said.

When Downey gives presentations to children and educators in school, she advises people working with young children to allow them to play death, to display their emotions through play.

Grieving Don’ts

Telling children platitudes like “time heals all wounds” may not be helpful for someone who is “acutely grieving,” Skariah said.

Downey added that telling children that a loved one is “sleeping” or that they should “stop crying, other people might get upset” provides mixed and confusing messages.

Telling children that “at least [the person who died is] not in pain anymore, they are in a better place” often doesn’t help and distracts people from feeling their emotional intensity, Downey said.

Downey cautioned youths, and their adult guardians, to manage over-indulgent behavior, such as with food or with excess spending.

While those indulgences provide temporary relief, they can also contribute to feelings of guilt, which can exacerbate grief, Downey cautioned.

Bradley Lewis, Administrative Manager for School Based Mental Health Services for South Oaks Hospital, said he has received numerous requests during the pandemic for support related to COVID-19.

Lewis said Downey’s presentations to some of the 11 school districts went beyond the thought of death, but include losses in other areas, like access to friends, senior awards dinners, and graduations.

“A lot of families appreciated the opportunity to learn more about grief and loss, to understand the different types of grief their children might be going through,” Lewis said.

With parents, Lewis urges parents to “end the stigma of mental health,” he said.

Not so fast! Soy milk may have a negative impact on the thyroid. METRO photo
Use extreme caution when taking supplements

By David Dunaief, M.D.

Dr. David Dunaief

Hypothyroidism can cause weight gain and low energy, but diagnosing and treating it can be tricky. The thyroid is a butterfly-shaped organ at the base of the neck, and it is responsible for maintaining our metabolism. The prefix “hypo,” derived from Greek, means “under” (1). Therefore, hypothyroidism indicates an underactive thyroid and results in slowing of the metabolism.

Blood tests determine if a person has hypothyroidism. Items that are tested include thyroid stimulating hormone (TSH), which is usually increased, thyroxine (free T4) and triiodothyronine (free T3 or T3 uptake). Both of these last two may be suppressed, or lowered (2).

There are two types of primary hypothyroidism: subclinical and overt. In the overt (more obvious) type, classic symptoms include weight gain, fatigue, thinning hair, cold intolerance, dry skin and depression, as well as the changes in all three thyroid hormones on blood tests mentioned above.

In the subclinical, there may be less obvious or vague symptoms and only changes in the TSH. The subclinical can progress to the overt stage rapidly in some cases (3). Subclinical is substantially more common than overt; its prevalence may be as high as 10 percent of the U.S. population (4).

The most common type of hypothyroidism is Hashimoto’s thyroiditis, where antibodies attack thyroid gland tissues (5). Several blood tests are useful to determine if a patient has Hashimoto’s: thyroid peroxidase (TPO) antibodies and antithyroglobulin antibodies.

Medications

Levothyroxine and Armour Thyroid are two main medications for hypothyroidism. The difference is that Armour Thyroid converts T4 into T3, while levothyroxine does not. Therefore, one medication may be more appropriate than the other, depending on the circumstance. T3 can also be given with levothyroxine, which is similar to using Armour Thyroid.

What about supplements?

A study tested 10 different thyroid support supplements; the results were downright disappointing, if not a bit scary (6). Of the supplements tested, 90 percent contained actual medication, some to levels higher than what are found in prescription medications. These supplements could cause toxic effects. There is a narrow therapeutic window when it comes to the appropriate medication dosage for treating hypothyroidism, and it is sensitive. Therefore, if you are going to consider using supplements, check with your doctor and tread very lightly.

Soy impact

In a randomized controlled trial, the treatment group that received higher amounts of soy supplementation had a threefold greater risk of conversion from subclinical hypothyroidism to overt hypothyroidism than those who received considerably less supplementation (7). According to this small, yet well-designed, study, soy has a negative impact on the thyroid. Therefore, those with hypothyroidism may want to minimize or avoid soy.

The reason that soy may have this negative impact was illustrated in a study involving rat thyrocytes (thyroid cells) (8). Researchers found that soy isoflavones, especially genistein, which are usually beneficial, may contribute to autoimmune thyroid disease, such as Hashimoto’s thyroiditis. They also found that soy may inhibit the absorption of iodide in the thyroid.

Weight loss

Wouldn’t it be nice if the silver lining of hypothyroidism is that, with medication to treat the disease, we were guaranteed to lose weight? In a retrospective study, results showed that only about half of those treated with medication for hypothyroidism lost weight (9). This was a small study, and we need a large randomized controlled trial to test it further.

WARNING: The FDA has a black box warning on thyroid medications — they should never be used as weight loss drugs (10). They could put a patient in a hyperthyroid state or worse, with potentially catastrophic results.

Coffee

Taking levothyroxine and coffee together may decrease the absorption of levothyroxine significantly, according to one study (11). It did not seem to matter whether they were taken together or an hour apart. This was a very small study involving only eight patients. Still, I recommend avoiding coffee for several hours after taking the medication.

Vegetables

There is a theory that vegetables, specifically cruciferous ones such as cauliflower, cabbage and broccoli, may exacerbate hypothyroidism. In one animal study, results suggested that very high intake of these vegetables reduces thyroid functioning (12). This study was done over 30 years ago, and it has not been replicated.

Importantly, this may not be the case in humans. In the recently published Adventist Health Study-2, results showed that those who had a vegan-based diet were less likely to develop hypothyroidism than those who ate an omnivore diet (13). And those who added lactose and eggs to the vegan diet also had a small increased risk of developing hypothyroidism. However, this trial did not focus on raw cruciferous vegetables, where additional study is much needed.

There are two take-home points, if you have hypothyroid issues: Try to avoid soy products, and don’t think supplements that claim to be thyroid support and good for you are harmless because they are over the counter and “natural.” In my clinical experience, an anti-inflammatory, vegetable-rich diet helps improve quality of life issues, especially fatigue and weight gain, for those with Hashimoto’s thyroiditis.

References:

(1) dictionary.com. (2) nlm.nih.gov. (3) Endocr Pract. 2005;11:115-119. (4) Arch Intern Med. 2000;160:526-534. (5) mayoclinic.org. (6) Thyroid. 2013;23:1233-1237. (7) J Clin Endocrinol Metab. 2011 May;96:1442-1449. (8) Exp Biol Med (Maywood). 2013;238:623-630. (9) American Thyroid Association. 2013;Abstract 185. (10) FDA.gov. (11) Thyroid. 2008;18:293-301. (12) Crit Rev Food Sci Nutr. 1983;18:123-201. (13) Nutrients. 2013 Nov. 20;5:4642-4652.

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.

Watching four or more hours of television has shown to cause an increased risk of cardiovascular disease mortality of 80 percent. METRO photo
Expanded viewing habits have effects on your physical and mental health

By David Dunaief, M.D.

Dr. David Dunaief

Comcast, one of America’s largest cable and internet providers, reported in May that Americans were watching an additional 8-plus hours of programming a week, whether on a television, computer or a portable device since the pandemic’s beginning (1). For our purposes, we’ll call this TV, because most is consumed while sitting, although the average watching modality has shifted considerably.

What impact does all this watching have on our lives? It may be hazardous to your health. I know this seems obvious, but bear with me. The extent of the effect is surprising. According to 2013 Netflix research, binge-watching, or watching more two or more episodes of a single program in a row, is perceived as providing a refuge from our busy lives.

This also has an addictive effect, prompting dopamine surges as we watch. Interestingly, it also can lead to post-binge depression when a show ends and to isolation and lower social interaction while viewing (2). Of course, while socially isolating, binge watching can help kill hours, but the negative effects are still relevant.

TV’s detrimental effect extends beyond the psychological, potentially increasing the risk of heart attacks, diabetes, depression, obesity and even decreasing or stunting longevity. My mother was right when she discouraged us from watching television, but I don’t think even she knew the extent of its impact.

Cardiovascular events including heart attacks

There was a very interesting observational study published in the New England Journal of Medicine that showed watching sporting events increases the risk of heart attacks and other cardiovascular events, such as arrhythmia (irregular heartbeat) and unstable angina (severe chest pain ultimately due to lack of oxygen). The researchers followed Germans who watched the FIFA (soccer) World Cup playoffs in 1996.

How much did watching increase the risk of cardiovascular events? This depended on what round of the playoffs and how close a game it was. The later the round and the closer the game, the greater the risk of cardiovascular events. Knockout games, which were single elimination, seemed to have the greatest impact on cardiovascular risk.

When Germany was knocked out in the semi-finals, the finals between France and Italy did not have any cardiovascular effect.

Overall, men experienced a greater than three-fold increase in risk, while women experienced an increased risk that was slightly below two-fold. According to the authors, it was not the outcome of the game that mattered most, but the intensity. The study population involved 4,279 German residents in and around the Munich area (3).

Another study found that, compared to fewer than two hours a day, those who watched four or more hours experienced an increased risk of cardiovascular disease mortality of 80 percent. I know this sounds like a lot of TV, but the average daily American viewing time is significantly over this. This study, called the Australian Diabetes, Obesity, and Lifestyle study (AusDiab) was observational looking at 8800 adults over a six-year period (4).

Impact on Life Expectancy

The adage that life tends to pass you by when you watch TV has a literal component. An observational study found that TV may reduce the life expectancy of viewers. In the study, those who watched at least six hours per day during their lifetime had a decrease in longevity of 4.8 years. However, this is not the whole story. What is even more telling is that after the age of 25, for every hour of TV, one might expect to potentially lose 21.8 minutes of life expectancy (5). According to the authors, these results rival those for obesity and sedentary lifestyles.

Diabetes and Obesity Risk

In the Nurses’ Health Study, for every two hours of television viewing on a daily basis there were increased risks of type 2 diabetes and obesity of 23 percent and 14 percent, respectively (6). The results show that sitting at work for two hours at time increased the risk of diabetes and obesity by only five percent and seven percent respectively, much less of an effect than TV-watching. The authors surmise that we can reduce the incidence of diabetes and obesity by 43 percent and 30 percent by cutting our TV time by 10 hours a week.

Modestly reducing the amount of television is a simple lifestyle modification that can have a tremendous impact on longevity, quality of life and prevention of the top chronic disease. So, step away from your television, tablet or computer and take a walk outside, do some calisthenics, or even take up a new hobby that doesn’t involve sitting on the couch. Your body and your psyche will thank you.

References:

(1) corporate.comcast.com (2) nbcnews.com/better/health/what-happens-your-brain-when-you-binge-watch-tv-series-ncna816991. (3) N Engl J Med 2008; 358:475-483. (4) Circulation. 2010 Jan 26;121(3):384-91. (5) Br J Sports Med doi:10.1136/bjsm.2011.085662. (6) JAMA. 2003 Apr 9;289(14):1785-91.

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.