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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. 

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Sleep clears toxins from the brain. METRO photo
Exercise and sleep are crucial to clearing the clutter

By David Dunaief, M.D.

Dr. David Dunaief

Considering the importance of our brain to our functioning, it’s startling how little we know about it. 

We do know that certain drugs, head injuries and lifestyle choices negatively impact the brain. There are also numerous disorders and diseases that affect the brain, including neurological (dementia, Parkinson’s, stroke), infectious (meningitis), rheumatologic (lupus and rheumatoid arthritis), cancer (primary and secondary tumors), psychiatric mood disorders (depression, anxiety, schizophrenia), diabetes and heart disease.

Although these diseases vary widely, they generally have three signs and symptoms in common: they either cause altered mental status, physical weakness or change in mood — or a combination of these.

Probably our greatest fear regarding the brain is a loss of cognition. Fortunately, there are several studies that show we may be able to prevent cognitive decline by altering modifiable risk factors. They involve rather simple lifestyle changes: sleep, exercise and possibly omega-3s.

Let’s look at the evidence.

Clutter slows us down as we age

The lack of control over our mental capabilities as we age frightens many of us. Those who are in their 20s seem to be much sharper and quicker. But are they really?

In a study, German researchers found that educated older people tend to have a larger mental database of words and phrases to pull from since they have been around longer and have more experience (1). When this is factored into the equation, the difference in terms of age-related cognitive decline becomes negligible.

This study involved data mining and creating simulations. It showed that mental slowing may be at least partially related to the amount of clutter or data that we accumulate over the years. The more you know, the harder it becomes to come up with a simple answer to something. We may need a reboot just like a computer. This may be possible through sleep, exercise and omega-3s.

Get enough sleep

Why should we dedicate 33 percent of our lives to sleep? There are several good reasons. One involves clearing the mind, and another involves improving our economic outlook.

For the former, a study done in mice shows that sleep may help the brain remove waste, such as those all-too-dangerous beta-amyloid plaques (2). When we have excessive plaque buildup in the brain, it may be a sign of Alzheimer’s. When mice were sleeping, the interstitial space (the space between brain gyri, or structures) increased by as much as 60 percent.

This allowed the lymphatic system, with its cerebrospinal fluid, to clear out plaques, toxins and other waste that had developed during waking hours. With the enlargement of the interstitial space during sleep, waste removal was quicker and more thorough, because cerebrospinal fluid could reach much farther into the spaces. A similar effect was seen when the mice were anesthetized.

In another study, done in Australia, results showed that sleep deprivation may have been responsible for an almost one percent decline in gross domestic product for the country (3). The reason? People are not as productive at work when they don’t get enough sleep. They tend to be more irritable, and concentration may be affected. We may be able to turn on and off sleepiness on short-term basis, depending on the environment, but we can’t do this continually.

According to the Centers for Disease Control and Prevention, four percent of Americans reported having fallen asleep in the past 30 days behind the wheel of a car (4). And “drowsy driving” led to 83,000 crashes in a four-year period ending in 2009, according to The National Highway Traffic Safety Administration.

Prioritize exercise

How can I exercise, when I can’t even get enough sleep? Well there is a study that just may inspire you.

In the study, which involved rats, those that were not allowed to exercise were found to have rewired neurons in the area of their medulla, the part of the brain involved in breathing and other involuntary activities. There was more sympathetic (excitatory) stimulus that could lead to increased risk of heart disease (5). In rats allowed to exercise regularly, there was no unusual wiring, and sympathetic stimuli remained constant. This may imply that being sedentary has negative effects on both the brain and the heart.

This is intriguing since we used to think that our brain’s plasticity, or ability to grow and connect neurons, was finite and stopped after adolescence. This study’s implication is that a lack of exercise causes unwanted new connections. Human studies should be done to confirm this impact.

Consume omega-3 fatty acids

In the Women’s Health Initiative Memory Study of Magnetic Resonance Imaging Study, results showed that those postmenopausal women who were in the highest quartile of omega-3 fatty acids had significantly greater brain volume and hippocampal volume than those in the lowest quartile (6). The hippocampus is involved in memory and cognitive function.

Specifically, the researchers looked at the levels of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) in red blood cell membranes. The source of the omega-3 fatty acids could either have been from fish or supplementation.

It’s never too late to improve brain function. Although we have a lot to learn about the functioning of the brain, we know that there are relatively simple ways we can positively influence it.

References:

(1) Top Cogn Sci. 2014 Jan.;6:5-42. (2) Science. 2013 Oct. 18;342:373-377. (3) Sleep. 2006 Mar.;29:299-305. (4) cdc.gov. (5) J Comp Neurol. 2014 Feb. 15;522:499-513. (6) Neurology. 2014;82:435-442.

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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METRO photo

Resolutions that focus on health and fitness are made each year. Numerous people are eager to lose weight, improve their physical fitness levels or even stop habits that can hinder their mental or physical wellness.

People have many options when they seek to lose weight. Fad diets may promise quick results, but highly restrictive eating plans or marathon workout sessions can be dangerous. Taking shortcuts or risks in the hopes of losing weight can lead to various health issues and ultimately put people’s overall health in serious jeopardy. Thankfully, there are many safe ways people can lose weight. The first step in safe weight loss is to visit a doctor and let him or her know your plans. The doctor can help determine if a specific eating plan or exercise routine is safe based on your current health.

Certain medications can affect metabolism and even contribute to weight gain, so a discussion with the doctor can help ensure people aren’t putting their health in jeopardy when their goal is to get healthy. It’s also vital that people trying to lose weight do not believe everything they read online.

Research published in The American Journal of Public Health in October 2014 found that most people who search the internet for tips on how to lose weight come across false or misleading information on weight loss, particularly in regard to how quickly they can shed some pounds. The Centers for Disease Control and Prevention advises the safest amount of weight to lose per week is between one and two pounds. People who lose more per week, particularly on fad diets or programs, oftentimes are much more likely to regain weight later on than people who took more measured approaches to losing weight.

In addition, the Academy of Nutrition and Dietetics notes it is better to lose weight gradually because if a person sheds pounds too fast, he or she can lose muscle, bone and water instead of fat. The calories in, calories out concept is something to keep in mind when attempting to lose weight. But metabolism and other factors, including body composition and physical activity levels, also are factors. How well one’s body turns calories into fuel also needs to be considered. The best ways to experiment are to start slowly. • Calculate the average daily calories consumed in a day using a tracker. This can be a digital app on a phone or simply writing down calories on a piece of paper. Track over a few days and see, on average, how many calories you’ve been consuming.

• Notice extra calories. Many diets can be derailed by eating extra calories that you don’t realize you’re consuming. That cookie a coworker insists you eat or the leftover mac-and-cheese from your toddler’s plate can be sources of extra calories. Be mindful of what’s being consumed, including sweetened beverages.

• Explore the science. According to the Scotland-based health service NHS Inform, one pound of fat contains 3,500 calories on average. Cutting calorie intake by 500 calories per day should see you lose 1 pound per week. The same goes in the other direction. Eating 500 more calories per day for a year can result in gaining close to 50 pounds. Small changes really add up.

• Eat filling foods. Choose low-calorie, high quality foods, like vegetables, whole grains and lean proteins. Meals that provide satiety can help eliminate between-meals snacks that can derail your weight loss efforts.

• Seek support as a way to create accountability. Share weight loss plans with a friend or relative who can help monitor your progress and keep you on track.

• Incorporate strength training. Good Housekeeping says the more lean muscle you have, the faster you can slim down. Start slowly with strength training, using free weights or body weights. Aim for strength workouts three to four times per week and alternate with calorie-blasting cardio. Explore safer ways to lose weight, including taking a gradual approach that promotes long-term weight loss.

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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

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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.

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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.”

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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.

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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. 

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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.

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