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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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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.

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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.

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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.

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Doctor Says People Can Be Impacted by Califorinia Fires as Far as Long Island

Stock photo

Scenes of the ash and smog from wildfires in the West Coast not only trigger sympathy for those with friends and family living in a paradise under siege, but also are a cause for concern for doctors who specialize in the lungs.

Dr. Norman Edelman. Photo from SBU

While doctors don’t know how far and wide the effects of these fires might be for those who are already struggling with their breathing, such as people with asthma, chronic obstructive pulmonary disease or chronic bronchitis, physicians said the effect could spread well beyond the areas battling these blazes.

The danger is “not just at the site of the fire,” said Dr. Norman Edelman, a professor of medicine at Stony Brook University and a core member of the program in public health at Stony Brook. “I’m sure [the effect of the fire] is pretty wide.”

Indeed, at some point down the road, the small and large particles that are aerosolized during the fire could reach as far away as Long Island.

“We know quite firmly that air pollution from coal burning generator plants [in the Midwest] emits pollution that makes its way all the way to the East Coast,” Edelman said.

The current use of masks may offer some protection for residents on the West Coast.

Particulates, which are aerosolized particles that can get in people’s lungs and affect their breathing, come in various sizes. The larger ones tend to get lodged in people’s noses, throat and eyes and can cause coughing, hacking, and watery eyes. An ordinary mask can filter some of those out, although masks are not completely effective for these bigger particles.

The smaller ones are more dangerous, Edelman said. They can get further into the lungs and can exacerbate asthma, chronic bronchitis and emphysema. They can even contribute to increased incidence of heart attacks.

“Nobody really knows” why these smaller particles contribute to heart attacks, Edelman said. Anecdotal evidence suggests that a reduction in pollution improves the health of a population.

When New York banned smoking in all public places, the level of heart attacks dropped by 15 to 20 percent.

“This level of pollution is nothing like what we’re seeing in the area of the wildfires,” Edelman said.

Additionally, lower pollution can improve the health of people with lung problems.

At the Summer Olympics in Atlanta in 1996, officials put in alternate day driving restrictions, which allowed people to drive every other day. By cutting down the pollution from traffic, doctors noticed a 25% reduction in admission to the emergency room for asthma.

If he were a doctor on the West Coast, Edelman said he would make sure his patients had all their medications renewed and available. He would also check in with his patients to make sure they had emergency instructions in case they need to boost the amount of any pharmacological agents.

The effect of the pollutants on people with asthma or other lung issues can be more severe if they are already dealing with an inflamed airway.

“The effects of various irritants are probably synergistic,” Edelman said. “If this is your allergy season, you become much more susceptible to the inflammatory effects of air pollution.”

COVID and the Lungs

As for the pandemic, Edelman said he didn’t come to the emergency room to work at the Intensive Care Unit during the pandemic.

His colleagues did, however, ask him to take care of patients who didn’t have to come in by telehealth. He’s continued to see many patients over the last three or four months.

One surprise from the data he’s seen related to the pandemic is that asthma does not seem to exacerbate the effects of COVID-19.

People with asthma “are not dying with COVID at any greater rate than the general population,” Edelman said.

He hasn’t yet seen the data for people with chronic bronchitis or COPD.

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The Centers for Disease Control and Prevention has recommended that people wear cloth face coverings in public settings where social distancing measures are difficult to maintain. Even as the world begins to unpause, wearing masks seems likely to continue.

Masks are designed not to prevent the wearer from getting ill, but to protect other people from getting the virus. Masks protect others from your germs when you cough or sneeze. They’re also an effective way to help people to avoid touching their faces.

Masks are exposed to the elements and germs each time they are worn, meaning they will require cleaning. Even though Harvard Health suggests COVID-19 may live more readily on hard surfaces than fabric, the CDC urges people to give cloth face masks the same level of care as regular laundry. Masks should be washed and dried often. The CDC offers these tips on how to clean most cloth and fabric masks.

• Fabric face masks should be washed depending on the frequency of use. More frequent use necessitates more frequent washing.

• A washing machine should be adequate for properly washing a face covering. Choose a warm setting for water temperature. Place masks in the dryer afterward.

• More delicate, hand-sewn masks may be washed by hand, suggests The Good Housekeeping Institute Cleaning Lab. Lather masks with soap and scrub them for at least 20 seconds with warm or hot water before placing in the dryer.

• For additional sanitation, iron masks on the cotton or linen setting for a few minutes to kill remaining germs.

• If masks are fortified with a filter, such as a coffee or HVAC filter, keep in mind that these filters are designed for single use. Paper filters should be replaced after each use. HVAC filters are washable, but manufacturers warn that their effectiveness decreases with each wash. Medium weight nonwoven interface used as filter material is typically washable.

Various health agencies do not condone using steam or microwaves to clean cloth face masks, as these sanitizing techniques are not as effective as regular laundering. Also, never microwave non-fabric dust or N95 respirator masks if you are using them. They can catch fire or be rendered useless.

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Exercise plays a crucial role in lowering blood pressure. Stock photo
Nighttime pressure readings may better predict cardiovascular events

By David Dunaief, M.D.

Dr. David Dunaief

Roughly 45 percent of adults in the U.S. have hypertension, or high blood pressure. That’s almost one in two adults, or 108 million people, of which 82 million do not have their hypertension con-trolled. If that isn’t scary enough, the Centers for Disease Control and Prevention (CDC) reports that almost a half-million people died in the U.S. in 2017 from complications of hypertension in 2017 (1).

Speaking of scary, the probability of complications, such as cardiovascular events and mortality, may have their highest incidence during nighttime sleeping hours.

Unfortunately, as adults, it does not matter what age or what sex you are; we are all at increased risk of complications from high blood pressure. Fortunately, hypertension is highly modifiable in terms of reducing the risk of cardiovascular disease and mortality (2). At least some of the risk factors are probably familiar to you. These include being significantly overweight or obese, smoking, poor diet, lack of exercise, family history, age, increased sodium, depression, low vitamin D, diabetes and too much alcohol (3).

Of course, antihypertensive (blood pressure) medications treat this disorder. In addition, some nonpharmacological approaches have benefits. These include lifestyle modifications with diet, exercise and potentially supplements.

Risk factors matter, but not equally

In an observational study involving 2,763 participants, results showed that those with poor diets had 2.19 times increased risk of developing high blood pressure. This was the greatest contributor to developing this disorder (4). Another risk factor with a significant impact was being at least modestly overweight (BMI >27.5 kg/m²), which put participants at 1.87 times increased risk. This surprisingly, albeit slightly, trumped cigarette smoking at 1.83 times increased risk.

The moral is that a freewheeling lifestyle can have a detrimental impact on blood pressure and cause at least stage 1 hypertension.

Hypertension complications are felt across gender, age and race

While the data show that more men than women have hypertension, 47 percent vs. 43 percent, and the prevalence of high blood pressure varies by race, the consequences of hypertension are felt across the spectrum of age, gender and race (1).

One of the most feared complications of hypertension is cardiovascular disease. In a study, isolated systolic (top number) hypertension was shown to increase the risk of cardiovascular disease and death in both young and middle-aged men and women between 18 and 49 years old, compared to those who had optimal blood pressure (5). The effect was greatest in women, with a 55 percent increased risk in cardiovascular disease and 112 percent increased risk in heart disease death. High blood pressure has complications associated with it, regardless of onset age. Though this study was observational, it was very large and had a 31-year duration.

Nighttime concerns

Measuring blood pressure in the clinic can be useful. However, in a meta-analysis (involving nine studies from Europe, South America and Asia), results showed that high blood pressure measured at nighttime was potentially a better predictor of myocardial infarctions (heart attacks) and strokes, compared to daytime and clinic readings (6).

For every 10 mmHg rise in nighttime systolic blood pressure, there was a corresponding 25 percent increase in cardiovascular events. This was a large meta-analysis that utilized studies that were at least one year in duration. Does this mean that nighttime readings are superior in predicting risk? Not necessarily, but the results are interesting. The nighttime readings were made using 24-hour ambulatory blood pressure measurements (ABPM).

There is something referred to as masked uncontrolled hypertension (MUCH) that may increase the risk of cardiovascular events in the nighttime. MUCH occurs in those who are well-controlled during clinic readings for blood pressure; however, their nocturnal blood pressure is uncontrolled. In the Spanish Society of Hypertension ABPM Registry, MUCH was most commonly seen during nocturnal hours (7). Thus, the authors suggest that ABPM may be a better way to monitor those who have higher risk factors for MUCH, such as those whose pressure is borderline in the clinic and those who are smokers, obese or have diabetes.

Previously, a study suggested that taking at least one antihypertensive medication at night may be more effective than taking them all in the morning (8). Those who took one or more blood pressure medications at night saw a two-thirds reduction in cardiovascular event risk. Now we can potentially see why. These were patients who had chronic kidney disease (CKD). Generally, 85 to 95 percent of those with CKD have hypertension.

Eat your berries

Diet plays a role in controlling high blood pressure. In a study, blueberry powder (22 grams) in a daily equivalent to one cup of fresh blueberries reduced systolic blood pressure by a respectable 7 mmHg and diastolic blood pressure by 5 mmHg over 2 months (9).

This is a modest amount of fruit with a significant impact, demonstrating exciting results in a small, preliminary, double-blind, placebo-controlled randomized trial. Blueberries increase a substance called nitric oxide, which helps blood vessels relax, reducing blood pressure.

In conclusion, nighttime can be scary for high blood pressure and its cardiovascular complications, but lifestyle modifications, such as taking antihypertensive medications at night and making dietary changes, can have a big impact in altering these serious risks.

References:

(1) CDC.gov. (2) Diabetes Care 2011;34 Suppl 2:S308-312. (3) uptodate.com. (4) BMC Fam Pract 2015;16(26). (5) J Am Coll Cardiol 2015;65(4):327-335. (6) J Am Coll Cardiol 2015;65(4):327-335. (7) Eur Heart J 2015;35(46):3304-3312. (8) J Am Soc Nephrol 2011 Dec;22(12):2313-2321. (9) J Acad Nutr Diet 2015;115(3):369-377. (10) JAMA Pediatr online April 27, 2015.

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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Owners of Huner’s Fitness Advantage in Port Jefferson said they believe they should be considered essential for the work they do helping people remain active and healthy. Photo from Huner’s Fitness Advantage website

After doing heavy lifting to ensure customer and employee safety, gyms can begin to reopen soon.

Suffolk County Executive Steve Bellone (D) announced a gradual gym reopening starting this Monday, Aug. 24. This comes after earlier this week Gov. Andrew Cuomo (D) said gyms can start to reopen once they receive guidance from local government.

Commercial gyms, such as Planet Fitness, LA Fitness, Retro Fitness and those that require a membership fee, along with indoor classes can restart next week.

Each fitness center will have to pass a county health inspection to make sure the gyms have sufficient procedures to protect staff and customers while following state guidelines established by Cuomo.

Hotel, office, higher education and residential gyms can reopen starting the following week, on Aug. 31.

On Thursday, Aug. 20, the county will host a virtual meeting with facility owners to review guidance, answer questions and provide any clarifications.

“With our infection rate holding steady at or below 1 percent and a robust testing system in place, we are confident we can reopen gyms in a way that is both safe and responsible,” Bellone said in a statement. “I want to remind our residents and gym owners that we are still in the midst of a pandemic.”

Bellone encouraged those attending gyms to wear a mask and follow all safety procedures.

Communal showers, whirlpools, saunas and steam rooms and water fountains and self-serve bars and samples must remain closed. According to the governor’s web site, individual showers and stalls can remain open as long as they are cleaned between use.

Classes are restricted to the most restrictive guidelines, which could either be six feet of distance in all directions from a participant, a limit of 33 percent capacity and no more than 50 people.

Gym owners also must provide sanitizing stations, acceptable face coverings, which exclude bandanas, buffs and gaiters and the limitation of physical contact activities including boxing and martial arts.

During each inspection, businesses will receive a gallon of NYS Clean hand sanitizer.

According to Cuomo, local health departments are required to inspect gyms prior to reopening or within two weeks of reopening, to ensure strict adherence to the state Department of Health guidance.

Indeed, the Suffolk County Department of Health Services will begin inspections on Monday, Aug. 24 for commercial and traditional gyms.

“New Yorkers must closely adhere to the guidelines and local health departments are required to strictly enforce them to help ensure gyms and fitness center reopen safely and protect the public health,” Cuomo said in a statement.

The Suffolk County Department of Economic Development and Planning will work with the Suffolk County Department of Labor, Licensing and Consumer Affairs and the Suffolk County Department of Health Services to create an online database of gyms and fitness centers within the county.

Before an inspection, gym owners will need to complete the affirmation for each location, which owners can find at the New York Forward website forward.ny.gov, that they reviewed and understood the state guidelines and will implement these protocols.

After owners attest to their safety plans, the county will schedule inspections. Suffolk will send out an email with the date and approximate time for an inspection.

Gym owners need to post a written safety plan describing the ways they are protecting employees and gym members from COVID-19.

Cuomo also requires that gyms use a MERV-13 or greater air-handling system. If the gym can’t operate at that level, the owners need to have a heating, ventilation and air conditioning professional document their inability to use such a system and adopt additional ventilation and mitigation protocols from the American Society of Heating, Refrigerating and Air-Conditioning Engineers and the U.S. Centers for Disease Control and Prevention.

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Walking helps strengthen your joints, bones and muscles. METRO photo
Walking’s benefits extend beyond physical fitness

By David Dunaief, M.D.

Dr. David Dunaief

There is great emphasis on exercise in medicine and in society. We have heard it is good for us ever since we were children in gym class striving for the presidential fitness award.

The average reaction, unfortunately, is an aversion to exercise. As kids, many of us tried to get out of gym class, and as adults, we “want” to exercise, but we “don’t have time.” The result of this is a nation of couch potatoes. I once heard that the couch is the worst deep-fried food. It perpetuates inactivity, especially when watching TV. Even sleeping burns more calories.

I think part of the problem, generally, is that we don’t know what type of exercise is best and how long and frequently to do it. These days, for many who depend on gyms, dance studios and other exercise-related facilities for exercise are struggling to find meaningful substitutes.

Well, guess what? There is an easy way to get tremendous benefit with very little time involved. You don’t need expensive equipment, and you don’t have to join a gym. You can sharpen your wits with your feet.

Jane Brody has written in The New York Times’ Science Times about Esther Tuttle. Esther was 99 years old, sharp as a tack and was independently mobile, with no aids needed. She continued to stay active by walking in the morning for 30 minutes and then walking again in the afternoon. The skeptic might say that this is a nice story, but its value is anecdotal at best.

Well, evidence-based medicine backs up her claim that walking is a rudimentary and simple way to get exercise that shows incredible benefits. One mile of walking a day will help keep the doctor away.

Walking has a powerful effect on preserving brain function and even growing certain areas of the brain (1). Walking between six and nine miles a week, or just one mile a day, reduced the risk of cognitive impairment over 13 years and actually increased the amount of gray matter tissue in the brain over nine years.

Those participants who had an increase in brain tissue volume had a substantially reduced risk of developing cognitive impairment. Interestingly, the parts of the brain that grew included the hippocampus, involved with memory, and the frontal cortex, involved with short-term memory and executive decision making. There were 299 participants who had a mean age of 78 and were dementia free at the start of the trial. Imagine if you started earlier?

In yet another study, moderate exercise reduced the risk of mild cognitive impairment with exercise begun in mid-to-late life (2).

Even better news is that, if you’re pressed for time or if you’re building up your stamina, you can split a mile into two half-mile increments. How long does it take you to walk a half-mile? You’ll be surprised at how much better you will feel — and how much sharper your thinking is.

This is a terrific strategy to get you off the couch or away from your computer, another hazard for many of us working or schooling from home. Set an alarm for specific points throughout the day and use that as a prompt to get up and walk, even if only for 15 minutes. The miles will add up quickly.

In addition to the mental acuity benefits, this may also help with your psychological health, giving you a mental break from endless Zoom calls and your eyes a break from endless screens.

If you ratchet up the exercise to running, a study showed that mood also improves, mollifying anger (3). The act of running actually increases your serotonin levels, a hormone that, when low, can make people agitated or angry. So, exercise may actually help you get your aggressions out.

Walking has other benefits as well. We’ve all heard about the importance of doing weight-bearing exercise to prevent osteoporosis and osteoporotic fractures. The movie “WALL-E” even did a spoof on this, projecting a future where people lived in their movable recliners. The result was a human skeletal structure that had receded over the generations from lack of use. Although it was tongue-in-cheek, it wasn’t too far from the truth; if you don’t use them, bones weaken and break. Walking is a weight-bearing exercise that helps strengthen your joints, bones and muscles.

So, remember, use your feet to keep your mind sharp. Activities like walking will help you keep a positive attitude, preserve your bones and help increase the plasticity of your brain.

References:

(1) Neurology Oct 2010, 75 (16) 1415-1422. (2) Arch Neurol. 2010;67(1):80-86. (3) J Sport Exerc Psychol. 2010 Apr;32(2):253-261.

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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