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METRO photo

By David Dunaief, M.D.

Dr. David Dunaief

We need help, and we need it fast. Not just for COVID-19, but also for diabetes, for the combination of the two is much worse than either disease alone. Type 2 diabetes can have devastating effects that can potentially result in patients dying prematurely from cardiovascular complications (1). COVID-19 symptoms can range from asymptomatic to severe or result in death.

Now combine diabetes with COVID-19 and you are at much higher risk of severe viral symptoms that require hospitalization and ICU admission. According to the CDC, about one-third ICU patients infected with COVID-19 have diabetes (2). 

Keeping patients out of the hospital

We know containment is critical to control COVID-19, but it’s equally important to get ahead of the mitigation of symptoms curve; we need to control the chronic diseases that exacerbate the virus’s severity. And Type 2 diabetes is one of the largest contributors. 

We can treat and reverse diabetes by empowering patients with lifestyle changes, especially diet. This is such an issue that the Mexican Deputy Minister of Health recently alluded to the fact that poor diet over at least the last 4 decades has resulted in more diabetes and obesity making people much more susceptible to COVID-19 and progressing to severe COVID-19 (3). 

It is tempting while staying at home for most of the day to want reach for comfort foods. Don’t do it. In fact, take the opposite approach and improve your diet. A whole food plant-based (WFPB) diet has been shown time and time again to prevent, treat and reverse diabetes potentially resulting in patients getting off their drugs and achieving levels that are considered normoglycemic, or non-diabetic. 

Let’s look at the evidence. 

Treating and reversing diabetes

Drugs help treat glucose, or sugar levels, and help reduce the risk of microvascular diseases such as diabetic retinopathy (eye disease causing blindness); nephropathy (kidney disease); and peripheral neuropathy, which can result in amputation. A few medications can even reduce macrovascular risk, or cardiovascular disease. Still, diet is still the best tool we have for reversing diabetes overall, with only beneficial side effects.

With COVID-19, those whose glucose is not under control are at highest risk of severe disease that results in a progression from hospitalization to ICU and the need for a ventilator to increased mortality risk. High sugars may have negative impacts on the white blood cells, which makes patients more susceptible to infection from viruses (4).

Medications’ impact

Diabetes medication alone can help control sugars, but it can’t reverse diabetes. In fact, studies with medication alone may actually increase the risk of death from polypharmacy, or too many medications. In the ACCORD trial, patients were put on an average of four diabetes medications. Researchers stopped the trial early after 3.5 years, because of a 22 percent increased rate of mortality (5). Patients did not reach their HbA1C (a three-month sugar reading) target of under 6.0 percent, because the increased death rate occurred at around 6.5. This was a large randomized controlled clinical trial with 10,251 patients, a mean age of 62.2 years, and mean HbA1C of 8.1 at baseline. 

Reversing Type 2 diabetes: plant-based dietary approach

On the other hand, studies with a WFPB diet, have shown significant reduction in sugars and potential reversal of diabetes. These include a small retrospective study and small randomized clinical trial comparing a WFPB diet to the American Diabetes’ (ADA) recommended diet. 

In a small retrospective study, the results showed a reduction of HbA1C from 8.2, which was a similar baseline as with the ACCORD trial, to 5.8 (6). Remember, the goal of the ACCORD trial was to get patients below a HbA1C of 6.0. These results occurred over a mean of seven months. In addition, patients were able to stop all of their diabetes medications and reduce their total number of medications from four to one.  The side effect was better health with a significant reduction in high blood pressure to normal levels, as well.

The weakness of this study was that it was retrospective (looking backward in time), only had 13 patients, and there was no control arm. However, it suggests that this type of diet is powerful to reduce and reverse type 2 diabetes. The foods used in the nutrient-dense WFPB diet included a non-starchy vegetable-rich approach, with an emphasis on dark green leafy vegetables, whole fruits, beans, and limiting grains, especially refined grains, and limiting starchy vegetables such as sweet potatoes, winter squashes, corn and pumpkin. 

In a larger study, results showed that a high fiber diet in patients with type 2 diabetes and hypertension significantly reduced HbA1C, fasting glucose, systolic (top number) blood pressure, branchial-ankle pulse wave velocity, serum cholesterol and waist-to-hip ratio, ultimately reducing the risk of cardiovascular disease (7). The participants were considered to be having high fiber if they increased their consumption 20-25 percent above recommended daily allowances. The fiber came from foods, not supplements, including vegetables, fruits, beans and whole grains. There were 200 participants over a six-month duration. 

A third study, which was a randomized controlled trial comparing the 2003 American Diabetes Association (ADA) diet to a low-fat vegan diet showed that a low-fat vegan diet significantly reduced the HbA1C compared to the 2003 ADA diet in a 74-week study (8). There were 99 type 2 diabetes patients in the study. A “side effect” of the low-fat vegan diet was that it also significantly reduced cholesterol. 

Preventing diabetes

There have been numerous studies demonstrating that a WFPB diet reduces the risk of diabetes. One of the best was the Adventist Health Study 2 (9). The results showed that a vegan diet reduced the risk of type 2 diabetes by 49 percent. This study is interesting because the different groups were very similar and it showed that small changes could have a big impact. Semi-vegetarians, pesco-vegetarians, and lacto-ovo vegetarians all had a reduced risk of diabetes compared to plant-focused non-vegetarians, but not as much as vegans. 

In a more recent study, results showed a 30 percent reduction in the risk of type 2 diabetes for those who ate a predominantly whole food plant-based diet including fruits, vegetables and whole grains (10). Participants were still eating some animal protein daily. This was over a 2-to-28 year period in a metanalysis involving nine observational trials.

In conclusion, the best way to reduce your risk of severe COVID-19 is to control and reverse chronic disease. Type 2 diabetes is one of the most common chronic diseases that may contribute to getting COVID-19 and progressing to a severe form. A nutrient-dense WFPB diet has been shown to potentially reverse type 2 diabetes. While you are mostly housebound, empower yourself by taking action to reduce your risk of getting COVID-19 and especially the severe disease. We have the tools: it starts with what you put on your plate.

References:

(1) Lancet 389(10085):2239–2251. (2) CDC.gov. (3) Reuters.com April 4, 2020. (4) Medscape.com March 18, 2020. (5) NEJM 2008;358:2545-2559. (6) OJPM 2012;2(3):364-371. (7) ACC Middle East Conference 2019 Presentation. (8) Am J Clin Nutr.2009 May; 89(5): 1588S–1596S. (9) Diabetes Care. 2009;32:791–796. (10) JAMA Int. Med. Online July 22, 2019.

Dr. 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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Port Jefferson EMS team has been on the front lines of the pandemic since its start. The team covers the Mount Sinai, Port Jefferson and Belle Terre communities. Photo from Michael Buckley

By Rich Acritelli

Working over 180 hours over the last two weeks, Paramedic Michael Buckley of Port Jefferson has been extremely busy providing dire medical attention to the North Shore community. During the ongoing coronavirus pandemic, Buckley has been a key member of the Port Jefferson Emergency Medical Services. Around the clock, Buckley has been caring for patients in Belle Terre, Port Jefferson and Mount Sinai. Like every American, he is looking forward for this nation to getting back to normal where he can go to the gym, see his friends and family, and go out to a nice dinner.

Michael Buckley in his military uniform with his brother Shawn. Photo from Buckley

Even during the interview, Buckley was called twice for services to bring sick residents to the Mather, St. Charles and Stony Brook University. It has been a trying period for our nation, but citizens like that of Buckley demonstrate their compassion to help other through perhaps the worst viral this nation has endured in recent memory. He is one of 250,000 Emergency Medical Service workers that immediately answers every type of health-related call. This particular ambulatory company is located on Crystal Brook Hollow Road in Mount Sinai and it is one of the nearly 22,000 transport medical organizations that answer an estimated 240 million calls made each year. During every type of weather condition, this ambulance company has tirelessly worked for the betterment of these local hamlets and villages.

This native of Port Jefferson completed his education at St. Anthony’s High School in Huntington. He enjoyed playing football, excelling at his grades, and continuing the strong tradition of family members that worked and went to this school.  As a young man, Buckley was an Emergency Medical Technician who worked closely with ambulance crews. After graduating in 2008, Buckley was accepted to St. Johns University in Jamaica, Queens. During his college years, he majored in business management and was accepted into the Officer Candid School for the military at his college.   

After earning his degree in 2012, Buckley enlisted into the U.S. Army in 2013 where he completed his Basic Training and Officer Candid School at Fort Benning, Georgia. He was later ordered to Fort Sill, Oklahoma and was later commissioned as a field artillery officer before being transferred to Fort Bragg, North Carolina. He was assigned to the field artillery for the combat renown 82nd Airborne Division.  With this elite unit, Buckley earned his wings and eventually made thirteen training jumps. Currently, he is a captain at reserve military base in Farmingdale, where he assists the enlistment of former officers through the Army Reserve Career Division.

This extensive military training has prepared Buckley for the rigors of being on the front lines of dealing with COVID-19. Every day, he is covered from head to toe with protective gear, including a N95 face mask and shield, gloves, goggles and a protective gown. As he still handles every type of medical call, Buckley responds to numerous suspected Covid-19 emergencies that bring people to the three major local hospitals. With twenty words or less, the ambulances quickly communicate with emergency rooms to inform them of the severity of the call. While Buckley does not know the name of every medical professional in these sick bays, he is always amazed at their unyielding devotion to help other during this crisis.

Chief Rob Stoessel is an executive director of this ambulance service and he is extremely proud in how hard his crews are working during this crisis. As he believes that there are less cardiac and respiratory calls, the COVID-19 cases are hampering the process of bringing patients to the hospital. With these crews wearing extensive protective clothing and constantly cleaning their vehicles, equipment and themselves after every call, it has been a daily challenge to carry out their tasks. In order to protect these men and women, they can take showers and wear clean clothing before they drive home in their own cars. The Port Jeff EMS has increased its mobile fleet to five ambulances and three emergency service vehicles that are operating during all hours of every day. Stoessel said he wanted to thank his EMTs who were students at Stony Brook University. For a time, many of these student-volunteers were without housing, but they have shown an extreme amount of comradery to support the operations of the ambulance company.  Currently, some of these volunteers are staying at Danford’s Hotel in Port Jefferson.   

Buckley said he believes that the “social distancing” has been working, but people still need to stay home and away from each other. Driving numerous hours through our local towns, Buckley has seen a tremendous growth in the use of face masks and gloves. From his own observations, he sees the importance of listening to Gov. Andrew Cuomo and following the guidelines issued by the Center by the U.S. Center for Disease Control and Prevention.  

Even as Buckley has been working through this daunting physical and mental schedule, he has been enrolled at the Farmingdale State College. He is using his Montgomery GI Bill to complete the necessary prerequisites to be accepted by a future medical school. With a wealth of military and health background, he is determined to help future citizens in becoming an emergency room doctor. Stoessel said he has been highly impressed by the skills and dedication of Buckley and he believes that this paramedic “represents all that is good with this country.” 

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Sticking to a plant-rich diet that can reduce high blood pressure. Stock photo
Call to arms to reverse high blood pressure, once and for all

By David Dunaief, M.D.

Dr. David Dunaief

Hypertension (high blood pressure) and COVID-19 are intertwined. Those who have hypertension are more susceptible to COVID-19 and are more likely to get a severe form and experience complications from the virus. A study done in China captured the statistics: of 1099 patients infected, 15 percent had hypertension, and of those with severe cases, 23.7 percent had hypertension (1). Ultimately, those with hypertension are at higher risk, but we don’t at this point understand the specifics of why.

Even before the COVID-19 pandemic, a recent study showed that the number of deaths from hypertension had increased a whopping 26 percent overall from 2007 to 2017 (2). 

What about medications to blunt the association? There is a THEORY, not a study, that angiotensin converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) may be harmful by increasing ACE2 in the lungs, which is a receptor that COVID-19 binds to; however, there is also a case for these medications having benefits (3). Do not stop or change your hypertension medications without talking to your doctor. Remember, this is just a theory, and theories are very dangerous; we don’t have research to support them, by definition (4).

I view this as a call to arms to control and, even more importantly, treat and reverse hypertension. Presently, only 54 percent of hypertension patients are controlled with medication (5). 

Potential to control and reverse hypertension through diet

We have the capability to treat and reverse hypertension with lifestyle modifications, including diet, exercise, sleep and stress management. We are going to focus on diet.

A whole foods plant-based diet (WFPBD) that is dark green leafy vegetable-rich has been shown to help prevent, control and possibly reverse hypertension. I call this the LIFE diet, which stands for Low Inflammatory Foods Everyday. The most researched type of WFPBD is the DASH (dietary approach to stopping hypertension) diet, which emphasizes fruits, vegetables, grains and reductions in saturated fats and total fat. DASH was the first randomized control trial to show that a predominantly whole food plant-based approach reduces blood pressure (6).

Why does diet have an effect? There are several factors, including inflammation; electrolytes, specifically sodium and potassium; and phytochemicals (plant nutrients and fiber content).

Why is inflammation so important?

Inflammation is a culprit in most chronic diseases, including hypertension. It also plays a crucial role in the severity of COVID-19. Those who take a turn for the worse in COVID-19 have high inflammation. On the news, an ER doctor noted that while COVID-19 patients may come in stable, they need to be watched carefully; in 3-24 hours, they could show high inflammation and fluid in their lungs and need to be on a ventilator.

There are several studies that show a direct relationship between high sensitivity C-reactive protein, one of the most well-studied biomarkers for inflammation, and hypertension in both men and women (7)(8). In the Physicians Health Study, those men who had high hsCRP (>3 mg/L) and hypertension had a 40 percent increased risk of stroke compared to those without hypertension and with hsCRP <1, which is optimal. Not to leave women out, the CARDIA study found that premenopausal women with elevated hsCRP were significantly more likely to have hypertension.

How can we decrease inflammation?

Anti-inflammatory drugs, including NSAIDS like ibuprofen, may suppress the immune system and make patients more susceptible to COVID-19. They also worsen hypertension and may increase the risk for cardiovascular events, such as a heart attack. In fact, prescription NSAIDS carry an FDA black box warning about this dangerous side effect. Anti-inflammatory drugs should not be the “go-to” solution.

Fortunately, a WFPBD is associated with reduction in inflammation, specifically hsCRP. We recently published a study showing that the LIFE diet has an inverse relationship between blood levels of beta carotene, a phytonutrient, and hsCRP (9). As you increase the intake of dark green leafy vegetables, the higher the beta carotene and the lower the hsCRP. There was a 75 percent reduction in inflammation with those that increased their beta carotene over the normal level compared to those who were non-adherent. The DASH diet also emphasizes an increased intake of vegetables.

There are studies to suggest that, as we lower animal protein intake, we are able to better reduce blood pressure. In the EPIC study, those who at who reduced animal protein to none had the biggest impact on blood pressure. This study compared meat-eaters, fish-eaters, vegetarians and vegans (10). 

Electrolytes – sodium and potassium

The optimal approach for these electrolytes is to have a sodium to potassium ratio that is less than one. For most, this means consuming less sodium and more potassium (11). The American Heart Association emphasizes low sodium, less than 1500 mg of sodium per day and higher potassium intake (12). 

What I find in my practice is that blood levels that are south of 140 mmol/L are better and that the bottom of the range is ideal; the range is between 135-145 mmol/L. This way, whether you are sodium-sensitive or not, you can either help control blood pressure or rule it out as a factor. Potassium should be 4.5 (units) or higher. These electrolytes should come from vegetables, especially dark green leafy vegetables, which have a natural balance of potassium and sodium. Other good sources of potassium are beans and nuts.

Ultimately, the power is in your hands. By changing your diet to one that is more plant-based and vegetable-rich, you can reduce inflammation, strengthen your immune system, possibly reduce or even get off anti-hypertension medications, reverse the trend of dying from hypertension, and reduce your susceptibility to severe COVID-19.

References:

(1) N Engl J Med. Online Feb 28, 2020. (2) J Am Coll Cardiol. Online March 19, 2020). (3) Nephron. Online Mar 23, 2020.) (4) Nature. Feb 2020, 579:270–273. (5) Circulation. 2016;133:e38–e360. (6) N Engl J Med. 1997 Apr 17; 336(16):1117-24. (7) JAMA.2015 Sep:4(9):e002073 (8) Menopause. 2016 Jun; 23(6):662. (9) AJLM Online. Dec. 21, 2019. (10) Oybkuc Gektg Bytr, 2002 Oct; 5(5):645-54. (11) Circulation Online. Oct 11 2017. (12) heart.org.

Dr. 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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Irritable bowel syndrome (IBS) is a common disorder that affects the large intestine. Stock photo
Lifestyle plays an important role in reducing symptoms

By David Dunaief, M.D.

Dr. David Dunaief

According to estimates, 10 to 15 percent of the population suffers from irritable bowel syndrome (IBS) symptoms, although only five to seven percent have been diagnosed (1). The general perception is that IBS symptoms are somewhat vague. They include cramping, abdominal pain, bloating, constipation and diarrhea. 

Physicians use the Rome III criteria, an international effort to create scientific data to help diagnose and treat functional gastrointestinal disorders, plus a careful history and physical exam for diagnosis. 

What epitomizes IBS is the colonoscopy study, where IBS patients who underwent colonoscopy had diagnostic findings of nil. This tended to frustrate patients more, not reduce their worrying, as the study authors had hoped (2).

Rather, it plays into that idea that patients don’t have diagnostic signs, like in inflammatory bowel disease, yet their morbidity (sickness) has a profound effect on their quality of life. Socially, it is difficult and embarrassing to admit having IBS. Plus, with a potential psychosomatic component, it leaves patients wondering if it’s “all in their heads.”

So, what can be done to improve IBS? There are a number of possibilities to consider.

Mental state’s effect

The “brain-gut” connection is real. It refers to the direct connection between mental state, such as nervousness or anxiety, to gastrointestinal issues, and vice versa.

Mindfulness-based stress reduction was used in a small, but randomized, eight-week clinical trial with IBS (3). Those in the mindfulness group (treatment group) showed statistically significant results in decreased severity of symptoms compared to the control group, both immediately after training and three months post-therapy.

Those in the treatment group were instructed to do meditation, gentle yoga and “body scanning” — focusing on one area of the body for muscle tension detection. The control group attended an IBS support group once a week.

A preliminary study has suggested there may be a link between IBS and migraine and tension-type headaches. The study of 320 participants, 107 with migraine, 107 with IBS, 53 with episodic tension-type headaches (ETTH), and 53 healthy individuals, identified significant occurrence crossover among those with migraine, IBS and ETTH. Researchers also found that these three groups had at least one gene that was different from that of healthy participants. Their hope is that this information will lead to more robust studies that could result in new treatment options (4).

The role of gluten

In a small randomized clinical trial, patients who were given gluten were more likely to complain of uncontrolled symptoms than those who were given a placebo (68 percent vs. 40 percent, respectively).

These results were highly statistically significant (5). The authors concluded that nonceliac gluten intolerance may exist. Gluten sensitivity may be an important factor in the pathogenesis of a portion of IBS patients (6).

I suggest to my patients that they might want to start avoiding gluten and then add it back into their diets to see the results.

Fructose intolerance

Some IBS patients may suffer from fructose intolerance. In a prospective (forward-looking) study, IBS patients were tested for this with a breath test. The results showed a dose-dependent response. When patients were given a 10 percent fructose solution, only 39 percent tested positive for fructose intolerance, but when they were given a 33 percent solution, 88 percent of patients tested positive.

The symptoms of fructose intolerance included flatus, abdominal pain, bloating, belching and alternating bowel habits. The authors concluded that avoidance of fructose may reduce symptoms in IBS patients (7).

According to another study, about one-third of IBS patients are fructose intolerant. When on a fructose-restricted diet, symptoms appeared to improve (8). Foods with high levels of fructose include certain fruits, like apples and pears, but not bananas.

What is the role of lactose?

Another small study found that about one-quarter of patients with IBS also have lactose intolerance. Two things are at play here. One, it is very difficult to differentiate the symptoms of lactose intolerance from IBS. The other is that most IBS trials are small and there is a need for larger trials.

Of the IBS patients who were also lactose intolerant, there was a marked improvement in symptomatology at both six weeks and five years when placed on a lactose-restrictive diet (9).

Though small, the trial results were statistical significant, which is impressive. Both the durability and the compliance were excellent, and visits to outpatient clinics were reduced by 75 percent. This demonstrates that it is most probably worthwhile to test patients for lactose intolerance who have IBS.

Do probiotics help?

Treatment with probiotics from a study that reviewed 42 trials shows that there may be a benefit to probiotics, although the endpoints were different in each trial. The good news is that most of the trials reached one of their endpoints (10).

Probiotics do show promise, including the two most common strains, Lactobacilli and Bifidobacteri, which were covered in the review.

All of the above gives IBS patients a sense of hope that there are options for treatments that involve modest lifestyle changes. I believe there needs to be a strong patient-doctor connection in order to choose the appropriate options that result in the greatest symptom reduction.

References:

(1) American College of Gastroenteroloy [GI.org]. (2) Gastrointest Endosc. 2005 Dec;62(6):892-899. (3) Am J Gastroenterol. 2011 Sep;106(9):1678-1688. (4) American Academy of Neurology 2016, Abstract 3367. (5) Am J Gastroenterol. 2011 Mar;106(3):508-514. (6) Am J Gastroenterol. 2011 Mar;106(3):516-518. (7) Am J Gastroenterol. 2003 June;98(6):1348-1353. (8) J Clin Gastroenterol. 2008 Mar;42(3):233-238. (9) Eur J Gastroenterol Hepatol. 2001 Aug;13(8):941-944. (10) Aliment Pharmacol Ther. 2012 Feb;35(4):403-413.

Dr. 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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Kingstone and Miles Fowler practice distance learning. Photo from Kristina Fowler

During challenging times like these, the Comsewogue School District reacted to be fully prepared to not only provide and keep its classes and academic standards at a high level but also to keep the students’ social and emotional well-being stable despite no longer being in the school buildings.

The administration, staff, students and community saw fit to have educational packets and more in place while the upper grades were provided with Chromebooks and resources online available before school was closed. The technology department was in close contact and continues to be communicating with everyone on a daily basis with updates and more.

“I was happy to receive additional training available up to the very last day,” said Camie Zale, a special education teacher.

“Teachers and students are comfortable with using technology and communicating with various websites and apps on a normal basis,” said Andrew Harris, a teacher at the middle and high school. “Unfortunately, I’m nowhere as savvy as most of these students who have grown up with this technology. If I ever have any problem, I can ask any of my students who usually solve it in a matter of seconds … they are amazing.”

Don Heberer, district administrator for instructional technology, said the 1:1 take-home Chromebook program in the high school and classroom carts at John F. Kennedy Middle School had allowed students and teachers to become comfortable with using the technology for education.

Melissa McMullan, a sixth-grade teacher in the middle school, said the school did a great job getting Chromebooks into kids’ hands. The process, she said, has been tricky to find what works and what doesn’t on an online space.

“The kids and I will solve the need for distance learning together like we always do,” she said.

Students in the elementary schools have grade-level packets posted online along with hard copies sent home. The district is also providing support to both teachers and parents remotely on using the technology.

”Comsewogue has always prided itself on being innovative and willing to try something new,” Heberer said. “We know that it will be a challenging change for everyone; however, Comsewogue staff has worked hard to provide the students, teachers and community resources during this period.”

The Comsewogue district has taken to online as well for interteacher-related processes. Harris said teachers received a message from the Pupil Personnel Services department that they will hold upcoming annual meetings on Google Hangouts as part of their annual review process. It has taken time and effort but he feels he has become comfortable and “up to speed” with the various programs.

“For me, I am learning as I go,” Harris said. “The first day I mostly communicated the way I was most familiar with — I picked up the phone and called most parents to let them know what was going on with their child’s education. From there I switched to text messages, and finally have been using Google Classroom and more as I get better.”

After checking in with several of the students, Harris said many teachers realized they were perhaps giving too much work. One parent communicated that her daughter was working from early morning until about 5 p.m. on her assignments and starting to stress out.

“I think many of the teachers didn’t want the students to feel like they were on vacation and get complacent,” said Joe Caltagirone, a teacher at the high school.

Harris said he wanted his very first assignment to be something light and be beneficial to his students and their families. He posted a YouTube video on how to do Box Breathing, a technique of taking slow, deep breaths to relieve some stress and help concentrate.

“I know people are highly stressed so I asked that the student watch this video first,” Harris said. “I also requested that they teach members of their family how to do it. I know from experience when you teach others you become very proficient at what you’re teaching. I asked them all to comment on how it made them feel.”

Harris, also a yoga instructor, said that breath work is easy to learn and perhaps the best thing people can do in these stressful situations.

Having said all of this, there are many in the Comsewogue community that may not be as comfortable as students are with technology, though there are many people willing to help distribute food and other resources to our senior citizens.

“The problem is that they may not know that there is help out there. Where many of us can easily access social media sites, many of these seniors don’t have the ability to do so,” said Ed Garboski of the Port Jefferson Station/Terryville Civic Association.

“Currently, I’m trying to find a way to bridge that gap,” said Harris. “We are trying to put together an electronic way to have our students write letters to the senior citizens who are being quarantined at local facilities. If we have to, we will have the letters printed and distributed to those seniors directly or through the facility’s printer, so they are not compromised.”

Superintendent Jennifer Quinn stated that the whole staff is committed to doing whatever is necessary to make sure the students continue to get everything they need to have a great education, and much more.

Information and quotes provided by Andrew Harris

Comsewogue Won’t Be Stopped by COVID-19

By Deniz Yildirim

Like the rest of New York, Comsewogue School District is facing unprecedented challenges with courage and teamwork. Following Gov. Andrew Cuomo’s (D) orders, all six of the district’s schools were closed on Monday, March 16, for a tentative two-week period. Administrators and teachers worked hard to create packets and uploaded countless resources onto the district’s website so students can continue their education at home.

Preparing work for over 5,000 students with numerous and distinct needs such as learning disabilities and language barriers could only be completed with hard work and collaboration. Reading teachers, English as second language teachers, teaching assistants and even special area teachers like music teacher Ellen Rios came together to create comprehensive packets that were sent home with students on Friday, March 13. Parents could come in person to pick them up if their child wasn’t in school to get it themselves.

Superintendent Jennifer Quinn has been regularly calling parents with updates and also informed families that the district is even willing to lend out its Chromebooks to students who couldn’t otherwise access the online learning tools.

“This is a scary time for everyone and our students’ health comes first. We want to share what we have to make them feel safe and help them continue to learn,” said Quinn. “Families are advised to call the district so they can prepare the appropriate materials and ensure a smooth and sanitary pick up.

In addition to student work, Comsewogue is continuously posting statements on its website (in English and Spanish) in order to keep families informed. One such notice comes from Robert Pearl, the district’s new administrator for Pupil Personnel Services and Micheala Finlay-Essig, the assistant director of PPS; they have been rescheduling important meetings regarding student services that will now be “teleconferencing” meetings through Google Meet. The instructional technology department led by Don Heberer has never been more critical and everyone can testify to the key role they are playing.

“We’re here to help our students, teachers and community,” Heberer said. “We have been supporting our teachers through technology professional development, so the teachers can support our students’ learning. We are updating the district website and mobile app daily to keep our community informed and provide vital resources.”

Comsewogue graduate, parent and now teacher Kristina Fowler said she’s never been prouder of her community. Fowler has a unique perspective because she’s been in everyone’s shoes, so it’s particularly meaningful to hear her say that Comsewogue is going above and beyond her expectations. She supports her two sons, fourth-grader Kingston and second-grader Miles and lets them “play” with their friends via FaceTime. Most recently, Kingston and Kristina helped classmate Liam Schneph with a question he had about his new hamster.

“It’s so important to stay connected and let kids be kids,” she said. “Comsewogue won’t be stopped by COVID-19.”

Deniz Yildirim is a librarian at the Terryville Road Elementary School

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Stock photo

The need for hospital beds to manage the ongoing coronavirus crisis continues to build each day. Earlier today, County Executive Steve Bellone (D) reported 103 people were in the Intensive Care Unit with the Covid-19 virus, which is more than double the number in the ICU in the last two days.

“We know hospitals are working on innovative solutions,” Bellone said on a daily conference call with reporters. “Those will continue to happen as we seek to get equipment and supplies to fight the virus.”

At the same time, more people are seeking food assistance, as the number of people applying to the Supplemental Nutrition Assistance Program reached 222 yesterday, which is up from an average of about 75 before the pandemic reached the county.

Bellone said he has heard mixed information from financial institutions as they have responded to businesses that are in various levels of distress amid New York Pause, which closed non essential businesses and slowed the economy.

The county exec said his office will be speaking with representatives from the financial services industry, adding, “we will be working to align what is being done with respect to business loans and mortgages, fines and penalties.”

Across the county, the number of positive tests for the virus is up to 2,735, as over 9,600 people have received tests. Stony Brook Hospital’s mobile site has conducted about 4,000 of those tests.

Including the ICU patients, the number of people hospitalized with the respiratory virus stands at 287.

For the 8th straight day, the number of deaths also climbed. Two people passed away with complications related to the virus. A man in his late 80’s died at Southampton Hospital yesterday and a man in his late 80’s died at Eastern Long Island Hospital on Monday. The total number of deaths connected to the virus in Suffolk County stands at 22.

With an expected surge in the numbers of people infected and the demands on the health care system expected to increase dramatically in the next two to three weeks, Bellone urged the public to follow social distancing and isolate themselves as much as they can.

Bellone himself has been in quarantine for almost two weeks, as he was in contact with Pete Scully, a Deputy Suffolk County executive who tested positive for the virus. Bellone’s quarantine ends Sunday.

For parents and their school-age children, Bellone believed that the date when schools would reopen would likely be after April 1.

“The expectation people should have is that that is going to be extended,” Bellone said. The increase in positive tests, hospital and ICU bed use, and the ongoing rise in virus-related mortalities are all “indications that we are in the thick of this. This wouldn’t be a time when you would be reopening schools.”

Meanwhile, the Suffolk County Police Department has had 46 checks to date of businesses that might be violating the social isolation order or that were non-essential and remained open. The police officers have found that six of the businesses were non-compliant.

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Taking Vitamin D may reduce the risk of developing Parkinson’s disease. Stock photo
Cumulative lifestyle changes can improve results

By David Dunaief

Dr. David Dunaief

According to the Parkinson’s Foundation, roughly 60,000 Americans are diagnosed with Parkinson’s disease (PD) each year, and approximately one million Americans are living with PD (1). PD is a neurodegenerative (the breakdown of brain neurons) disease with the resultant effect of a movement disorder.

Most notably, patients with the disease suffer from a collection of symptoms known by the mnemonic TRAP: tremors while resting, rigidity, akinesia/bradykinesia (inability/difficulty to move or slow movements) and postural instability or balance issues. It can also result in a masked face, one that has become expressionless, and potentially dementia, depending on the subtype. There are several different subtypes; the diffuse/malignant phenotype has the highest propensity toward cognitive decline (2).

The part of the brain most affected is the basal ganglia, and the prime culprit is dopamine deficiency that occurs in this brain region (3). Why not add back dopamine? Actually, this is the mainstay of medical treatment, but eventually the neurons themselves break down, and the medication becomes less effective.

There’s a lot we still don’t know about the causes of PD; however, risk factors may include head trauma, reduced vitamin D, milk intake, well water, being overweight, high levels of dietary iron and migraine with aura in middle age.

Is there hope? Yes, in the form of medications and deep brain stimulatory surgery, but also with lifestyle modifications. Lifestyle factors include iron, vitamin D and CoQ10. The research, unfortunately, is not conclusive, though it is intriguing.

Reducing iron in the brain

This heavy metal is potentially harmful for neurodegenerative diseases such as Alzheimer’s disease, macular degeneration, multiple sclerosis and, yes, Parkinson’s disease. The problem is that this heavy metal can cause oxidative damage.

In a small, yet well-designed, randomized controlled trial (RCT), researchers used a chelator to remove iron from the substantia nigra, a specific part of the brain where iron breakdown may be dysfunctional. An iron chelator is a drug that removes the iron. Here, deferiprone (DFP) was used at a modest dose of 30 mg/kg/d (4). This drug was mostly well-tolerated.

The chelator reduced the risk of disease progression significantly on the Unified Parkinson Disease Rating Scale (UPDRS) during the 12-month study. Participants who were treated sooner had lower levels of iron compared to a group that used the chelator six months later. A specialized MRI was used to measure levels of iron in the brain.

The iron chelator does not affect, nor should it affect, systemic levels of iron, only those in the brain specifically focused on the substantia nigra region. The chelator may work by preventing degradation of the dopamine-containing neurons. It also may be recommended to consume foods that contain less iron.

Does CoQ10 slow progression?

When we typically think of using CoQ10, a coenzyme found in over-the-counter supplements, it is to compensate for depletion from statin drugs or due to heart failure. Doses range from 100 to 300 mg. However, there is evidence that CoQ10 may be beneficial in Parkinson’s at much higher doses. In an RCT, results showed that those given 1,200 mg of CoQ10 daily reduced the progression of the disease significantly based on UPDRS changes, compared to the placebo group (5). Other doses of 300 and 600 mg showed trends toward benefit but were not significant. This was a 16-month trial in a small population of 80 patients. Though the results for other CoQ10 studies have been mixed, these results are encouraging. Plus, CoQ10 was well-tolerated at even the highest dose. Thus, there may be no downside to trying CoQ10 in those with PD.

Is Vitamin D part of the puzzle?

In a prospective (forward-looking) study, results show that vitamin D levels measured in the highest quartile reduced the risk of developing Parkinson’s disease by 65 percent, compared to the lowest quartile (6). This is quite impressive, especially since the highest quartile patients had vitamin D levels that were what we would qualify as insufficient, with blood levels of 20 ng/ml, while those in the lowest quartile had deficient blood levels of 10 ng/ml or less. There were over 3,000 patients involved in this study with an age range of 50 to 79.

While many times we are deficient in vitamin D and have a disease, replacing the vitamin does nothing to help the disease. Here, it does. Vitamin D may play dual roles of both reducing the risk of Parkinson’s disease and slowing its progression.

In an RCT, results showed that 1,200 IU of vitamin D taken daily, may have reduced the progression of Parkinson’s disease significantly on the UPDRS compared to a placebo over a 12-month duration (7). Also, this amount of vitamin D increased the blood levels by two times from 22.5 to 41.7 ng/ml. There were 121 patients involved in this study with a mean age of 72.

So, what have we learned? Though medication with dopamine agonists is the gold standard for the treatment of Parkinson’s disease, lifestyle modifications can have a significant impact on both prevention and treatment of this disease. Each lifestyle change in isolation may have modest effects, but cumulatively their impact could be significant. The most exciting part is that lifestyle modifications have the potential to slow the progression the disease and thus have a protective effect.

References:

(1) parkinsons.org. (2) JAMA Neurol. 2015;72:863-873. (3) uptodate.com. (4) Antioxid Redox Signal. 2014;10;21(2):195-210. (5) Arch Neurol. 2002;59(10):1541-1550. (6) Arch Neurol. 2010;67(7):808-811. (7) Am J Clin Nutr. 2013;97(5):1004-1013.

Dr. 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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Gov. Andrew Cuomo (D) File photo by Sara Meghan Walsh

Governor Andrew M. Cuomo (D) announced earlier today that he is shutting down all businesses that are not considered essential starting this Sunday evening.

Businesses that will remain open include grocery stores and pharmacies, among others.

At a press conference, Cuomo said, “this is the most drastic action we can take,” adding these provisions will be enforced.

“These are not helpful hints,” he said. “These are legal provisions. They will be enforced. There will be a civil fine and mandatory closure for any business that is not in compliance. Your actions can affect my health. That’s where we are.”

He tackled misconceptions among younger people. He said bad information includes the perception that young people can’t get it or that young people can’t transmit it if they’re not symptomatic. Those are both “factually wrong,” Cuomo said. He cited that 20 percent of coronavirus cases are from people ages 20 to 44, according to the Centers for Disease Control and Prevention.

The 56th Governor of the Empire State said non-essential gatherings of individuals of any size for any reason are canceled at this time.

To protect those most at risk, Cuomo is also announcing Matilda’s Law to protect New Yorkers who are over 70 years old with compromised immune systems. He urges them to remain indoors, pre-screen visitors by taking their temperature, and require visitors to wear masks and remain six feet away from others. He strongly discouraged people in this group from taking public transportation, “unless urgent and absolutely necessary.”

He is also implementing a 90-day moratorium on evictions for residential and commercial tenants.

“I understand that may affect businesses negatively and I’ve spoken to a number of them,” Cuomo said. “I know that we’re going to put people out of work with what I did. I want to make sure I don’t put them out of their house.”

Cuomo said the order was definitely not a “shelter-in-place” order, but rather was a way to “tighten the valve” on the density of the population, reducing the risk of exposure and contagion.

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Stock photo

The first day after the Stony Brook University mobile testing site started administering tests for the coronavirus Covid-19, the number of positive tests continued to build.

Earlier today, Suffolk County had 239 confirmed cases, according to County Executive Steve Bellone (D). That includes 64 in Huntington, 39 in Islip, and eight in Smithtown.

Among those with the virus, 27 are in the hospital, with 7 in the intensive care unit. Public health officials said the majority of the cases remained adults.

The current treatment involves supportive management, which includes maintaining oxygenation through ventilatory support, and maintaining fluid balances, Dr. Gregson Pigott, Commissioner of the county Department of Health Services, said on a conference call with reporters.

Bellone suggested that the number of cases climbs as testing increases, adding that the virus is here throughout the county and is spreading through community transmission.

Bellone urged people to keep practicing social distancing and to keep their children, who might otherwise want to congregate in larger groups amid the warmer weather and the time off from school, from gathering.

Suffolk County has tested over 1,500 people to date. Those with symptoms can call 888-364 -3065 to set up an appointment for drive thru testing at Stony Brook University’s South P Lot. Bellone has heard that people have complained about the time they need to wait for an appointment, but he asks for patience amid the growing need. He also reminded residents that they won’t necessarily get a test without medical authorization from a doctor or telephone reference.

The county’s text alert update, which residents can receive by texting CovidSuffolk to 67283, now has 26,000 people signed up, while 5,500 people have signed up to create a Smart911 profile.

The county executive said the county delivered personal protective equipment to hospitals yesterday and is continuing to make similar deliveries today.

Bellone reiterated that “experts have made clear that this virus may not reach its peak for four to five weeks. When it does, we will see the need for hospital beds to rise and potentially rise dramatically. That is an issue of great concern.”

At the same time that hospitals have been able to increase the number of beds in the county by 300, Suffolk County officials are working to identify potential spaces for future sites to treat residents who are battling the virus.

As of earlier today, Suffolk has 479 beds available, including 74 in the intensive care unit.

“The question is not what’s available now, but it’s a question of what’s going to be needed in three to five weeks,” the county executive said.

The county has considered a site adjacent to the jail in Yaphank. They have also spoken with Suffolk County Community College about evaluating space for potential future patients as well.

Despite murmurs that New York City officials are considering a shelter in place order, effectively asking residents to not leave their homes, Suffolk officials said they have no expectations of sheltering in place.

In the meantime, Suffolk County law enforcement have an adequate supply of personal protective equipment, although they are seeking additional equipment in the future, according to Suffolk County Police Chief Stuart Cameron. The police are also modifying some of their procedures and are considering altering some interactions with the public.

“If we can, we are asking members [of the public] to come outside to meet our officers,” Cameron said. “We are much more able to maintain social distance outdoors and are muc less apt to be exposed to surface contamination.”

Additionally, the police department is considering requiring the public to make some routine reports by phone or through a citizen-based online reporting, instead of making it optional.

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Image from CDC

Just a week after Suffolk County had no confirmed cases of the coronavirus Covid-19, the number of positive tests continues to climb. As of Tuesday, the county had 97 positive tests, with 13 in Brookhaven, 24 in Huntington, 11 in Islip and three in Smithtown.

None of the people who tested positive in the county to date is below the age of 18.

At the same time, the number of deaths attributable to the pandemic stood at three, as a woman in her 90s who was at Huntington Hospital died after contracting the virus.

Suffolk County Executive Steve Bellone (D) extended his condolences to the families of those who lost a loved one to the virus.

The County has tested 564 people, with 17 percent testing positive so far.

On a media briefing conference call, Bellone said the “idea that there are individuals that are traveling and bringing the virus here” is no longer relevant. People in the county came down with the virus through community transmission, which is why the county is joining so many other areas of the country in continuing to encourage social distancing while restricting access to sites where people might otherwise congregate, particularly on a day like St. Patrick’s Day. Bars and restaurants will only offer take-out and delivery.

At the same time, the county has closed the Civil Service Office. People can submit test applications online.

Suffolk County has accepted financial aid from the state, specifically $700,000 from the New York State Department of Health. These funds will support the local health department and “critical work on the front lines,” Bellone said.

Additionally, Suffolk County is transferring $500,000 from the Department of Public Works’s Snow Removal Fund to support the Department of Fire, Rescue and Emergency Services. This will support emergency responses efforts underway and will help purchase additional protective equipment.

“We caught a break with snow removal,” Bellone said. “We had very little snow this year.”

Bellone said he continues to work with a business response team, which the Department of Economic Development and Planning and the Suffolk County Department of Labor are leading.

Bellone said the business group was in the “discovery phase” of the plan, as the Department of Labor takes the lead on collecting data from businesses to find out “what’s happening on the ground with their work force.”

Bellone encouraged residents to sign up for Smart911, to provide emergency responders with critical medical information. Residents can sign up through the web site smart911.com. Residents can also sign up for text message updates on their mobile devices if they text CovidSuffolk to 67283.

Suffolk County hopes to have a mobile testing site up and running later this week. Suffolk County residents can make an appointment for a test by calling 888-364-3065. A triage nurse or health care professional will determine if people need tests.

It generally takes two to three days to get the results of the tests.

Separately, starting on Thursday, Stop & Shop will allow seniors who are over 60 years old to shop at their stores from 6 am to 7:30 am. The delis will open at 7 am.

Meanwhile, Brookhaven National Laboratory has suspended site access for all users, visitors and guests starting today, March 17th. The only exceptions are for users who are already on site and for users and guests permanently based at the laboratory. Facilities including the Relativistic Heavy Ion Collider, the National Synchrotron Lightsource II and the Center for Functional Nanomaterials will continue to operate.

BNL has also canceled all of their Educational and Science Learning Center programs through April 17th. The Department of Energy lab will review the program at that point. BNL has also canceled all open-to-the-public events and smaller group public tours for the next 30 days.

The lab is reviewing meetings of more than 30 people over the next month and will decide which to cancel.

BNL is encouraging telework for those people whose job responsibilities allow them to do so. The lab also has a pandemic plan that specifies essential positions and a minimum number of essential employees if they have to go to a reduced level of operations.

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