Monthly Archives: August 2012

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As part of a research group, he studies a wide variety of potential treatments to help patients heal

Burns present an especially challenging problem for doctors and medical researchers. While lacerations and abrasions harm skin directly affected by the injury, a burn can cause damage to skin nearby.

Adam Singer, the director of research for Stony Brook Medical School’s emergency medicine program, has worked with a team of physicians, students and researchers to understand how to limit the damage from a burn.

In the lab, they have tested a range of therapies, from using age-old remedies derived from spices and other natural substances to creating new products.

“Our main efforts are focused on understanding how burns progress,” Singer explained. “Unlike a mechanical injury, where the maximum extent of the injury takes place at the time of wounding, burns tend to extend in depth and size. Burns are more challenging because the injury tends to get worse before it gets better.”

Singer and a team at Stony Brook that includes Dr. Richard Clark in the dermatology department and Mary Frame in the bioengineering department, have studied synthetic products and natural herbs to understand burns.

The researchers examined blood flow in preclinical burn models treated with curcumin. Found in the spice turmeric, curcumin has been used for years in a range of herbal remedies. In testing, curcumin increases the dilation of blood, which might help nearby skin.

Singer explained that curcumin has been used in India before nuptials to add color
to the cheeks of those getting married.

“It was used for centuries in weddings,” explained Singer. “We found out it causes vasodilation. That’s probably how it caused that flushing.”

Singer explained that the medical school has tested other ways of minimizing damage and scarring, including stem cells.

There is no Food and Drug Administration approved treatment that prevents the progression of a burn injury. Treatment using topical solutions or antibiotics promotes healing without infection, but doesn’t address the surrounding skin, he explained.

The research in the emergency department at Stony Brook draws from several places. In addition to a group that could include doctors and Ph.D.s from around the campus, the effort may include postdoctoral students, graduate students, medical students, international fellows and even interested high school students.

“We’ve created one of the first academic associate programs for undergraduate students,” explained Singer. “They spend time in the emergency department, screening and enrolling patients in clinical students. In return, they get credit from
the university.”

He estimated that there are between 20 and 30 undergraduates per semester who rotate through the emergency department.

“There are a wide spectrum of studies, from cell to human patients at all levels of basic research,” said Singer.

Another challenge with burns lies in predicting which ones will be deep and require surgery and which ones will heal on their own.

Doctors currently use laser Doppler to look at the blood flow in a wound. While the Doppler is helpful, it may not be reliable until the third day after a burn or injury. During that time, patients wait in a hospital, where they are exposed to the risk of infection.
The Stony Brook team is looking at novel technologies to try to predict which burns will progress to the point where they’ll require surgery.

One approach is based on infrared light emissions and the other is based on a fluorescent marker. Fluorescein measures flow, whereas infrared light measures temperature, which is dependent on underlying blood flow. The less flow, the colder the skin.

“We’re looking at state of the art technology to diagnose burn depth early to improve the care of patients,” explained Singer, who divides his time equally between treating patients and conducting or directing research.

Singer and his wife Ayellet, who designs jewelry, have three children, Daniel, who is starting medical school, Lee, who is premed, and Karen, who is attending a SUNY School and wants to study biomedical engineering.

Singer, who grew up in Westchester and spent 20 years in Israel, has connections to Long Island that predate his move here. His grandfather, Seymour Singer, was active in the Chamber of Commerce in Smithtown, which named Singer Lane after him. His father grew up in Lake Ronkonkoma.

As for Stony Brook’s research department, Singer explained that it has been involved in trials of products that emergency room physicians use regularly, including glue to seal lacerations and incisions.

Stony Brook was the “largest site in the country” for clinical trials of a glue that has now been used millions of times per year.

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The world’s largest digital camera will help scientists ‘see’ dark matter, asteroids and much more

Paul O’Connor at Brookhaven National Laboratory is part of a team building a combination telescope and camera whose “wow” factor is off the charts. When the Large Synoptic Survey Telescope (LSST) is up and running in 2021, it will allow us to look deep into billions of galaxies, keep a close eye on nearby asteroids and even help us see so-called dark matter, which does not emit, reflect or absorb light.

The LSST will be the largest digital camera in the world, will survey a volume of the universe in its first week of operation larger than all previous telescopes combined, will take three-gigapixel photographs, and will survey the entire sky every three nights.
And, from its perch at 8,800 feet in Cerro Pachon in Chile, the LSST will monitor asteroids near the planet.

The telescope will make an “orbit determination for asteroids that may pose a threat from colliding with our planet,” O’Connor explained.

It will also be able to see dark matter, which comprises 25 percent of the universe, or 5 times more than things we can see, like puppies, the Olympic games and fireworks.

Here’s how it works: the telescope looks at light that comes from incredibly far away that was sent into space billions of years earlier. If there weren’t any dark matter, the light would take a direct route. Dark matter, however, causes the light to bend, as if it were going through a lens. How the light bends reveals the “clumpiness” of the dark matter. (If you’re wondering about the remaining 70 percent of the universe, that’s comprised of dark energy, a force that played a role in cosmic evolution and works against gravity, allowing the universe to expand.)

O’Connor is helping with the “film” part of the camera. The LSST will need over 200 charge-coupled devices, which process even the faintest of signals.

The charge-coupled devices will be arranged in a mosaic inside the telescope and have to be almost perfectly flat when lined up, with no more than a 10-micron tilt in any direction. The thickness of a human hair, by comparison, is 100 microns.

The LSST team has asked private companies to build these charge-coupled devices. When those are completed, the read out time on them will be 10 times faster than the state of the art in astronomy. One of O’Connor’s jobs is to test their work, to make sure they meet the requirements for the telescope.

“We give them our suggested design approach and then we let the companies provide a manufacturing method,” he offered. “When the prototypes come back, we have to verify that they’ve met the requirements. It involves a rigorous test protocol.”

O’Connor, who is the associate division head of the instrumentation unit at BNL, does considerable coordinating between scientists and the manufacturers. He can spend seven hours or more on teleconference calls, speaking with collaborators.

“It’s the nature of big science projects,” he explained. It’s required to keep “coherent, large collaborations functioning and communicating well.”

Assembling and testing the small parts necessary for this three-ton telescope requires clean rooms, where scientists have to wear full-body suits, masks and gloves.

Brookhaven has a clean room and is in the process of building another, which will be finished later this year. Its initial occupant will be the LSST project.

“Human beings are the worst actors in producing particles,” explained O’Connor. “We have to take precautions.”

O’Connor lives in Bellport with his wife Leslie, who is an elected trustee of the village.

The O’Connors have one daughter at Massachusetts Institute of Technology and another who is entering her final year at Bellport High.

When he’s not checking parts for the LSST, O’Connor enjoys kayaking and sailing in the Great South Bay.

As for his work, O’Connor explains that he is “charged to provide the next generation technology in the support of a science mission.” He enjoys the opportunity to work in a multidisciplinary effort. He has also worked on projects closer to home, including developing a process for screening for breast cancer that combines the best of positron emission tomography and magnetic resonance imaging.

“It’s very exciting and satisfying to be able to work in all those fields of cutting edge science,” he explained.

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There may be contradictions with obesity, but risks far outweigh benefits

When studies have unexpected results, I feel the need to investigate further.
In life we run into paradoxes all the time. A paradox is defined as a statement or opinion that seems to contradict itself. For instance, “You should not go near the water until you learn to swim” is a paradox. You can’t learn to swim until you get in the water.

There are two recent apparent medical contradictions, both obesity paradoxes. One refers to heart attacks and the other to type 2 diabetes.

Obesity paradox in heart attacks

A newly published meta-analysis involving two studies finds that obese patient are more likely to survive a heart attack at year one than are patients who have a normal body mass index, known as BMI (Am J Med. 2012 Aug;125(8):796-803).

In other words, the results show that a patient’s risk of mortality from a heart attack is inversely related to weight. Those who were obese had the lowest mortality rate from a heart attack: 4.7 percent. Those who were overweight had a 6.1 percent mortality rate, and those with normal weight had a 9.2 percent mortality rate. This is a paradox. It’s logical to assume the higher the weight the higher the risk of mortality, but that isn’t the case.

Although the reasons were unknown, the authors surmise that this effect may occur because obese and overweight patients seek medical attention with their symptoms earlier than normal weight patients. Overweight and obese patients may have a heighten awareness of their heart attack risk.

So what do we do about the paradox? At face value the study would seem to imply that it is better to be obese, because your prognosis may be better after suffering a heart attack. However, if you look below the surface, it is a more complex issue. Obese patients may be at higher risk for all-cause mortality and
cardiovascular disease.

Obesity’s impact on all-cause mortality

Obesity was found to increase the risk of all-cause mortality. This was demonstrated in a very large observational study, The Nurses’ Health Study, which showed a linear relationship with risk. Patients who were overweight had a 30 to 60 percent increased chance of all-cause mortality, while obese patients had over a 200 percent increased risk of death (N Engl J Med. 1995;333(11):677). Also, gaining 22 pounds or more after age 18 resulted in increased risk of all-cause mortality in middle age.

Obesity and cardiovascular risk

Obesity seems to be an independent risk for heart disease beyond high blood pressure, high cholesterol and type 2 diabetes, according to the American Heart Association (Circulation. 2006;113(6):898).

The Framingham Heart Study, a large observational study, showed a statistically significant increased risk for cardiovascular disease in both overweight and obese patients, with some patients followed for as long as 44 years (Arch Intern Med. 2002;162(16):1867). Those who were obese had the highest risk, with a 46 percent increase in men and 64 percent increase risk in women.

Obesity and fatal heart attacks

In an observational study following men over approximately 15 years, obesity in middle-aged men significantly increased their risk of death from heart attacks (Heart 2011;97:564-568). Interestingly, this study, just like the obesity paradox study, controlled for other risk factors, and even with these taken into account, the men had a 60 percent greater risk of dying from a heart attack. The authors suggest the reason is that inflammation underlies obesity’s effects.

The obesity paradox in type 2 diabetes

There were counterintuitive results in a recent meta-analysis, involving a group of five studies, with participants who became type 2 diabetes patients during the study (JAMA. 2012;308:581-590). The patients who were normal weight were two times more likely to see an increase in total mortality compared to patients who were obese. There was no significance difference in cardiovascular mortality.

The authors could not explain why there was a higher mortality in normal weight patients except to hypothesize that it may have to do with inflammation, pancreatic beta cell functioning and/or the extent of plaque development in the arteries. However, only 11 percent of patients who had type 2 diabetes were of normal weight, whereas 89 percent were overweight or obese.

It is interesting because more than 80 percent of cases of type 2 diabetes are associated with obesity (www.uptodate.com). Some in the medical field have taken to calling the phenomenon “diabesity.” This study reinforces that notion. Even though the normal weight patients had a higher mortality rate, the overall risk of developing type 2 diabetes was much higher in obese patients.

In the accompanying editorial to the diabetes study, the author refers to diabetes patients of normal weight as MONW (that is, metabolically obese normal weight) individuals (JAMA. 2012;308(6):619-620).These are obviously not healthy patients, despite their BMIs being in the normal range. The author recommends healthy weight loss — an alteration in body composition so that there is a loss of fat mass and an increase in lean body mass. This, she suggests, can occur with a Mediterranean-type diet and exercise.

The caveat with normal weight

Normal weight does not necessarily equal health. It is a paradigm that is long overdue for a shift. I hear people say all the time that this person is thin, so he or she must be healthy, and we know that is not necessarily true.

Chronic diseases occur in patients of all different BMIs — cancers, heart disease, autoimmune diseases and even diabetes — although weight may exacerbate or increase risk. The scary part is that almost one quarter of patients in the U.S. are metabolically abnormal, according to the Third National Health and Nutrition Examination Survey (Arch Intern Med. 2008;168(15):1617-1624).

The moral of the story is that it’s important to read between the lines in some studies. Whatever you do, know that there are many complications that are associated with obesity.

Just because there may be an apparent benefit to obesity, there are more downsides. Thin or normal weight does not imply fit or lean body mass. Monitoring body composition changes in combination with a healthy lifestyle is the best defense against getting caught up in the aforementioned paradoxes.

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, go to the website www.medicalcompassmd.com and/or consult your personal physician.

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Caffeine and omega-3 fatty acids may help treat the disease

Dry eye disease (keratoconjunctivitis sicca) is not always dry. Paradoxically, one of its symptoms may be excessive tearing. Other symptoms may include burning, stinging, itching, light sensitivity, dryness, blurred vision and foreign body sensation (Arch Ophthalmol. 2009;127:763-768).Dry eye is a result of either increased tear evaporation or decreased tear production.

Inflammation may play a role in causing or exacerbating dry eye, although the causes are not completely clear. It is associated with chronic diseases, such as diabetes and Sjögren’s syndrome. Some medications such as some antihistamines, some antidepressants, some sleeping pills and some blood pressure medications may also be contributing factors.

Dry eye is very common, affecting approximately 3.9 percent of men between the ages of 50 and 54. Its prevalence doubles to 7.7 percent as men reach 80 years old, according to the Physicians’ Health Study (Arch Ophthalmol. 2009;127(6):763-768). Sixty-six percent of dry eye disease occurs in women and also increases with age (Am J Ophthalmol. 2003;136(2):318-326). While we can’t reduce the risk from aging, this is only one of many factors.

There are a number of risk factors that are modifiable. Diet is one of them, since patients with dry eye may have low vitamin A and low omega-3 fatty acid levels. Vitamin A comes from foods like carrots and broccoli, and omega-3 fatty acids are in fish, nuts, seeds and fish oil. These deficiencies are easily rectifiable and should not go unnoticed.

Treatments of dry eye

There are a variety of treatments for dry eye, ranging from using artificial tears, consuming omega-3 fatty acids and potentially caffeine to the use of topical medications that reduce inflammation, such as cyclosporine and tofacitinib (in the early phases of development) to the placement of punctal plugs in the tear ducts — a minor procedure to block tear drainage.

The impact of omega-3 fatty acids

Why are omega-3 fatty acids important? Omega-3 fatty acids may work, at least partially, by blocking factors that increase inflammation, such as interleukin-1 and tumor necrosis factor-alpha. In the Women’s Health Study, involving 32,470 participants, those who were in the highest intake group for omega-3 fatty acids had a significantly decreased risk of developing dry eye disease, compared to those with the lowest intake of fatty acids (Am J Clin Nutr 2005;82:887-893).

But even more impactful was that those women with the highest ratio of omega-6 (pro-inflammatory) to omega-3 (anti-inflammatory) fatty acids had an increased risk of dry eye that was more than 2.5-fold greater than those with a much lower ratio of less than 4:1.

Interestingly, in the standard American diet that most of us eat, the ratio of omega-6 to omega-3 is about 20:1, whereas with a high nutrient, plant-rich diet, the ratio hovers around the optimal greater than 4:1 ratio.

Fish oil supplementation types: triglyceride vs. ethyl ester

The type of fish oil may also make a difference when supplementing with omega-3 fatty acids. A triglyceride formulation is the natural form of fish oil. In a study, it seems that the triglyceride formulation is absorbed to a greater extent than the ethyl ester formulation, which may translate into better results with treating dry eye (Biochem Biophys Res Commun. 1988 Oct 31; 156(2):960-3). Patients may be able to decrease the dose, and thus potential side effects, with the triglyceride formulation. To boost omega-3 levels, take fish oil with a meal containing some good fats. Eating fish may be the best way to get the natural triglyceride formulation (Lipids. 2003;38:415-418).

Caffeine effects

In a small double-blind crossover trial (meaning both groups in the study will eventually consume caffeine), caffeine appears to increase the capability of the dry eye patient to increase tear production (Ophthalmology. 2012 May;119(5):972-8). This may help overcome the symptoms of dry eye for patients. Caffeine seemed to increase the amount of tears in the eye — by 30 percent. There were 78 participants in the study, and it was only two sessions long, spanning a six day interval. Though the results are impressive, more study is obviously needed. Daily caffeine intake also seemed to have an impact on increasing tear production.

Disease association and inflammation

It makes sense that dry eye is associated with diabetes, rheumatoid arthritis and Sjögren’s syndrome — the latter two being autoimmune diseases — because these diseases have inflammatory components. In a study, there was a linear association between the risk of dry eye and diabetes (BMC Ophthalmology, June 2008). In other words, the longer patients had diabetes, the higher the probability of having dry eye disease. Also, patients who had diabetic retinopathy, a complication of diabetes affecting the back of the eye, were at greater risk of developing dry eye. This is just another reason that it is so important for diabetes patients to keep their blood glucose levels under control with lifestyle modifications and/or medications. Diabetic retinopathy occurs when blood sugar levels are too high on a chronic basis.

Thus, though dry eye is a common malady, there are a variety of ways to treat the disorder. It is important to not only get enough omega-3s, but also to optimize the ratio of omega-6 to omega-3s. This will only happen if patients embrace a nutrient-rich diet. Consult your ophthalmologist for the most effective treatment for you. However, increasing omega-3s with diet is only beneficial so it won’t hurt to embrace dietary changes.

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, go to the website www.medicalcompassmd.com and/or consult your personal physician.

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Some have suggested that the link is so tight that they are manifestations of the same disease

The answer is A, not B. The appointment was at 11 am on Tuesday, not 1 pm. The Magna Carta was signed in 1215, not 1512. You’re wrong, you’re wrong, you’re wrong!

Those are innocent enough mistakes. It turns out, though, that the neurological reaction to those mistakes is different for some children, especially those with anxiety disorders.
Stony Brook assistant psychology professor Greg Hajcak (pronounced “high-chuck”) has found that the brains of different children react to mistakes differently. An anxious child will likely have a larger neurological response than the brain of someone who shows no signs of anxiety.

Hajcak treats patients at the Anxiety Disorders Clinic while he also does research to look for ways the brains of people with different disorders react under various conditions.

In a doctor’s office, many children present symptoms that are nearly identical in cases of anxiety or depression.

“The link in anxiety and depression is so tight that some have suggested these aren’t really separate diseases, but are manifestations of the same disease,” Hajcak offered.

That’s not the case, however, when the brain responds to mistakes. Putting caps that look like Olympic swimwear (except for the noninvasive electrodes inside them) on the heads of his young subjects, Hajcak conducted electroencephalograms (EEGs) as his young charges performed tasks in his lab. The children with anxiety disorder showed stronger electrical reactions after errors even than those with depression.

This kind of information could be helpful for parents and doctors, especially if it provides early evidence of the development of emotional challenges.

Hajcak’s research provides the “notion that we could have unique markers for these difficult-to-distinguish disorders,” he suggested. “We might be able to say what the earliest place where we could differentiate the trajectories of risk.”

That could be useful for the 10 to 20 percent of the population that will likely have an anxiety disorder before they’re 18, explained Hajcak.

To be sure, Hajcak and other researchers are years from being able to connect brainwave activity in response to a test or set of tests to the likelihood of a disorder.
Nonetheless, these types of studies are important first steps in looking for signs of anxiety or depression that could become useful for children, parents, and mental health professionals.

Hajcak recognizes that these markers could suggest to parents what kind of programs might help their children if they see signs of anxiety.
Like any biological marker, a potential sign for anxiety disorder could become one part of the total medical picture.

“If we know that child A vs. child B is at risk, it’s just a risk factor,” he explained.
The son of a retired clinical psychologist, Hajcak described himself as a “more worried kid” when he was younger. “Lots of people in clinical psychology would say that people tend to study things that are more relevant to them. Those personality features drew me to the anxiety world.”

A resident of Manhattan who commutes to Stony Brook to do his clinical and research work, Hajcak said he had a unique opportunity when he attended graduate school at the University of Delaware to study with Edna Foa, who works at the University of Pennsylvania. Foa, whom Hajcak described as “one of the foremost experts on anxiety disorders,” was named one of Time Magazine’s 100 most influential people in the world in 2010.

Hajcak worked with Foa for four years, during which time he learned “everything I know about anxiety disorders and their treatment,” including cognitive therapy, an especially effective solution for anxiety.

“Treating anxiety disorders is so fulfilling,” he offered. “It works so well: 75 percent or more of people will see at least a 50 percent reduction in symptoms. That’s pretty much as good as it gets in the mental health world.”

Hajcak got engaged earlier this month to Christine Proudfit, an obstetrician/ gynecologist who works with high-risk pregnancies at New York University. The couple, who work out together at the gym, also have plans to marry their professional pursuits. They have talked about examining how anxiety among low and high-risk populations relates to obstetrical and neonatal outcomes.

In the world of pregnancy, labor and childbirth, where new mothers face daunting challenges, anxiety can go hand-in-hand with picking out names and shopping for baby clothing.

“Unknowns and uncertainty,” explained Hajcak “are the wind in the sails of anxiety.”

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Vitamin D levels may be inversely related to disability in M.S. patients

Medicine has made great strides in the treatment of multiple sclerosis over the last few decades.
M.S. is an autoimmune disease, where there is underlying inflammation and the immune system attacks its own tissue. This causes demyelination, or breakdown of the myelin sheath, a protective covering on the nerves in the central nervous system. The result is a number of debilitating effects, such as cognitive impairment, numbness and weakness in the limbs, fatigue, memory problems and inflammation of the optic nerve causing vision loss and eye pain (optic neuritis), and mobility difficulties.

There are several forms of M.S.. The two most common are relapsing-remitting and primary-progressive. Relapsing-remitting has intermittent flare-ups and occurs about 85 percent to 90 percent of the time. Primary-progressive (steady) occurs about 10 percent of the time. Relapsing-remitting may eventually become secondary-progressive M.S., which is much harder to control, although dietary factors may play a role.

Diagnosis and progression

M.S. is diagnosed in several ways. The ophthalmologist may be the first to diagnose the disease with a retinal exam (looking at the back of the eye). If you have eye pain or sudden vision loss in one eye, it is important to see your ophthalmologist.

Another tool in diagnosis is an MRI of the central nervous system. This looks for lesions caused by the breakdown of the myelin sheath.

The MRI can also be used to determine the risk of progression from a solitary CNS lesion to a full-blown M.S. diagnosis. This is accomplished by examining the corpus callosum, a structure deep within the brain, according to a recent presentation at the European Neurologic Society (Abstract O-293; June 2012).

Approximately half of patients with one isolated lesion will progress to clinically definite M.S. within six years. An MRI may be able to predict changes in this portion of the brain within two years. Patients with a family history of M.S. should discuss this diagnostic with a neurologist.

Medication

Interferon beta is the mainstay of treatment for M.S. for good reason. Data shows that it reduces recurrence in relapsing-remitting M.S. and also the number of brain lesions.

However, in a recent study, interferon beta failed to stop the progression to disability in the long term (JAMA. 2012;308:247-256). Many M.S. patients will experience disability over 20 years. Ultimately, what does this mean? Patients should continue therapy, however they should have realistic expectations. This study was retrospective, looking back at previously collected data — not the strongest of studies.

Vitamin D impact

Vitamin D may play a key role in reducing flare-ups in relapsing-remitting M.S.. There were several studies that showed this benefit with vitamin D supplements and/or with interferon beta.
In one study, interferon beta had very interesting results showing that it may help increase the absorption of vitamin D from the sun (Neurology. 2012;79:208-210). This was a randomized controlled trial, the gold standard of studies, involving 178 patients. The study’s authors suggest that interferon beta’s effectiveness at reducing the frequency of relapsing-remitting M.S. flare-ups may have to do with its effect on the metabolizing of vitamin D.

In those who did not have higher blood levels of vitamin D, interferon beta actually increased the risk of flare-ups. Physicians should monitor blood levels of vitamin D to make sure they are adequate. It may be beneficial for M.S. patients to get 15 to 20 minutes of sun exposure without sunscreen per day. However, patients with a history of high risk of skin cancer should not be in the sun without protective clothing and sunscreen.

In a prospective (forward-looking) observational study, patients with higher levels of vitamin D, even in those without interferon beta treatment, had reduced risk of relapsing-remitting M.S. flare-ups (Neurology. 2012;79:254-260).The patients with higher levels had 40 ng/ml, and those with lower levels had 20 ng/ml. Patients’ blood samples were assessed every eight weeks for a mean duration of 1.7 years. The relationship with vitamin D was linear — as the blood level increased two-fold, the risk of flare-ups decreased by 27 percent.

In an RCT, higher levels of vitamin D in the blood showed a trend toward reduced disability in timed tandem walking and in disability accumulation (J Neurol Neurosurg Psychiatry. 2012;83(5):565-571). The results did not reach statistical significance, but approached it. A much larger RCT needs to be be performed to test for significance.

Diet and lifestyle

Interestingly, a recent study found that caffeine, alcohol and fish — fatty or lean — intake may result in delay of secondary progression of relapsing-remitting M.S. (Eur J Neurol. 2012 Apr;19(4):616-24). This observational study involved 1,372 patients. The reduction in risk of disability was as follows: moderate daily alcohol intake resulted in a 39 percent reduction; daily coffee consumption showed a 40 percent reduction; and fish two or more times a week showed a 40 percent reduction. All of these results were compared to patients who did not consume these items. However, the same effect was not shown in primary-progressive M.S. patients: fatty fish actually increased risk of progression, compared to lean fish.

With M.S., vitamin D blood levels may be critically important. They are one of the easier fixes, although it may take higher doses of vitamin D supplementation to reach sufficient levels, once low. While food (fish with bones, for example) provides vitamin D, it falls short of the amount needed by an M.S. patient. Interferon beta and vitamin D supplementation may have added effects. Lifestyle changes or additions also have tantalizingly appealing possibilities.

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, go to the website www.medicalcompassmd.com and/or consult your personal physician.

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The physicist turned biologist working to map the entire brain’s circuitry

Partha Mitra sees a landscape dotted with isolated settlements. The researchers in each region focus on their area, but few have taken a step back to tackle the total terrain. A professor in neuroscience and theoretical biology at Cold Spring Harbor Labs, Mitra’s landscape is the brain. The Calcutta-born scientist wants to change that by mapping the entire brain circuitry.

“Parts of the brain get neglected,” he asserted. “I want to get coverage of the whole brain.”

There is considerable scientific research into the regions of the brain responsible for vision and smell, for example, but the core circuitry where emotions reside — apart from the “fear” and “reward” circuitry, has received considerably less attention.
Looking at the interaction of the entire mouse brain should provide a database that researchers exploring a wide range of topics — from evolution to psychiatric disorders — may employ.

Up until the last decade, a significant problem has been the cost of looking at the whole brain. In 1990, the expense for examining a mouse brain at a resolution of one micron was in the millions of dollars. Just for a sense of scale, a human hair is about 100 microns thick. Now, scientists can gather and store that information, which uses as much as 1 terabyte, or 1,000 gigabytes of computer storage, for closer to hundreds of dollars.

Mitra has taken what he calls a meso-level approach to the brain.

“We’re using classical neuroanalytical methods,” Mitra offered. “We inject a tracer into a part of the brain and let neurons transport that, either from synapse to cell body or from cell bodies to synapses.”

The big picture map of the brain is similar to what genetic scientists did when they mapped the human genome. By recognizing how the genome comes together, researchers can look for changes to understand diseases.

A more complete overview of the brain’s circuits could also help provide evidence in evolutionary debates.

“There are big controversies” relating to the brains of different animals, Mitra explained. “There is no empirical evidence to settle the controversy.”

Scientists used to believe brains evolved like onions – with a reptilian core, a “bird brain” intermediate shell and a mammalian cortical outer layer. While this theory has been discredited and scientists have suggested there are portions of the bird brain that are similar to the cortex, the controversy continues.

“Having the circuit diagram for the mouse brain and a comparative diagram for the bird brain of an appropriate species will help settle this,” he explained.

Mitra believes the publication process could use modification and improvement. Within minutes of something major happening in Egypt, people around the world can learn about it. A major advance in a scientific lab, however, can sometimes take years before people see it.

To that end, Mitra releases data as it comes off his experimental pipeline before publishing a manuscript on the subject. While this model is more common in physics, it hasn’t gained the same kind of traction in the biology community.

“The style now accepted in the physics community seems to be a better solution as it speeds up the communication of results,” he suggested.

Mitra believes an author-driven, freely published preprint, followed by a more traditional journal publication, strikes a balance between the conventional publication model and the potential for sharing results in real time.

When he’s not at the lab or at home in Manhattan, Mitra enjoys the chance to practice yoga. He attends three to six classes a week. A certified instructor, he hasn’t taught yoga since last fall.

He has been at Cold Spring Harbor since 2003. He earned a PhD in physics from Harvard and then went to Bell Labs, where he registered for about 10 patents, including improving wireless transmission capacity and holographic data storage.
Mitra also did research for about a decade examining song learning in the Zebra Finch. He believes nature plays a more important role in learning songs than had previously been thought.

The physicist turned biologist — who has also recorded a CD of himself singing Indian music — acknowledged he doesn’t fit into the usual mold of a biomedical researcher.

“I keep a broad scope,” he concluded.

Suffolk officers revive two people days after department puts overdose-ending medicine into police cars

File photo

Jeff Reynolds recently attended a funeral in Huntington for a young woman, a heroin addict who had gotten clean but died of an overdose after a relapse. Reynolds, the executive director of the Long Island Council on Alcoholism and Drug Dependence, said two weeks later, the young woman’s boyfriend also died from an overdose.

Drug use has become more and more of a problem on Long Island in recent years. According to a special grand jury report from the Suffolk County District Attorney’s office, there were 231 overdose deaths from controlled substances in Suffolk County last year.

Opioid painkillers accounted for 75 percent of them.

But an initiative to combat opioid overdoses — from drugs like heroin, Vicodin and Percocet — is already showing promise, just days after it was launched. Suffolk County Police Department’s Michael Alfieri, an officer in the 7th Precinct, responded to a call of an overdose in Mastic Beach last week. According to the police, Alfieri found a 27-year-old man unresponsive and not breathing, and revived him by intranasally administering Naloxone, an opioid blocker known by its brand name, Narcan. The officer also gave the man oxygen before he was transported to the hospital. That overdose victim survived.

Officers Thomas Speciale and David Ferrara revived a woman in Lake Ronkonkoma who had overdosed on heroin on Aug. 5. The 4th Precinct officers responded to a 911 call at 1:20 pm and found the 21-year-old woman in a parked car, unresponsive and barely breathing, police said. Speciale administered Narcan and Ferrara provided additional medical care before the woman was transported to the hospital for treatment.

The New York State Department of Health piloted a program that allows those in certain counties, including Suffolk, with basic life support training, such as volunteer emergency medical technicians, to administer Narcan. Previously, it was limited to those with advanced life support training.

Legislator Kara Hahn (D-Setauket) sponsored a bill, which the county Legislature adopted, that expanded this to include officers in the Suffolk County Police Department, many of whom have basic life support training. A police spokesperson said it is being piloted in the 4th, 6th and 7th Precincts and the Marine Bureau, and 267 officers have already been trained to administer the intranasal medicine.

“Our officers are first on the scene in virtually all medical emergencies,” Dr. Scott Coyne, SCPD’s chief surgeon and medical director, said in a phone interview. He said it is important that officers have resources like Narcan to treat people because “it’s really during those first critical minutes that they mean the difference between life and death, particularly in overdose situations.”

Last Monday was the first day the officers were on the street with Narcan, according to the police department. Alfieri saved the man who overdosed two days later, and Speciale and Ferrara saved the Lake Ronkonkoma woman on Sunday.

“There was one less mother grieving for her child,” Hahn said in a phone interview after the first incident. She expressed her hope that the program would save more lives in the future.

Reynolds said Narcan works by quickly surrounding opiate receptors, blocking the drug’s ability to access the brain. “The person will experience some withdrawal but the overdose will come to an immediate end.”

Other benefits of the medicine are that it’s inexpensive and there aren’t any negative consequences if it is administered to someone who has not overdosed on opioids, Reynolds said. Signs of an overdose include blue nail beds, blue lips, unconsciousness and the inability to remain upright.

Dr. Coyne said, “Undoubtedly this pilot program will be a great benefit to the citizens of the county and particularly it’s going to result in, I believe, many lifesaving events.” Dispatchers are receiving more and more calls about drug overdoses, he said, adding that 60 police cars now carry Narcan.

Other states have had success with similar programs. According to The Boston Globe, Narcan reversed more than 1,000 opioid overdoses in 12 Massachusetts cities between 2007 and 2011 through a pilot program that allowed substance abuse treatment centers to train people how to use the overdose antidote.

Dr. Coyne said the SCPD precincts piloting the Narcan program were selected because they appeared to have more overdoses. The Marine Bureau was chosen because it serves Fire Island, and the time it takes to transport someone to a hospital could be longer than in other places.

Dr. Coyne and Hahn both said they would like to see the local program expanded and Reynolds said Narcan “should be in every police car,” and even school nurses and parents of addicts should carry it.

For friends and family of those addicted to opioids, LICADD trains people to identify an overdose and administer Narcan through an injection into the leg — different from the police department’s aspirator — and sends trainees home with two vials of Narcan and two syringes.

Reynolds said the best way to prevent an overdose is to not use drugs in the first place, but that Narcan is an important measure in helping those struggling with addiction survive long enough to receive help.

He said Narcan “gives these kids a second shot.”

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You don’t need to be an Olympian to get gold medal results

I am inspired by the 30th Olympiad to discuss the implications of exercise. It would be nice if we could all be in the shape of Olympians, but most of us simply hope that, if we exercise more, we will burn more calories and lose more weight. However, there is a new study addressing this assumption, and the results are disappointing.

Does this mean we should give up exercise, or that exercise has little impact on our lives? The answer is a resounding “no.” We have to look beyond weight loss, just as we do when considering the differences in diets — as I did in last week’s article — to disease prevention and modification.

We know that exercise can alter the course of many chronic diseases, including the top 10 diseases responsible for killing many Americans, including diabetes, heart disease, stroke and cancer. I am going to focus on diabetes treatment and prevention, highlighting several recent studies.

Weight loss and exercise

The presumption has always been that if we exercise, we will lose weight equivalent to the amount of effort that we put into the activity. But, as many of us have experienced, we lose weight at a slower rate than predicted, maintain our weight or even continue to gain weight. Why is this?

In a study, anthropologists looked at a tribe in Tanzania to try to explain why exercise does not seem to reduce weight to the degree that we would expect (PLoS One. 2012;7(7):e40503). They followed the Hadza tribe — hunter and gatherers — for 11 days with GPS, tracking how active they were and their metabolic rates. While they were more active than most Americans — seven miles a day for men and three miles a day for women — they did not have a higher resting metabolic rate. In other words, they were not burning more calories. Their bodies seemed to adapt.

The authors, therefore, surmise that exercise cannot overcome the typical western high-calorie diet. This seems to be reinforced by another study that concluded the same thing about calorie-dense diets being hard to overcome (Obes Rev. 2012 Jun 11). For those of you who think that exercise is a pass to eat what you want, think again.

Also, lower body mass burns fewer calories for the same level of effort. For example, if my wife and I get on two treadmills with the same settings and for the same period of time, since I weigh more, I burn more calories than she does.

The researchers who investigated the Hadza tribe, did not look at weight-lifting or resistance training and their impacts on body composition. As we build muscle, it may be hard to lose weight. A pound of muscle, while weighing the same as a pound of fat, has a higher density. So you can be fit without losing as much weight as you replace fat with muscle. Just look at those Olympians.

Weight-lifting impact

Resistance training seems to have more of an impact on body composition. In a randomized controlled trial of women, ages 25 to 44, participants who were in the treatment group saw a significantly greater reduction in body fat percentage than the control group, at 3.8 percent and 0.14 percent respectively (Am J Clin Nutr. 2007 Sep;86(3):566-72). The treatment group followed a regimen of strength training twice a week, compared to the control group, who were given brochures for aerobic exercise.

Aerobic and anaerobic impact on diabetes

In a meta-analysis (a group of studies, including a very large prospective observational study called EPIC), patients who had diabetes at baseline and were physically active had a much lower risk of dying from cardiovascular disease and a significant reduction in total mortality, compared to those who were least active (Arch Intern Med. online August 6, 2012). Interestingly, the group that did moderate amounts of activity daily saw the largest reductions in overall mortality and death due to cardiovascular disease, at 38 percent and 49 percent respectively. Therefore, you don’t have to be an Olympian to get gold medal results in preventing complications from diabetes.

There were also surprisingly inspiring results with short durations of exercise in diabetes. Three short anaerobic exercise bouts of 10 minutes each daily were potentially more efficacious in helping to control glucose levels in diabetes patients, compared to 30 minutes once a day, as the results showed in a small randomized controlled trial (Diabetologia. 2007 Nov;50(11):2245-53).

Intensity did not seem to be as important as duration in preventing diabetes. In the Health Professionals Follow-up Study, 150 minutes a week of strength training or aerobic exercise are critical to reducing diabetes risk (Arch Intern Med. online August 6, 2012), at 34 percent and 52 percent respectively. The greatest reduction in risk was when participants did a combination of strength and aerobic activities within the 150 minutes.

So the message ultimately is that putting on lean body mass by weight lifting may be a more effective way to change body composition than aerobic exercise alone. And aerobic exercise has tremendous benefits in treating and preventing chronic disease, even in moderate amounts done in short bursts. Ideally, lifestyle modifications should include both exercise and diet in order to reach weight-loss goals.

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, go to the website www.medicalcompassmd.com and/or consult your personal physician.

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A low-carbohydrate, high-protein diet may increase cardiovascular disease risk

The hotly debated topic about the importance of diet type was in the news recently. In terms of weight loss, a calorie may be a calorie. However, in terms of its effect on body composition, disease modification and prevention, this may not be true. Some diets may have more beneficial or detrimental effects on health than others.

A low-carb, high-protein and high-fat diet

There was a recent study that showed a low-carbohydrate, high-protein diet was more effective at burning calories after initial weight loss than other diets (JAMA 2012 Jun 27; 307:2627). In this study, patients were given a 12-week “washout period” where they lost 10 to 15 percent of their body weight. They were then put on three different diets and assessed over a four-week period with each: a low glycemic index diet, a low-fat diet and a very low-carbohydrate diet.

The diet that seemed to show the most benefit for maintaining weight loss was the very low-carbohydrate diet, which was high in protein and high in fat — an Atkins-type diet. This diet lowered the resting energy expenditure the least, meaning that the body burned calories more efficiently. Patients expended 300 more calories on this low-carbohydrate diet than on the low-fat diet and 150 more calories than on the low glycemic index diet. This study was a prospective (forward-looking) randomized crossover trial involving 21 young obese and overweight adults; each participant was on each diet for a month. However, the study’s duration may be too short to tell us anything meaningful.

Why did the low-carbohydrate diet show the best results for maintaining weight loss and burning more calories? This question was answered in the Science Times section of The New York Times on July 9 by Dr. Jules Hirsch, emeritus physician in chief at Rockefeller University. He has a background that includes 60 years of obesity research, and he believes that the difference seen with the Atkins-type diet was due to water loss. He says that, ultimately, weight loss is dependent on the traditional formula — the amount of calories consumed minus the amount of calories burned on a daily basis — not the diet’s composition. He aptly points out, however, that diets’ compositions are important, because they affect patients’ overall health.

Low-carb, high-protein diet negative effects

Ironically, another study published the same week as the JAMA study showed a potentially increased risk of cardiovascular disease with a low-carbohydrate, high-protein diet (BMJ 2012 Jun 26; 344:e4026). The study was a prospective trial involving 43,396 Swedish women with a 15.7 year duration. There was a 4 percent increase in risk for every 10 percent increase in protein or, as the authors point out, for every additional boiled egg consumed. This is a modest, yet harmful, effect.

Low-carb, high-protein diets have also shown an increased risk of kidney stones. There was a doubling of uric acid levels in the kidney and a significant increase in urine calcium levels over a six-week period (Am J Kidney Dis. 2002 Aug;40(2):265-74). The weaknesses of this study are that it was small, 10 participants, and short in duration. However, it does make you think that low-carb, high-protein diets from animal sources may not be the best option for overall health.

Interestingly, another study showed that a low-carb, high-protein diet may vary in its effects, depending on the source of protein (Ann Intern Med 2010;153:289-298). If high protein levels and fat came from animal sources, then there was an increased risk of death from heart disease and cancer — 14 percent and 28 percent respectively. However, if the protein and fat came from plant sources, such as nuts and beans, the risks of all-cause mortality and mortality from cardiovascular disease were decreased by 20 percent and 23 percent, respectively, over the same length of time. The study was a meta-analysis (a group of two studies) that included the Nurses’ Health Study, with over 85,000 women, and the Physicians’ Health Study, with approximately 45,000 men, with a duration of 26 years and 20 years of follow up, respectively.

Mediterranean diet’s effect on body composition

We know a Mediterranean-type diet has profound effects on risk reduction for many diseases (BMJ 2008;337:a1344). Recently, I had a patient who began a nutrient-rich, plant-based diet with an incremental approach. After one month of having altered one meal a day, the patient lost two pounds.
However, this was not the whole story. Using a clinical-trial-grade body composition scale, I found that the patient had lost 10 pounds of fat mass, 4 percent body fat and had gained 7 pounds of fat-free mass, most of it water, without having exercised during the month. This demonstrates that a diet can do far more than alter body weight.

No one will argue that weight loss is important, especially for those patients who are obese. However, when looking at a diet, it is important to also consider its effectiveness for disease treatment and prevention. Diets that are considered to be most effective include a Mediterranean-type diet, the DASH diet, the Ornish diet and any other diet that is plant-based and nutrient-rich. Why lose weight for vanity only, when you can lose weight and gain health at the same time?

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, go to the website www.medicalcompassmd.com and/or consult your personal physician.

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