Monthly Archives: November 2012

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Statins may reduce some cancer risks but contribute to fatigue

Statins are one of the most commonly prescribed medications in the United States. Yet, some in the medical community believe that more patients should be on this class of drugs while others think it is one of the most overprescribed medications. Suffice to say, this is one of the most polarizing topics in medicine — probably rightfully so.

The debate is over primary prevention with statins. Primary prevention is treating people with high cholesterol and/or inflammation who may be at risk for a cardiovascular event, such as a stroke or heart attack. Fortunately, most physicians would agree that statins have their place in secondary prevention — treating patients who have had a stroke or heart attack already or have coronary artery disease.

We are going to look at benefits and risks for the patient population that could take statins for primary prevention. On one side, we have the statin as Rocky Balboa, coming out to fight off cancer risk, both overall and esophageal, as well as improving quality of life and eye disease (glaucoma). On the other, we have the statin as Evel Knievel, demonstrating that being reckless doesn’t provide longevity, promotes fatigue and increases eye disease (cataracts). Let’s look at some of the evidence.

Effect on cancer

A recent study published in The New England Journal of Medicine involved 300,000 Danish participants and investigated 13 cancers. It showed that statin users may have a 15 percent decreased risk of death from cancer (N Engl J Med 2012;367:1792-1802). This is exciting news.

However, there were major limitations with the study. First, the researchers did not control for smoking, which we know is a large contributor to cancer. Secondly, it was unknown which of the statin-using population might have received conventional cancer treatments, such as radiation and chemotherapy. Thirdly, the dose of statins did not correlate to risk reduction. In fact, those who took 1 percent to 75 percent of prescribed statin levels showed more benefit in terms of cancer-mortality risk than those who took more. There needs to be a better-designed trial that is prospective (forward looking) to determine whether there really is an effect. I would say that Rocky Balboa came out of this fight pretty banged up.

Another study showed that statins may play a role in reducing the risk of esophageal cancer. This is important, since esophageal cancer, especially adenocarcinoma that develops from Barrett’s esophagus, is on the rise. The results showed a 30 percent risk reduction in this type of cancer. The authors of the study surmise that statins may have a protective effect. This was meta-analysis of 13 observational studies. The study abstract was presented at the American College of Gastroenterology 2012 Annual Scientific Meeting (Abstract 1 May 22, 2012).

Although there is an association, these results need to be confirmed with randomized controlled trials. Remember, aspirin has about the same 30 percent reduction in colorectal cancer, yet is not recommended solely for this use because of side effects.

Eye diseases: mixed results

In two common eye diseases, glaucoma and cataracts, statins have vastly different results. In one new study, statins were shown to decrease the risk of glaucoma by 5 percent over one year and 9 percent over two years (Ophthalmology 2012;119(10):2074-2081). It is encouraging that the longer the duration of statin use, the greater the positive effect on preventing glaucoma.

Statins also help to slow glaucoma progression in patients suspected of having early-stage disease at about the same rate. This was a retrospective study (backward-looking) analyzing statin use with patients at risk for open-angle glaucoma. There is a need for prospective (forward-looking) studies. With cataracts, it is a completely different story. Statins increase the risk of cataracts by over 50 percent, as shown in the Waterloo Eye Study (Optom Vis Sci 2012;89:1165-1171). Statins exacerbate the risk of cataracts in an already high-risk group: diabetes patients. For more details on this topic, see my Oct. 18 article, “Taking cataracts seriously to maintain good health.”

Quality of life and longevity: a mixed bag again

In a meta-analysis involving 11 randomized controlled trials, considered the gold standard of studies, statins did not reduce the risk of all-cause mortality in moderate to high-risk primary prevention participants (Arch Intern Med 2010;170(12):1024-31). This study analysis involved over 65,000 participants with high cholesterol and at significant risk for heart disease.

However, in this same study in Archives of Internal Medicine, participants at high risk of coronary heart disease saw a substantial improvement in their quality of life with statins. In other words, the risk of a nonfatal heart attack was reduced by more than half and nonfatal strokes by almost half, avoiding the potentially disabling effects of these cardiovascular events.

Fatigue effect

Some of my patients who are on statins ask if statins can cause fatigue. The answer is “maybe,” but now there is a randomized controlled trial that reinforces the idea that statins increase the possibility of fatigue (Arch Intern Med 2012;172(15):1180-1182).

Women, especially, complained of lower energy levels, both overall and on exertion, when they were blindly assigned to a statin-taking group. The trial was composed of three groups: two that took statins, simvastatin 20 mg and pravastatin 40 mg; and a placebo group. The participants were at least 20 years old and had LDL (bad) cholesterol of 115 to 190 mg/dl, with less than 100 mg/dl considered ideal.

In conclusion, some individuals who are at high risk for cardiovascular disease may need a statin, but with the evidence presented it is more likely that statins are overprescribed in primary prevention. As www.update.com points out, evidence of the best results points to lifestyle modification, with or without statins, and all patients with elevated LDL (bad) cholesterol should make changes that include a nutrient-dense diet and exercise.

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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Decreased sardine yield and rising water temperatures are part of global warming trend

As if the southern Caribbean weren’t already hot enough, the water temperature has climbed in the last 14 years at the same time that trade winds have weakened. While this may sound encouraging to scuba divers, it’s not such good news for plankton, the sardines that feed on them and the Venezuelan fishermen who depend on these small fish for their livelihood.

Above the Cariaco Basin, an ocean trench a few miles offshore from Venezuela, a local decline in trade winds has limited the movement of nutrient rich waters, contributing to a reduction in plankton production and, in part, to a collapse in local sardine fisheries, according to research by Gordon Taylor, a professor of microbiology at Stony Brook’s School of Marine and Atmospheric Sciences.

Working in collaboration with Mary Scranton, a Stony Brook professor, as well as researchers at several other U.S. and Venezuelan institutions, Taylor has traveled from Stony Brook to Venezuela every six months, monitoring oxygen, carbon, sulfur, nitrogen and other metals in the water, as well as the abundance and growth of microorganisms from the surface to the sea floor.

The decline in sardines, as measured by some of Taylor’s colleagues, has been dramatic. Sardine fishery landings were 40,000 tons in the last year, down dramatically from 200,000 tons in 2004. Overfishing also contributed to the steep drop.

Slower trade winds are a problem for the region because they interfere with a process called nutrient upwelling. The deeper, cooler regions of the ocean have more nutrients because that’s where plants and animals decompose. As this living matter sinks, it releases “the Miracle-Gro of the ocean,” Taylor explained.

The chemicals involved in water cycling through the ocean include nitrogen, phosphorous, silica and trace metals — some similar components people put on their lawns or potted plants.

The nutrients in the colder water typically cycle towards the surface. In upwelling, friction from winds pushes surface water away from the coast. That brings deeper, nutrient-rich water to the surface to replace it. With the change in the winds, the nutrients don’t reach the basin.

At the same time, the temperature of the water has increased by about 1.1 Celsius degree. While Taylor acknowledged that “1 degree doesn’t sound like a lot,” he urged people to “keep in mind that 1 degree represents a tremendous amount of heat being stored in the ocean.”

Global warming is causing both the higher water temperatures and the change in the trade winds, Gordon asserted.

“All indications from the International Panel on Climate Change is that the heat budget for the planet is on a one-way track at the moment because of fossil fuel combustion,” he said. “We continue to add more carbon dioxide to the atmosphere much faster than it’s being consumed.”

The Stony Brook professor said he has been aware of climate change for four decades, but his research has helped him understand the pace of that change.

“I was aware of the Greenhouse Effect back in my college days in the 1970s,” he indicated. “However, I remained skeptical about how fast it may be occurring, its dangers and didn’t appreciate the many ramifications of climate change until about 15 to 20 years ago.”

His studies, however, suggested “how fast the effects can be detected in the Tropics.” He cautioned that once the planet crosses a tipping point, the ecosystem can enter a “new state in a very short amount in time.”

Taylor lives in East Setauket with his wife, Janice, and their Rhodesian ridgeback dog, which is all of 113 pounds and is still not fully grown.

Their daughter Olivia just completed a program in fine arts. She lives in Manhattan, where she paints and sculpts, and works in a clothing boutique in SoHo.

Taylor has also studied the western part of the Long Island Sound, where he has examined the physical, chemical and biological causes of low oxygen levels, or hypoxia.
Taylor enjoys traveling to Venezuela, where he can continue to gather information, visit with colleagues, and study an area that he’s gotten to know well over the more than a decade since he started collecting water samples.

He has a “terrific set of friends” that he started this project with and, because he’s been doing this for so long, they’re all “growing old together.”

The microbes that are the subject of his work and his teaching at Stony Brook “are underappreciated,” he suggests. “We all owe our existence to them.”

Correction:
In the Power of Tree column that ran last week (Nov. 22), the caption for Esther Takeuchi incorrectly indicated her location. She was in her lab at Stony Brook University. She has a joint appointment from SBU and Brookhaven National Laboratory. The photo was provided by SBU. We regret the errors.

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Roller derby gets the adrenaline pumping

When asked to describe roller derby in one word, the girls of Strong Island Derby Revolution kept saying the same thing: “Awesome.”

It isn’t surprising though, as there isn’t any sport that really compares to roller derby — the derby names, the high energy, the cringe-worthy wipeouts, the makeup and uniforms — whose leagues have taken roller rinks by storm over the past few years. Strong Island Derby Revolution is no exception, as its players and fans took over the Sports Arena rink in St. James for their last bout of the season on Saturday night.

“It’s amazing just to see how many people we have,” Marie “Jett Bruise” Letourneau, said at the game, known as a bout, on Saturday, which also marked the league’s one-year anniversary. SIDR has grown from about 12 people to more than 50.

Strong Island Derby Revolution battles it out against Shoreline Roller Derby. Photo by Erika Karp
Strong Island Derby Revolution battles it out against Shoreline Roller Derby. Photo by Erika Karp

According to Jennifer “Jenny from the block” Dutton, SIDR was established by a group of local women skaters and debuted Nov. 19, 2011 with a sold-out bout. Last March, SIDR began its first full season with another sold-out bout.

“It is unusual for a team to be formed and to have their first bout only four months later,” Dutton said. “Most teams don’t sell out like we have with over 600 tickets sold in our season opener last November.”

Each bout consists of two 30-minute periods with an unlimited number of jams, where a skater known as the jammer tries to get through a pack of skaters known as blockers. The first jammer to make their way through the blockers becomes the lead jammer. Blockers work to block an opposing jammer, while also helping their jammer get through. A jammer scores points for every blocker she passes after making the first pass.

Lindsay “Vixen Bone Breaker” Estes, one of SIDR’s coaches, said she loves the strategy involved in the game and how different it is from other sports.

“It’s the only sport that plays offense and defense at the same time,” she said.
Estes also said the sport is really empowering for women, as there aren’t many full-contact sports for women.

According to Dutton, the league is owned, managed and operated by skaters and volunteers, with skaters paying monthly dues. Even so, the team still finds time to give back to the community, such as having a fundraiser for Long Island Cares and supporting the Wounded Warrior Project.

Stephanie “Trinity” Finochio, a jammer on the team, said the amazing thing about roller derby is you don’t have to be an athlete — everyone fits in.

“This is something that everyone can do,” she said.
Veronica “Queen Benzene” Bickmeyer, one of the team’s newer members, said she had no experience when she first joined.

“I got started and now I am obsessed,” she said.

Strong Island Derby Revolution players huddle. Photo by Erika Karp
Strong Island Derby Revolution players huddle. Photo by Erika Karp

She called the game addicting and added with a laugh that while she played soccer in high school, in roller derby you’re actually allowed to hit.

“It’s a good way to get out some aggression,” she said. “But in a friendly way.”

Even though SIDR lost Saturday’s game to Shoreline Roller Derby, a Connecticut-based team, Dutton said the team will spend the offseason practicing and working harder for next season, which will begin in late March or early April.

While each skater seemed to enjoy different things about the game, they all agree they love the new friends it has given them.

“I love playing, but I’ve made so many friends,” Letourneau said. “The camaraderie and the community; the feeling of family. I have a lot of friends now and its really good!”

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Calorie restriction alone may not reduce cardiovascular events

Diabetes seems to be getting more and more unclear in terms of the appropriate path to treat and prevent the disease. The Accord trial, a large, randomized controlled trial, which I wrote about in my Jan. 25, 2011 article, showed that intensive lowering of glucose (sugars) with medications disappointingly showed no improvement in cardiovascular disease. Even worse, there was an increase in fatalities in the treatment group, compared to the placebo group (NEJM 2008;358:2560-2572).

So what about intensive lifestyle modification? We are constantly told that diet and exercise are very important for preventing and treating Type 2 diabetes. Many of us can relate to being told we need to lose 10 or 20 pounds. But the problem is that we are not given a road map as to how to best go about this process. Are all diets the same? How about exercise — does it matter how much and what we do? What does the evidence tell us?

Diet’s impact

We know that not all diets are equal and that diets fail patients all the time. In fact, there was a recent randomized clinical trial, the gold standard of studies, called the Look Ahead study, that looked at Type 2 diabetes patients and dietary effects. This trial involved intensive lifestyle modifications — dietary changes and increased fitness for one group were compared to a group given only diabetes support and education. The trial was halted because of its failure to impact cardiovascular disease.

We expect dietary trials to fail, but not one that is large, following 5,000 overweight or obese patients over 11 years, and funded by the National Institutes of Health. Part of the problem was that the amount of weight loss was less than 5 percent. The goal had been 7 percent, which should not be difficult to achieve when the patients’ mean starting weight was high. We know that the impact is greater with the more weight lost.

Worse still is that the interim analysis at year four of this study, published in 2010, showed encouraging results for reducing cardiovascular risk. There were significant improvements in parameters such as HbA1c (a three-month history of sugar levels), blood pressure, weight, HDL (“good cholesterol”), triglycerides, and number of medications. This is because patients had lost more weight at this point (Diabetes Care. 2010 Jun;33(6):1153-58; Arch Intern Med. 2010;170(17):1565-75).

At year one, analysis of the Look Ahead trial showed substantially more effect on reducing cardiovascular risk factors in Type 2 diabetes patients, with greater weight loss in the intensive treatment group. Those who lost 5 percent to 10 percent of their body weight saw results similar to the year four analysis above. And those who had a 10 to percent 15 percent loss of body weight experienced even greater risk reduction (Diabetes Care. 2011;34(7):1481-6).

However, there was good news with the trial: according to the authors, patients had lost weight and their physical conditioning had improved. The authors note that there was a low incidence of cardiovascular events (nonfatal heart attacks, nonfatal strokes, hospitalization from angina (chest pain), and death) for both groups, which made it difficult to observe a difference between the groups. Thus, this trial may have not been large enough to show an effective difference. I would argue that the weight difference may not have been great enough.

The treatment group with intensive lifestyle changes was following a calorie-restricted diet. This is not the same as a nutrient-rich, plant-based diet. Calorie restriction may help you lose modest amounts of weight, but trials have shown it does not necessarily add to longevity nor reduce risk factors for cardiovascular disease in Type 2 diabetes patients.

What is the message that this study is conveying? Does this mean that all diets are ineffective? Should we, to quote Marie Antoinette, “Let them eat cake”? I know some patients would like to be told that, but diet can play a significant role in Type 2 diabetes and its cardiovascular risk.

What is more important is diet composition. It appears to have more of an impact than just calorie restriction. In my Sept. 11, 2012 article, I go into much more detail on diet composition and an example of a nutrient-rich diet, with its beneficial impact on cardiovascular disease (Arch Intern Med. 2008;168:713-720).

In another recent trial, a meta-analysis (a group of 24 studies) with a dietary approach that involved a high-protein group compared to standard-protein group, the results disappointed (Am J Clin Nutr. online Oct 24, 2012). Though a high-protein diet showed a very modest reduction in weight, 1.8 extra pounds over three months, there was not a corresponding change in cardiovascular risk parameters, such as blood pressure, cholesterol and insulin levels. This analysis involved over 1,000 patients.
Again, it goes to the composition of the diet. In this case, the focus was on macronutrients, such as protein and carbohydrates, rather than micronutrients, including phytochemicals (plant nutrients).

Sedentary lifestyle

Though we are encouraged to exercise for 150 minutes per week — or five days a week for 30 minutes each — this does not take into account what we do the other 23.5 hours on the days that we are exercising.

In a meta-analysis (a group of 18 trials), there was a greater than two-fold increased risk of developing Type 2 diabetes in those who were most sedentary, compared to those who were least sedentary (Diabetologia. 2012;55:2895-2905). If that is not enough, there was also a greater than two-times risk of having a cardiovascular event, such as a heart attack or stroke, in those most sedentary. It is a good idea to at least stand up, but also to walk around, for a few minutes every hour if possible during your waking hours.

Therefore, if there is one message I could hammer home, it would be that diet and movement do play significant roles in treating, preventing and reversing Type 2 diabetes and reducing its risk for complications. Weight and diet composition are very important to achieving these goals. Even very little exercise can have a substantial effect on diabetes risk reduction.

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 or consult your personal physician.

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Work leads to understanding how viruses infect cells; has potential for correcting genetic disorders

With their miniature parallel tracks twisting and turning and their connections in the middle, the structure looks like a winding ride. As it turns out, it is, although not for humans.

Using an 11-amino acid sled, viruses shuttle proteases along the double helical structure of DNA, enabling them to infect other cells.

Leading an international team of researchers, Walter Mangel, a biophysicist at Brookhaven National Laboratories, recently found the sled that slides along the phosphate spine of DNA. It carries a protease important in the activation of a virus to its destination.

When the protease and another protein collide on DNA, it begins a reaction that leads to the removal of clumps of proteins that support the construction of viral DNA.
Mangel likens the proteins that are cut away to the scaffolding builders use when they put together a cathedral. With the scaffolding in place, the viral DNA can’t become an effective invading genetic force.

“We took a model virus, one that was not dangerous to work with, and we wanted to understand how this protein functions,” Mangel said. “If we do, we can inhibit that protein.”

The researchers chose the adenovirus, which causes common colds, pink eye, blindness, weight gain and diarrhea.

The molecular sled moves by thermal (i.e. heat) energy and doesn’t use miniature wheels to move along the track, but rather has electrical charges that keep it stuck to the DNA. The sled has four positive charges that interact with the negatively charged phosphates in the major groove of the DNA.

“The sled enables the molecule to collide with another molecule on DNA,” he explained.

Once the protease removes the scaffolding, the virus can infect other cells. Mangel said the concept of a molecular sled came together in his mind when he was visiting a museum in Vermont that had farm equipment. He saw a large sled and realized this was likely how these proteins were navigating through the nucleus to their destination.

“Once we saw the 11-amino acid peptide slide by itself, we thought it might be a sled,” he said. This molecular sled not only could transport molecules to the right destination in the DNA, but could also ensure that they collided in a way that ensured a reaction would take place.

In a solution, molecules typically only bind to each other when they collide at a specific speed at particular sites on their surfaces. In most collisions, even those molecules with complementary functions recoil. If both molecules are stuck to DNA and one or both slide on the sled, the speed of the collisions is set by the speed of the sled.

“This could give rise to chemistry that is far more efficient, in which almost all collisions by sliding lead to binding,” Mangel said.

While researchers will try to disable or deactivate the sled — perhaps by attaching other blocker molecules to keep the protease from navigating down to its spot on the viral DNA — they may also find ways to use the sled.

“The sled is capable of carrying anything attached to it,” Mangel said. That means it could be used in transgenic therapy, where doctors and scientists may want to replace one genetic sequence for another, potentially correcting a genetic disorder.

Mangel explained that the experiments with the molecular sled took considerable collaborative coaxing. He wrote to 10 labs that had equipment that would allow him to do single molecule experiments. When he spoke to Sunney Xie at Harvard, a partnership began.

The first set of experiments in Massachusetts failed.

He had planned to return to Long Island the next day, but wanted to try one last experiment, in which he increased the acidity of the solution. Immediately, he saw considerable sliding.

Mangel lives in Shoreham with his wife Anne. They enjoy running together and visiting the beaches and parks in the area, especially along the east end.

Mangel is a fan of opera and classical music and has conducted his work while listening to classical music from a BBC station. He also is an avid artist and has sketched his colleagues in the lab.

The direction of his work and his artistic interested collided when he discovered the use of this molecular sled.

“What comes out of the work is rather simple,” he said, alluding to the sled. “The experiments are sophisticated to support that theory.”

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We may not be able to move to Greece, but we can modify our lifestyle for the better

Most of us would like to achieve longevity, as long we also maintain a good quality of life. We are finding, however, as I mentioned in my Sept. 20 article, that calorie restriction alone may not be the route to achieving this goal.

There was a very interesting article published in the New York Times Magazine on Oct. 28 entitled, “The Enchanted Island of Centenarians,” by Dan Buettner, a modern-day explorer and educator who focuses on longevity. Of course, there was no way I was going to pass up an opportunity to read an in-depth article on this subject. He wrote about a man named Stamatis Moraitis who was born on Ikaria, a small Greek island.

At this point, you may ask yourself, “What does this have to do with me, since there are numerous stories about the Greek lifestyle?” Well, Moraitis immigrated to the United States around 1943 and lived initially in Port Jefferson. He eventually moved to Florida, where he was diagnosed with lung cancer and given less than a year to live. In response, he decided to move back to Ikaria to get his affairs in order.

Approximately 35 years after his diagnosis, he is 97 years old and fully functional, with no signs of lung cancer. One might say he overcame advanced lung cancer. The skeptics at this point are probably thinking that he was misdiagnosed initially and never had cancer. However, he had received multiple second opinions from physicians, and they all concurred on his diagnosis.

So what was on this island that helped him not only recover from his disease, but live a long and prosperous life? His recovery involved a multitude of factors, such as diet, social support, sleep, physical activity and regular sex.

While his story is anecdotal, we have seen these same results in studies looking at other societies, such as the Okinawans, the Seventh-day Adventist community of California and some provinces of China. What does the research tell us?

Diet and physical activity impact

The Women’s Health and Aging Studies I and II, one of the most recent studies on lifestyle modification, suggests that substantial disease and mortality risk reductions are possible. There were 713 participants ranging in age from 70 to 79 (J Am Geriatr Soc. 2012;60(5):862-868).

The results showed that women who were more physically active, compared to those who were least active, were significantly less likely to die with a 72 percent reduction in five-year mortality risk. And in terms of diet, there was a 50 percent reduction in death for women in the highest third of fruit and vegetable consumption compared to the lowest third. This is important, since the most rapidly expanding age group in the U.S. is those 65 and over (Demographic Res. 2000;3:1–20).

To confirm fruit and vegetable consumption in the different groups, the researchers measured carotenoid levels in the participants’ blood. Carotenoids are phytochemicals, or nutrients, found in a plant-based diet. This is the same technique I use to measure whether my patients are achieving a vegetable-rich diet. The Ikarians’ diet is also composed of vegetables, with an emphasis on greens and a variety of beans and a de-emphasis on dairy and other animal products. According to Dan Buettner, who spent time in Ikaria, most Ikarians walked up at least 20 different hills throughout the day.

The role of napping

While we have heard conflicting reports about napping, recent studies suggest that it may have beneficial effects. In the Greek portion of the European Prospective Investigation into Cancer and Nutrition (EPIC) trial, there was a 34 percent reduction in the risk of death from heart disease when taking a siesta (midday nap), regardless of frequency and duration (Arch Intern Med. 2007;167(3):296-301). This study involved 23,681 participants. For men, those who were working saw more significant results in mortality reduction than those who were not. In the Ikarian society, most of the individuals took naps in the middle of the day.

The influence of social connections

Who you associate with may have a significant effect on your health. In the Framingham Heart Study, the chance of becoming obese (BMI of greater than 30) increased if you had a friend who had become obese (N Engl J Med. 2007;357:370-379). In this study, which involved 12,067 participants, there was a 57 percent increased risk of obesity if your friend was obese well. The authors describe this phenomenon as a social contagion, much like how a virus spreads. Among Seventh-day Adventist communities, Buettner observed that there is a positive social contagion: at picnics you see a predominance of fruit and vegetable dishes, rather than the typical American barbecue with beef or chicken.

Though there are no formally published studies on the Ikarian society, there are studies on other societies with increased longevity, such as the Okinawans, the Seventh-day Adventists and Sardinians. Unlike many of the other society studies, which are mainly international, the Seventh-day Adventists studied live in Loma Linda, Calif., outside Los Angeles.

In a study looking at approximately 34,000 Californian Seventh-day Adventists, those at age 30 had a considerably higher life expectancy than other Caucasian Californians (Arch Intern Med. 2001;161(13):1645-1652). For men, there was a 7.28 year increase in life expectancy, and for women, there was 4.42 year advantage. The factors that play a role are similar to those that are important to the Ikarians: diet, physical activity and not smoking.

What do all of these different societies have in common? They eat a high-nutrient, plant-rich diet, physical activity is a given and strong societal networking is integral to their lifestyles.

Though we may not be able to emigrate to Ikaria or many of the other societies with greater lifespans, we can modify our lifestyles to emulate many of the benefits. We can improve our diet, make sure we get enough sleep – naps should be encouraged, rather than frowned upon – and strengthen our social connections. These changes will help to foster prevention and reversal of chronic disease and potentially increase our longevity.

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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Strokes, cancer and other diseases can be more accurately studied and treated with new technology

Yingtian Pan works at the cutting edge of biological imaging, looking with increasing breadth and depth into cells ranging from bladder cancer to diabetes. Congwu Du, meanwhile, who has also done imaging, has studied the effects of cocaine on the brain.

One night, Du suggested the two Stony Brook scientists, who met when they were undergraduates studying biology in their native China, work together to get a better view of how blood flow changes in the brain after cocaine use.

Strokes, in which brain cells die because they don’t have enough oxygen, are one of the most serious medical risks of cocaine abuse. Getting a closer look at blood flow in the brain might suggest how these strokes develop.

Pan didn’t take too long with his decision. After all, he said he was eager to collaborate with Du, who isn’t just his professional colleague, but is also his wife and the mother of their two children.

Using animal models, Pan and Du employed 3D optical Doppler imaging tomography to look closely at the effect of cocaine on cerebral blood flow. Sure enough, even a single dose of the drug causes the flow to decrease. The scientists observed a disruption in some terminal arterioles and the connecting capillaries.

“When cocaine is administered, it causes constriction,” Pan explained. “The local brain oxygen is reduced.”

Cerebral blood flow decreased by as much as 70 percent within two to three minutes after a dose of cocaine. While the blood flow often returns to normal within three minutes, some flows were shut down and did not come back for at least 45 minutes. The delayed recovery was a new observation, Pan explained.

Another dose of cocaine soon thereafter causes the area with restricted blood to grow like a cloud.

“We see more of this shutting down” of blood flow, Pan commented. “That’s very unhealthy. There’s a long period of time with very low oxygen supply.”

The next step in this research is to look at the effects of longer-term cocaine abuse.
Pan, who has been at Stony Brook since 2002, has applied his imaging skills to a wide range of projects.

He worked on bladder cancer, which, if detected early, can have a good prognosis but becomes much more problematic if it progresses without intervention.

Using optical coherence tomography, which is similar to the Doppler technology he used for the cocaine study, Pan was able to increase the reliability of determining cancer screenings from 75 percent to 94 percent for sensitivity.

While some scientists have called this type of screening optical biopsies (i.e. looking closely at suspected cancers without removing any living tissue and screening it in at pathology lab), Pan is cautious in his use of that term.

“The issue with any new technology is that before it’s been clinically approved and without histological (or cellular) proof, we haven’t reached that stage yet,” he explained.

With these images, however, doctors can be more specific and targeted in their approach to bladder tumors. The next step is to provide computer-aided diagnosis to physicians for more accurate diagnosis in the operating room and for outpatient facilities.

Pan has also worked with wound healing for people with diabetes. By using imaging technology, doctors can monitor every lesion and can understand the exact benefit, or lack thereof, of any potential drug.

At this point, that work was limited to an animal model to track the growth of skin under different bioactive implants.

He has also worked on interstitial cystitis (also called IC, a condition in which people can feel intense pain in their bladder when they urinate) and geriatric incontinence.
Pan said he has found collaborators by building up a network of fellow researchers, many of whom approach him with imaging questions and opportunities.

“We hope we can provide a device to physicians,” he said. “We need to give them some understanding of the technology so they can get a good idea of how to interpret the images.”

Eventually, Pan expects that this technology, which is already widely used in eye clinics, will become similar to ultrasound in its medical usage. While it has high resolution, its image depth is limited depending on the type of tissue.

Right now, the field is very competitive, with scientists around the world looking for better, clearer, and more specific images of biological systems.

“We like competition,” he offered. “It means we have to work hard.”

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Engineering hardier plants could feed a growing population or provide biofuel

The sports adage, “it’s not the size of the athlete in the fight, but the size of the fight in the athlete,” might apply to Ben Babst’s research.

Instead of studying athletes, the Brookhaven National Laboratory researcher is looking at something that fights numerous unseen battles — plants.

A postdoctoral fellow at BNL since 2010, Babst uses positron emission topography scans to track how labeled elements move and change as they go through plants. This is the same technology doctors use to test for breast or lung cancer.

Babst is examining corn, sorghum, grasses and some of their relatives to understand how they grow and respond to their environment. He is also looking at what makes some grow bigger than others, while others tolerate drought or low-soil nutrients.

“We need to understand the underlying mechanism for fast growth, for stress tolerance, for pest resistance,” he offered. “We are not only measuring how big they are or how they look, but what they are doing inside. [We are looking at] what is happening with their metabolism and with signaling.”

The benefits of understanding plant growth apply to the conversion of plants to biofuels and the expansion of previously unused or undeveloped land for agriculture. Down the road, this could enhance our ability to generate plants to feed the increasing global population and to provide alternative, sustainable energy.

“One of our major goals is to come up with new strategies to find or engineer plants that can grow vigorously on lands not useful for food production,” he explained. “Another goal is to find new strategies to develop plants that have a biochemical composition favorable for conversion to fuel, for example high sugar or starch content.”

The challenge is to combine all the desirable traits into one crop.
Through agriculture, farmers have gone through a selection process that might not benefit the plants, or us, in the long run.

By watering, fertilizing and using pesticides to get rid of insects, bacteria and fungi, we have produced plants with an unintentional loss of hardiness. By cultivating plants under these conditions, we may have diminished the resistance plants might have to some of these challenges.

Babst and his colleagues are studying plant hormones, called phytohormones, to see how they protect plants. The plant hormones might tell a tree in a drought to close the pores on its leaves to prevent water loss.

“A recent new direction for the group is that we’re using carbon 11 [a radioactive carbon that’s easy to see with the advanced technology] to label specific phytohormones and biomolecules,” he explained. “We are looking to see how the phytohormones are made and if, under different treatments, they are made at different rates.”

He is also looking at movement of the phytohormones because the rate of that movement might determine their effect.

Babst started working with PET when he did his Ph.D. research at Tufts University. While he was there, he simulated an insect infestation with plants to determine their reaction. To his surprise, the plants in his experiment hid some of their precious resources in their roots, farther away from what they perceived as a threat from insects that might steal their sugars.

“I had a different project goal in mind,” he recalled. “When I saw that plants were bunkering their resources down in the roots after a herbivore attack, I was pretty excited. It changed the course of my research.”

In addition to seeking basic information about plant growth and metabolism, Babst also hopes to contribute to an understanding of how to harness plants for biofuel and how to help find plants that might grow in areas of the world people had once thought couldn’t sustain plant growth.

“Energy is central to our economy and has an impact on everybody’s everyday life,” he said. “I’ve noticed [in recent years ] that every time the economy seems to get moving, gas prices and energy prices go up and that muzzles economic progress.”

A married father, Babst lives in Manorville with his wife Clare Norcio, an adjunct professor of history, and two primary-school children.

He recently took his children to the pumpkin festival at Suffolk County Farm. He enjoys hiking along some of the trails on Long Island.

“When I see plants, I see one that looks stressed, or one that has caterpillars that have mauled it. Sometimes, I see it for its beauty. I’ll see an understory plant that looks so tiny but is probably decades old.”

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