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Yearly Archives: 2012

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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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Middle Country Board of Education is considering closing Bicycle Path Pre-K/Kindergarten Center due to low enrollment. Photo by Erika Karp

As enrollment continues to decline, Middle Country Central School District is considering closing Bicycle Path Pre-K/Kindergarten Center .

At the district’s Space/Bond Committee meeting on Oct. 18, Board of Education President Karen Lessler assured community members that no decision has been made but that the purpose of the meeting was to have a discussion between stakeholders and the board.

If Bicycle Path Pre-K/Kindergarten Center were to close, Unity Drive Pre-K/Kindergarten Center would become the district’s pre-k center next year and the elementary schools would be reorganized to serve kindergarten through fifth grade.

“It is an opportunity to capture another savings early enough in the school year [and] to work it into the budget,” Superintendent Roberta Gerold said. “We will continue to look for other
options anyway.”

According to Herb Chessler, assistant superintendent for business, the change would result in transportation, building and staff savings totaling about $750,000 a year. Gerold said an administrative position would be eliminated and staff would either be placed elsewhere in the district or excessed.

The $750,000 in savings could change, depending on what the district decides to do with the building. Lessler said it is possible that the district would lease the building. The district will also consider moving its central offices, which are currently located at Dawnwood Middle School, to Bicycle Path. Lessler said she would like to see the old office space turned into science laboratories. The cost of the transition is yet to be determined.

Capital improvement projects like this may be possible if the district decides to put a bond up for a public vote in March.

Lessler said the committee has discussed the option and asked building principals to compile a list of projects they would like to see completed. While the board decided to continue preparing for a bond, should they decide to put one up, some members voiced concern with the time constraints of preparing the bond resolution, which would have to be completed by Christmas.
According to Gerold, size and proximity to the district’s trailers were factors in the decision to look at closing Bicycle Path.

“Unity gives us more opportunities to have a variety of uses,” Gerold said.

Lessler and Gerold said the district wouldn’t sell the building and that it would be maintained since the district’s enrollment may change in the future.

“We certainly have declining enrollment now, but I don’t think that will continue,” Lessler said.
According to Gerold, the district saw a drop in the number of kindergarten classes from 33 classes last year to 30 this year.

Last year, the district discussed closing an elementary school or moving 6th-grade classes back to the elementary schools, but ultimately decided the disruption to students was not worth the savings.

Bicycle Path PTA President Dawn Sharrock said she wants the board to make sure there is adequate space in the elementary schools in order to accommodate the influx of students, while Michael Herrschaft, chairman of physical education and health, asked the board to see if kindergarteners have benefited in anyway from being in separate buildings.

“As a district administration we appreciate the opportunity to collect that data because we too will have to report out,” Gerold said. “So it’s not a matter of money — It’s having a thorough analysis of the topic.”

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Gender and age may play a role in the effectiveness of multivitamins

Multivitamins are one of the most commonly consumed supplements in the United States, taken by at least one-third of the population (J Nutr. 2011;141(2):261-266). We are bombarded by vitamin advertising. Yet we hear so much conflicting information about them from physicians and marketers. Are they beneficial or are they detrimental? At least with multivitamins, I will attempt to address these questions with several studies.

The quick and dirty answer is that it appears to depend on the demographics utilizing them and also the content of the multivitamins themselves. So the real question becomes, who should and who should not be taking them? There are studies that have been done on men and women looking at mortality risk and chronic diseases, such as cancer and age-related macular degeneration.

Cancer benefit in men

The Physicians’ Health Study II is the only well-designed, randomized, double-blinded, placebo-controlled trial (RCT), the gold standard of studies, to date that looks at multivitamins. This study was published in JAMA and indicates that multivitamins may be beneficial for men to prevent the overall risk of cancer (JAMA online Oct. 17, 2012). The results showed that men who took a daily multivitamin were 8 percent less likely to develop cancer overall compared to the placebo group. Even though this is a modest effect, the results were statistically significant.

For those who did have cancer, there was also a trend toward reduction in cancer mortality of 12 percent, but it did not reach the threshold of statistical significance. When they analyzed cancers individually, such as prostate and colorectal cancers, there was no difference with the placebo group. The duration of the study was considered substantially long at 11 years. The demographics included 14,641 healthy male U.S. physicians who were at least 50 years old. The multivitamin used in the study was Centrum Silver.

It may be well worth the effort for men over the age of 50 to take a multivitamin, since it is an easy way to reduce the risk of a broad category of chronic diseases, including cancer that is difficult to treat in many circumstances. The authors stressed that this should not replace a good diet and exercise, which are more likely to have larger beneficial effects on cancer.

Cancer effect for postmenopausal women

In the Women’s Health Initiative, a large observational study, there was neither an increase nor a decrease in the risk of cancer with multivitamins (Arch Intern Med. 2009(3);169:294-304). Does this mean that multivitamins don’t have the same effect in women? Not necessarily.

The design of each of the two studies was different. The previous study was a randomized controlled trial comparing a group of males who took a multivitamin to those who took a placebo, whereas this study was large, but observational — participants were observed over time — and thus is not as well designed. Therefore, the Physicians’ Health Study II had a better design and more definitive results. Interestingly, the authors of this study concluded that diet, with an emphasis on fruits and vegetables, and exercise are more beneficial than a multivitamin. This conclusion is a similar to the previous study.

Mortality effect for postmenopausal women

For postmenopausal women, taking a multivitamin may be detrimental. There was an increased risk of mortality of 6 percent in women taking a multivitamin which, though modest, is still statistically significant, according to the Iowa Women’s Health Study (Arch Intern Med. 2011;171(18):1625-1633).

However, according to this study, copper was found to have a 45 percent increased risk of mortality in postmenopausal women. I described this study in more detail in my Oct. 25, 2011 article.
So why do I mention this study? To emphasize the fact that, though this is a large observational study like the Women’s Health Initiative, it is not as well designed, nor are the results as definitive as a RCT like the Physician’s Health Study II mentioned above. For instance, I could not find details about the dose of copper nor whether one standard multivitamin was used.

Regardless, there needs to be a RCT to determine if multivitamins are harmful in postmenopausal women. What I might suggest is that postmenopausal women think twice about taking the multivitamin in the Physician’s Health Study II, since it contained copper. It is important to ask your doctor whether multivitamins are appropriate for you and, if so, which one.

Age-related macular degeneration (AMD) and multivitamins

A multivitamin was shown to be beneficial in preventing the progression of AMD to advanced stage disease. This was a well-designed RCT called the AREDS study (Arch Ophthalmol. 2001;119:1417-1436). The results showed a significant 28 percent reduction in risk of worsening disease in patients between the ages of 55 and 80 years old. The study’s duration was 6.3 years. The multivitamin used contained a combination of vitamin C (500 mg), vitamin E (400 IU), beta carotene (15 mg), zinc (80 mg) and copper (2 mg).

This multivitamin combination also prevented visual acuity loss by 27 percent. These results are impressive, since advanced AMD is the leading cause of central vision loss in patients 65 years and older (Arch Ophthalmol. 1998;116(5):653-658). The study’s conclusion suggests that patients with AMD take this multivitamin combination as long as they don’t have contraindications, such as smoking. Before starting this type of multivitamin, please consult an ophthalmologist.

To review or summarize, multivitamins in the right population have substantial risk reduction effects, such as in cancer with men. However, benefits may be dependent on the population, for with postmenopausal women, multivitamins may actually increase the risk of mortality. They may also depend on the multivitamin’s composition — not all multivitamins are created equal. For example, a certain combination of elements is beneficial for macular degeneration, not just any multivitamin. Thus, one size does not fit all. And remember, a supplement is just that, it should supplement a healthy diet.

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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Like many school districts across the country, Middle Country Central School District is adjusting to new regulations for the National School Lunch Program, while trying to avoid grumbling from students and their stomachs.

At a Board of Education meeting on Oct. 3, William Kidd, assistant business administrator for the MCCSD, led a presentation on the new regulations, which include calorie restrictions based on grade level, an emphasis on larger servings of fruits and vegetables, and smaller servings of proteins (students in Middle Country can expect to see five chicken nuggets as opposed to the seven they saw last year, for example), and a switch to fat-free or 1 percent milk.

The U.S. Department of Agriculture’s National School Lunch Program provides reduced price and free meals to students in public and private schools nationwide. The new rules, which stem from the passage of The Healthy, Hunger-Free Kids Act, are the first major changes to school lunches in 15 years. Accompanying Kidd were representatives from Whitsons Culinary Group, the district’s food service management company.

According to Kidd, the district is reimbursed $1.4 million in federal and state funding based on the sale of the regulated meals.

“The school lunch program is self-sustaining when it takes in more revenue than it spends,” Kidd said in an email. “Here at Middle Country, we have been fortunate that this has been the case for many years. All annual meal/food deposits, plus the federal and state funding reimbursements that come from those sales, have allowed the Food Service Program to operate as self-sustaining.”

According to Kidd, the district has seen an increase in the number of students receiving free and reduced price meals over the past few years. This year 2,011 students receive free meals in the district.

Elementary school lunch costs $2, while secondary school lunch costs $2.25. According to Kidd, since last year, the price rose 10 cents for elementary school lunch and 25 cents for secondary school lunch.

The transition has been frustrating at times, Kidd said. Some new options, like a deli sandwich service, which was a success in the schools, had to be revamped because of the new rules — gone are the large deli rolls.

According to Christine Kunnmann, a district manager at Whitsons, there are plans to introduce a new deli station, which will be modeled after Subway and offer students a selection of vegetable toppings since there are no limits on vegetables.

In a phone interview on Monday, Kunnmann said while portions have changed, students are still getting quite a large amount of food. She has been traveling to different districts across Long Island in an effort to educate principals, teachers, cafeteria staff and students about the regulations.

Sue Merims, a food service consultant, said that adapting to the new regulations is “a work in progress.” She said work could be done to improve the lunch’s presentation, as well as offering students more variety and flavorful foods.

After the presentation, board President Karen Lessler said that earlier in the day the board had met with students who vocalized their displeasure with the lunch program. Lessler asked to meet with Whitsons’ representatives to discuss the matter.

“We heard the grumblings,” Lessler said. “… These are serious comments being made by our students.”

On Monday, Kunnmann said meetings were arranged with board members and students to address the issues.

“Now more than ever we need to meet with the student[s],” Kunnmann said in her presentation. “We need to be involved with those students to get their feedback because we know that there are a couple of grumblings out there and we really want to make sure the kids are happy and they understand what is happening with the regulation.”

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Carotenoids from diet may reduce the risk of cataracts

In last week’s article on fall risk, I briefly mentioned cataracts as a contributor. Cataracts, the nuclear type, reduce visual acuity in an insidious process. What is important about cataracts is that they affect so many Americans, and their incidence is rising. Well, as it turns out, cataract surgery may not only reduce the risk of falls and hip fracture but, at the same time, pressure in the eye.
A diet rich in carotenoids may also prevent the occurrence of cataracts, whereas statins may have the reverse effect by increasing risk.

Cataract surgery and hip fracture

In a recent study, elderly cataract patients who underwent surgery were significantly less likely to experience a hip fracture during a year of follow-up than those who did not have surgery (JAMA. 2012;308:493-501). This was a retrospective (backward-looking) observational study, and its size was considerable, with over one million patients 65 and older. The results showed a 16 percent reduction in the risk of hip fractures overall. Those who were older — between 80 and 84 — had the most to gain, with a 28 percent reduction in hip fracture risk.

The reason for the increased fall risk and subsequent hip fracture risk in those with cataracts is the decrease in visual acuity and depth perception and the reduction in visual field that accompanies cataracts (J Am Geriatr Soc. 2009 Oct;57(10):1825-1832). As we know, hip fractures have tremendous impact on the ability of elderly patients to remain independent. Thus, avoiding them is the best strategy, since many of these patients do not regain their prior mobility.

Cataract surgery and intraocular pressure

Yet another benefit of cataract surgery is the potential reduction in intraocular pressure (IOP). Why is intraocular pressure (pressure within the eye) important? High IOP has been associated with an increased risk of glaucoma. A comparative case series (looking at those with and without cataract surgery) utilizing data from the Ocular Hypertension Treatment Study showed that those cataract patients with ocular hypertension (higher than normal pressure in the eye) who underwent cataract surgery saw an immediate reduction in IOP (Ophthalmology. 2012;119:1826-1831). This effect lasted at least three years. The removal of the cataract lowered the IOP by 16.5 percent from 23.9 mm Hg to 19.8 mm Hg. This would be close to the lower end of pressure reduction goals in glaucoma treatments, 20 to 40 percent. Therefore, cataract surgery may be synergistic with traditional glaucoma treatment.

Cataract surgery and macular degeneration risk

In a May 15, 2011 article, I wrote about a study that suggested cataract surgery increased the risk of progression of age-related macular degeneration (AMD). However, this may not be the case after all. There is conflicting evidence from a second study. Rather than increasing AMD risk, cataract surgery may uncover underlying AMD pathology that is hidden because the cataract obfuscates the view of the retina (back of the eye) (Arch Ophthalmol. 2009;127:1412-1419). The study’s strengths were the use color retinal photographs and fluorescein angiography (dye in blood vessels of eye), both very thorough approaches.

Cataract prevention with dietary carotenoids

Diet may play a significant role in prevention of cataracts. In the Women’s Health Initiative Observational Study, carotenoids, specifically lutein and zeaxanthin, seem to decrease cataract risk by 23 percent in women with high blood levels, compared to those with low blood levels (Arch Ophthalmol. 2008;126(3):354-364). In fact, those in the highest quintile (the top 20 percent) had an even more dramatic 32 percent risk reduction when compared to those in the bottom quintile (the lowest 20 percent). As the authors commented, it may not have been just lutein and zeaxanthin. There are more than 600 carotenoids, but these were the ones measured in the study. Some of the foods that are high in carotenoids include carrots, spinach, kale, apricots and mango, according to the USDA. Interestingly, half a cup of one of the first three on a daily basis will far exceed the recommended daily allowance. Thus, it takes a modest consistency in dietary carotenoids to see a reduction in risk.

Vitamin C effect

The impact of vitamin C on cataract risk may depend on the duration of daily consumption. In other words, 10 years seems to be the critical duration needed to see an effect. According to one study, those participants who took 500mg of vitamin C supplements for 10 or more years saw a 77 percent reduction in risk (Am J Clin Nutr. 1997 Oct;66(4):911-916). However, only very few women achieved this goal in the study, demonstrating how difficult it is to maintain supplementation for a 10-year period.

Those who took vitamin C for fewer than 10 years saw no effect in prevention of cataracts. In the well-designed AREDS study, a randomized controlled trial, the gold standard of studies, those who received 500 vitamin C supplements along with other supplements did not show any cataract risk reduction, compared to those who did not receive these supplements. There were 4,757 patients involved in the study with duration of 6.3 years of daily supplement consumption. Therefore, I would not rush to take vitamin C as a cataract preventative.

Statin use

Statins have both positive and negative effects, and the effect on the eyes is negative. In the Waterloo Eye Study with over 6,000 participants, those patients taking statins were at a 57 percent increased the risk of cataracts (Optom Vis Sci 2012;89:1165-1171). Diabetes patients saw an increased risk of cataracts as well. And in diabetes patients, statins seem to increase the rate at which cataracts occurred. The authors surmise that this is because higher levels of cholesterol may be needed for the development of epithelial (outer layer) cells and transparency of the lens. This process may be blocked with the use of statins. Before considering discontinuing statins, it is important to weigh the risks with the benefits.

Thus, if you have diminished vision, it may be due to cataracts. It is important to consult an ophthalmologist for cataract surgery, which can reduce your risks of falls, hip fractures and intraocular pressure. For those who do not have cataracts, a diet rich in carotenoids may significantly reduce the risk of occurrence.

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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Shinnecock Bay gets help from Christopher Gobler, Ellen Pikitch and their team

Christopher Gobler is tired of being the bearer of bad news for Shinnecock Bay. Every time someone wants to talk about ecological problems in the bay, they reach out to the Stony Brook scientist for information.

Gobler finally has some good news to share. He and a team of scientists at Stony Brook received a $3 million grant from the Simons Foundation and a private donor to turn the tide in Shinnecock Bay. Through a five-year plan, Gobler and fellow scientist Ellen Pikitch are leading an effort to restore the water quality and improve conditions at Shinnecock Bay. They hope their efforts will allow the bay to sustain larger populations of shellfish and finfish.

“We’re trying to do something to improve and reverse the things that have happened in the bay,” Gobler offered.

The effort was funded by a philanthropic gift from the Laurie Landeau Foundation, matched by similar funds from the Simons Foundation.

The eastern-most lagoon along the South Shore estuary system, Shinnecock contains 9,000 acres of open water, salt marshes and intertidal flats.

The bay, which was once home to a thriving range of shellfish, has had a decline in water quality because of the run off of nutrients like nitrogen and phosphorous, especially from septic tanks. Researchers believe nitrogen loading and the absence of shellfish are the biggest contributors to toxic red and brown tides, Gobler said.

“Part of the problem is that there’s stuff going into the bay” that leads to algal blooms, he offered.

Shinnecock is a tale of two bays. On the eastern side, it’s still closer to the best of times, as ocean water flushes through every day. The west side, however, is suffering through closer to the worst of times, as nutrients introduced by human actions remain in the bay for over a week because of less active ocean cleansing.

Researchers at Stony Brook’s School of Atmospheric and Marine Sciences plan to turn that around. The first step involves restocking shellfish, which will filter the water, and replanting eelgrass beds. This will create habitats for juvenile fish, which can hide from predators.

Scientists will also bring seaweed into the bay, which will act as a sponge, taking out the nutrients that lead to these red and brown tides. The scientists will remove the seaweed once it has absorbed enough nutrients, and will bring in a fresh batch.
Researchers like Pikitch and Gobler will monitor the bay regularly.

“This will be a continual effort we will build on,” suggested Gobler, a graduate of Ward Melville High School who now lives in East Quogue with his wife Dianna Berry and their three primary school-aged children. “We’re starting out with hard clams and oysters.”

Pikitch has already started surveying fish throughout the bay and has found, as she expected, that there is a greater range of fish living in the eastern part of the bay, where the water quality is considerably better.

Pikitch expects improvements in water quality and an expansion of a healthy habitat throughout the bay to foster growth of a broad range of fish.

“As water quality improves and as eelgrass beds flourish, fish will be able to reproduce, hide from predators, and grow,” she suggested.

Stony Brook University President Samuel Stanley hopes the restoration effort will “serve as a template for similar projects worldwide,” he said in a statement.

Those interested in learning more about the restoration program can visit the website www.shinnecockbay.org.

Pikitch, who lives in East Quogue, said one of her favorite activities is to take her grandchildren to the ocean, where she hopes they fall in love with it at an early age, the way she did.

“I worry about what kind of world my grandchildren will grow up in,” she offered. “I worry about harmful algal blooms. I wonder: What if we didn’t do anything and things got worse.”

If, she added, “the bays aren’t healthy, we won’t be healthy.”

She said she feels a sense of urgency about her work. After all, humans caused the problem and we should be able to turn it around, she offered.

“We’re going to make a big dent,” she predicted. “This is a problem that can be solved.”

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Middle Country Public Library’s toddler program is copied throughout the country

At Middle Country Public Library, 14-month-old Shane Looney takes a crawl through a play tunnel. Photo by Erika Karp

A large room full of blocks, puppets, arts and crafts, instruments and more than a dozen lively toddlers seems more like a room in a nursery school than a library, but it is exactly how Middle Country Public Library Director Sandy Feinberg wanted the room to be.

The room is home to the library’s Parent-Child Workshop, a five-week program that provides an opportunity for young children to play with each other and their parents, and for the parents to connect with each other and learn about community resources.

It has been more than three decades since Feinberg first developed the program, which emphasizes the role of parents as the primary teachers in a child’s life. The program became the Family Place Libraries initiative in 1996, keeping the Parent-Child Workshop as one of its core components. Today, more than 300 libraries in 24 states offer Family Place Library programs and that number is continuing to grow, as 28 more libraries will soon implement the program thanks to a $450,000 grant MCPL received from the Institute of Museum and Library Services, an independent government agency.

Feinberg said that winning such a prestigious grant was an honor.

“It’s really an acclimation of my work and our work here,” she said.

Feinberg said that when she first developed the program in 1979, toddlers weren’t welcome in libraries.

“At the time there were no toys in the library,” she recalled.

But after having a child of her own and becoming immersed in parenting, she realized the positive impact libraries could have on the community if they focused on parents and caregivers.

To become a Family Place Library, libraries must complete three phases. First, librarians from all over the country attend a three-day Family Place Training Institute at Middle Country Public Library and complete seven hours of online training. Next, they go back to their libraries to implement the program within one year of the training. Lastly, evaluators visit those libraries and answer questions.

“It changes the focus of the children’s librarian to integrate toddlers and parents,” Feinberg said. “It broadens their perception of themselves [and] who they can reach.”

Kathleen Deerr, the national coordinator for Family Place Libraries, said that the program works well in all communities and helps parents engage their children in developmentally appropriate activities.

“Parents need to love first of all, and talk, play, sing and share books with their kids,” she said.

Anthony Smith, a senior grant program officer with the Institute of Museum and Library Services, said that the IMLS is always looking to support libraries and museums that serve as community anchors. The IMLS has awarded more than $2.5 million in grants this year.

“There really is strong emphasis with funding projects that demonstrate libraries and museums are working collaboratively with other community organizations,” Smith said.

Feinberg said that the role of libraries is changing and it is a goal for them to become more of a community education center. She said that she believes the IMLS grant can prove how Family Place programming can impact the entire library. Deerr agreed, stating how a library’s mission is to support lifelong learning — from cradle to grave.

“Young children learn through good relationships,” Deerr said. “[The program] helps [parents] bond with that child. That is going to really help strengthen the initial relationships that are really at the core of learning.”

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Vitamin D may reduce the risk of falls by as much as 72 percent

Falling is not a big deal when you are young, but that changes with age. Most of us have seen the commercial where the woman has fallen and can’t get up. Although this commercial has been mocked, for older adults, falling can be seriously debilitating or cause life-threatening complications. In a study, 24 percent of people over the age of 71 who had at least one fall experienced reduced quality of life (J Gerontol A Biol Sci Med Sci. 1998;53A(2):M112-M119).

In a survey, 80 percent of women said they preferred death over the risk of a “bad” hip fracture from a fall that would cause loss of independence and nursing home admission (BMJ. 2000;320(7231):341-345). Unfortunately, falls in those over age 65 are quite common, with 30 to 40 percent falling annually (Clin Geriatr Med. 2002;18(2):141-158).

Now that I have your attention, what increases the risk of falls and what can we do to prevent them? When we think of the risk, we think of making the home safer by, for example, making sure that there are no loose rugs or by providing adequate lighting. But the potential causes and prevention go far beyond these steps. The factors that increase risk include chronic diseases, such as osteoarthritis, Parkinson’s, dementia, atrial fibrillation, AMD and cataracts, as well as obesity and medications.

Medication’s impact

Many patients over the age of 65 are on blood pressure medications. It turns out that diuretics (water pills) may increase the risk of falls. In a case-control study (those with high blood pressure compared to those without), nursing home patients who newly started diuretics or had their dose increased had a significant twofold increased risk of fall, especially the first day (Pharmacoepidemiol Drug Saf. 2012 May;21(5):560-563). Loop diuretics, such as Lasix (furosemide), had the most damaging effects on risk.

The authors recommend close surveillance of elderly patients for at least two days when initiating diuretic medications to treat high blood pressure. High blood pressure can be effectively treated with lifestyle modifications, such as an antioxidant-rich diet like the DASH diet that focuses on fruit, vegetables and low saturated fat (Circulation. 2010;122:A18589).

Chronic diseases

Those with osteoarthritis (OA), especially of the knee, are more likely to fall. This makes sense, since it is more difficult to walk with OA. In the GLOW study, a prospective (forward-looking) study involving postmenopausal women, those with OA had a 27 percent greater risk of falling, compared with those who didn’t have the disease (Ann Rheum Dis. online June 23, 2012). There was also a 21 percent increased risk of fracture that occurred, as well. Over 50,000 women with a mean age of 68 participated in the study. I recommend reading my article on the treatment and prevention of OA from July 10 for more details.

Obesity effect

We tend to associate falls and fractures with elderly patients who are gaunt and frail. However, it turns out that obesity increases the risk of falls. In an observational study, there was a linear relationship between obesity and fall risk (J Am Geriatr Soc. 2012 Jan;60(1):124-129). In other words, as patients increased their BMI, their fall risk went up proportionally.

Even more interesting, the risk of fracture increased with increasing BMI associated with obesity. Just a reminder that obesity is a BMI of 30 kg/m2 or over. According to the authors, the reason for obesity’s effect is that people who are obese have difficulty with balance. In this study, underweight patients did not have an increase in falls. To treat obesity, lifestyle modifications have shown significant results. And as you decrease weight and inflammation, it also helps to treat osteoarthritis.

Vitamin D

Although it is not surprising that vitamin D helps to prevent falls, since this supplement strengthens bones and muscle in the elderly, dose and frequency are determining factors of whether it is beneficial or detrimental. In a randomized controlled trial (RCT), the gold standard of studies, annual oral doses of 500,000 IUs of vitamin D3 actually increased the risk of falls and fracture in elderly patients, 15 percent and 26 percent respectively (JAMA. 2010;303:1815-1822).

However, when given on a daily basis, vitamin D does what we have come to expect, decreases the risk of falls and fractures with the appropriate dose. In a secondary analysis of a RCT, it was the lower doses of 200 IUs, 400 IUs and 600 IUs that were ineffective, while the higher dose of 800 IUs taken daily showed a large, statistically significant 72 percent reduction in the risk of falls (J Am Geriatr Soc. 2007;55(2):234-239).

The difference between this and the previous study on vitamin D was the frequency and dosing regimen. Hence, taking vitamin D is an easy and very efficient way to reduce falls and fractures in the elderly. Many elderly are deficient in vitamin D and should have their blood levels checked. Regardless of the results, they should receive at least 800 IUs of vitamin D — if not more — on a daily basis. This will either maintain or improve blood levels of vitamin D.

Exercise

In a RCT, exercise in women with a mean age of 65 increased the bone mineral density (BMD) of the spine by 77 percent compared to a control group, which had a 66 percent reduction in BMD. In other words, the women developed stronger bones with increased exercise. The trial design looked at the exercise group, which focused on increased exercise intensity, and compared it to a control group with low-intensity and low-frequency exercise. This translated into a significant reduction in fall risk for the exercise group.

We should be aware of the risk factors for falls. Complications from falls are the leading cause of mortality in older adults. This is not something to be taken lightly. Fortunately, many of the risk factors are modifiable with lifestyle changes, including a nutrient-dense diet, vitamin D supplementation and increased 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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