Monthly Archives: April 2013

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Researcher examines the relationships between the structure, size and optics of rare earth oxides

James “Jay” Dickerson isn’t sitting back and waiting for people to come to him. The assistant director at the Center for Functional Nanomaterials at Brookhaven National Laboratory, Dickerson is actively looking to find ways for the technological powerhouse to collaborate with everyone from small-business owners with innovative ideas to scientists to multinational companies.

“We at CFN need to reach out to the industrial community in Long Island, New York state and the mid-Atlantic area,” he said. “We sometimes are guilty of saying ‘Hey, we’re here. Come and find us.’”

This problem is most evident, he said, with small businesses that may have brilliant ideas, but may not have the resources to use expensive equipment, the background, or the contacts to use nanotechnology characterization or equipment.

At CFN, he suggests they have waited for people from industry to come to them. He suggests a more efficient approach involves actively pursuing and engaging local companies through workshops to show them what is available.

A facility that’s about 10 years old, the CFN is housed in a two-story glass building on the BNL campus. The research ranges from electronic nanomaterials, including structures for photovoltaics and electrochemical energy storage systems, to soft and biological nanomaterials, theory and computation, electron microscopy and nanoscale catalysis and interface science.

“We are a Department of Energy facility,” Dickerson said. “That means our taxpayer dollars are paying for our facilities. My personal interest is not just helping out the scientific community, be it universities or national labs, but also helping out the commercial or industrial community.”

That could include facilitating companies to conduct research in areas that will help their bottom line, either through nonproprietary research, in which the results of the experiments are expected to be published, or through proprietary research, in which the results of the studies can remain privately held. In the latter case, the companies provide full cost recovery for use of the facilities, capabilities and expertise that the center would incur.

“If you’re a company that is a manufacturer of a type of material that might have a nanostructure, feel free to contact me,” he offered.

Since he arrived, Dickerson said he has worked with companies interested in proprietary and nonproprietary research, including electronic and biomedical materials device companies.

The physical, chemical and mechanical properties of nanomaterials tend to be different from the same properties for larger materials, even when the atoms of both are identical. Scientists explore ways to exploit those properties for new devices, processes, and materials.

Dickerson said he expects some of the products companies are developing with the CFN may become commercially available (either individually or as a part of something else) within the next 10 years.

In his own research, Dickerson has examined the relationships between the structure, size and optical properties of rare earth oxides, such as europium sesquioxide. Many cathode ray tube TV screens used europium-based compounds to produce red color. His work looks toward applications, such as in highly efficient display devices and X-ray intensifying screens.

“I’m really interested in understanding fundamentally how the structure, composition, and the physical properties of nanomaterials correlate with each other. Particularly, I’m interested in trying to understand how the structure of a material, down to very small nanoscale, relates to how magnetism evolves as you shrink materials further and further down, approaching a single molecule of europium and sulfur.”

A past chairman of the Committee on Minorities in Physics of the American Physical Society, Dickerson was a recipient of an APS scholarship in 1989 and 1990.

His participation on the committee was a chance to “help those students in kindergarten through 12th grade, as well as students in undergraduate programs, at junior colleges and graduate students in their progression to the next stage in their academic lives and careers,” he said.

The number of minorities in physics has grown over the last 25 years, he said, but it’s still not “exactly reflective of the demographics of minorities in greater society. That’s something we’re endeavoring to improve.”

He said the imbalance needs to be addressed not just for the sake of having a balance in the numbers, but to solve the nation’s need for more technology and science development.

A resident of Brooklyn, Dickerson is married to Courtney Martin, an art historian and professor at Vanderbilt University in Nashville, Tenn.

Dickerson encourages anyone with an interest in BNL’s facilities, to meet their commercial or research goals, to reach out to him.

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Associating calories with exercise expenditures results in better choices

When we think of losing weight, calories are usually the first thing that comes to mind. We know that the more calories we consume, the greater our risk of becoming overweight or obese and developing many chronic diseases, including top killers such as heart disease, diabetes and cancer. Despite this awareness, obesity and chronic diseases are on the rise according to the Centers for Disease Control.

How can this be the case? I am usually focused on the quality of foods, rather than calories, and I will delve into this area as well, but we suffer from misconceptions and lack of awareness when it comes to calories. The minefield of calories needs to be placed in context. In this article, we will put calories into context, as they relate to exercise, and help to elucidate the effects of mindful and distracted eating.

Let’s look at the studies.


Impact of energy expenditure

One of the most common misconceptions is that if we exercise, we can be more lax with what we are eating. But researchers in a recent study found that this was not the case (J Exp Biol. 2013; Abstract 367.2). The results showed that when menu items were associated with exercise expenditures, consumers tended to make better choices and ultimately eat fewer calories. In other words, including the amount of exercise needed to burn calories was paired on the menu with food options, resulting in a significant reduction in overall consumption. The example that the authors gave was that of a four-ounce cheeseburger, which required that women walk with alacrity for two hours in order to burn off the calories.

Those study participants who had menus and exercise expenditure data provided simultaneously, compared to those who did not have the exercise data, chose items that resulted in a reduction of approximately 140 calories, 763 versus 902 kcals.

Even more interestingly, study participants not only picked lower calorie items, but they ate less of those items. Although this was a small preliminary study, the results were quite impactful. The effect is that calories become a conscious decision rooted in context, rather than an abstract choice.


The importance of mindful eating

Most of like to think we are multitaskers. However, when eating, multitasking may be a hazard. In a meta-analysis (a group of 24 studies), researchers found that when participants were distracted while eating, they consumed significantly more calories immediately during this time period, regardless of dietary constraints (Am J Clin Nutr. 2013 April;97:728-742).

This distracted eating also had an impact on subsequent meals, increasing the amount of food eaten at a later time period, while attentive eating reduced calories eaten in subsequent meals by approximately 10 percent. Distracted eating resulted in greater than 25 percent more calories consumed for the day. When participants were cognizant of the amount of food they were consuming, and when they later summoned memories of their previous eating, there was a vast improvement in this process.

The authors concluded that reducing distracted eating may be a method to help in both weight loss and weight management, providing an approach that does not necessitate calorie counting. These results are encouraging, since calorie counting frustrates many who are watching their weight over the long term.


The perils of eating out

Most of us eat out at least once in a while. In many cultures, it is a way to socialize. However, as much as we would like to control what goes into our food, we lose that control when eating out. In a study that focused on children, the results showed that when they ate out, they consumed more calories, especially from fats and sugars (JAMA Pediatr. 2013;167:14-20). Of the 9,000 teenagers involved in the study, between 24 percent and 42 percent had gone to a fast food establishment and 7 to 18 percent had eaten in sit-down restaurants when asked about 24-hour recall of their diets on two separate occasions.

Researchers calculated that this resulted in increases of 310 calories and 267 calories from fast food and sit-down restaurants, respectively. This is not to say we shouldn’t eat out or that children should not eat out, but that we should have more awareness of the impact of our food choices. For example, the Bloomberg administration has required calories be displayed in many New York City chain restaurants.


Quality of calories

It is important to be aware of the calories we are consuming, not only from the quantitative perspective, but also from a perspective that includes the quality of those calories. In another study involving children, the results showed that those offered vegetables for snacks during the time that they were watching television needed significantly fewer calories to become satiated than when given potato chips (Pediatrics. 2013;131:22-29). The authors commented that this was true for overweight and obese children as well, however, they were more likely to be offered unhealthy snacks, like potato chips.

In a paper published in JAMA in June 2012, the authors state that we should not restrict one type of nutrient over another, but rather focus on quality of nutrients consumed (JAMA 2012; 307:2627-2634).

In my practice, I find that when my patients follow a vegetable-rich, nutrient-dense diet, one of the wonderful “side effects” they experience is a reduction or complete suppression of food cravings. As far as mindless eating goes, I suggest if you are going to snack while working, watching TV or doing some other activity, then snack on a nutrient-dense, low-calorie food, such as carrots or blackberries. If you don’t remember how many vegetables or berries that you ate, you can take heart in knowing it’s beneficial. It can also be helpful to keep a log of what you’ve eaten for the day, to increase your cognizance of distracted eating.

Therefore, rather than counting calories and becoming frustrated by the process, be aware of the impact of your food choices. Why not get the most benefit out of lifestyle modifications with the least amount of effort? Rather than having to exercise more to try to compensate, if you actively choose nutrient-dense, low-calorie foods, the goal of maintaining or losing weight, as well as preventing or potentially reversing chronic diseases, becomes attainable through a much less painful and laborious process.

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 and/or consult your personal physician.

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International scientific team seeks causes of the decline of ancient reptiles

Enormous and powerful though they were, dinosaurs didn’t appear on the Earth and muscle out other animals — mostly reptiles. Somehow, many of those reptiles, who were eating, sleeping and reproducing for about 50 million years during the Triassic period, died during a major extinction event, making it possible for dinosaurs to dominate during the Jurassic period.

What, scientists have wondered, caused such a major shift from one set of creatures to another?

In a new paper in the prestigious journal Science, researchers from Stony Brook University, Columbia, MIT, Rutgers and Université Mohammet Premier in Oujda, Morocco believe they may have the answer.

These scientists, including Associate Professor Troy Rasbury from SBU, looked at rocks in Newark, N.J., and Hartford, Conn., that were a part of an area called the Central Atlantic Magmatic Province, which is likely the largest of the Large Igneous Provinces. These rocks suggest that a large outpouring of gases and aerosols may have been responsible for the extinction.

The lava and gases were released in four pulses over 600,000 years, which is a relatively short time frame for such violent environmental changes.

Scientists had known about the extinction and the lava flows, but they hadn’t been able to pinpoint the time frame over which the Earth may have been less habitable. During the Triassic period, the Earth was just starting to break apart from a period when it was the supercontinent called Pangaea.

The researchers used a process called uranium-lead dating using zircon. Zircon crystals that are millions of years old are extremely resistant to lead. They do, however, include uranium. The only way lead, however, can become embedded in the crystals is if it starts out as an isotope of uranium and decays slowly into lead.

This dating technique, coupled with others that examine the periodic effect of other celestial bodies like the planets in our milky way, has greatly enhanced the ability to narrow down the time span during which these major events occurred.

“There’s definitely rocks contemporaneous with extinction,” said Rasbury. “We can imagine that there’s a lot of gases that come with that, as they’re being erupted. There’s an out-gassing and an environmental deterioration. That’s the link.”

Rasbury praised the work of her colleagues, who have done “a tremendous job” by analyzing samples that were collected from the surface.

“That’s what makes this such a special study. The ages are demonstrating that it’s plausible,” she said. The coincident timing of the presence of these gases and the animal turnover suggests there may be a causal link between the mass extinction and the relatively sudden environmental change.

Rasbury’s main role in this study is to bring the team together. She put together the National Science Foundation proposal that provided some of the funding for this research.

Rasbury and her colleagues at Stony Brook will soon be able to do some of the same research on other rock samples. The university received funding for a mass spectrometer. The lab had a grand reopening on April 19.

“The equipment is here and there’s a lot of hard work in front of us to make sure we can do the high-precision analysis,” she said. “It requires an enormous amount of attention to details.”

Born in North Carolina but raised in Texas, Rasbury speaks at a rapid pace.

“I had a professor at the University of New Orleans who said he didn’t know it was possible to have a Texas accent and talk that fast,” she laughed.

Her identical twin Sidney Rasbury Hemming, who was born 27 minutes before Troy, is also a geologist and attends some of the same professional gatherings.

“I was at a meeting and everybody was calling me Sidney because we talk and laugh the same,” she said.

Rasbury is married to Department of Geosciences Professor William Holt. The couple, who live in East Setauket, have two daughters. Rebecca, 12, is in sixth grade at Setauket School while Virginia, who will be 9 next month, is in third grade.

The house is filled with rocks, although Rasbury said her daughters bring many of them in from the beaches. Her daughters also love to go to gem and mineral shows.

She and her husband talk about geology at home “as long as our kids will let us.”

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Two studies provide seemingly conflicting information on heart disease

L-carnitine, or carnitine, has been around for a while. The people most familiar with it may be athletes, because for years it has been touted as possibly providing more energy, though the research has not borne out on this topic.

What is L-carnitine and why is it of interest? It is derived from amino acids and most healthy individuals can get sufficient amounts regardless of their type of diet. Carnitine helps in the production of energy in the cell. It is involved in bringing long-chain fatty acids to the mitochondria — “the powerhouse” of the cell — which are then utilized for energy through oxidation. It also keeps potential waste from accumulating in the mitochondria so it performs more efficiently. Thus, it may have antioxidant properties (

So why is all of this important? L-carnitine may play a role in several chronic diseases, such as heart disease, type 2 diabetes, high blood pressure and even fatty liver disease.

Let’s look at the evidence.


Heart disease

There are two studies with conflicting results on heart disease. In one study, the results are negative, while the other study shows beneficial results. How could that be the case?

In the first study, L-carnitine appears to increase the risk of heart disease through the development of atherosclerosis, or plaque deposits, in the arteries (Nat Med Online. 2013 April 7). L-carnitine is found in foods such as red meat. In this study, mice and healthy human volunteers who regularly ate red meat were observed. Interestingly, the bacteria in the gastrointestinal tract, or gut, in those who consumed red meat were such that L-carnitine was broken down into a metabolite called trimethylamine-N-oxide (TMAO).

This metabolite was then found to increase cholesterol deposits in the arterial walls of mice. In other words, TMAO may promote the development of atherosclerosis. In humans, there was a predicted elevated risk of developing cardiovascular disease and cardiac events, such as heart attacks, strokes and death after three years, but like the mice, only in those that had elevated TMAO levels.

Also of interest, the researchers demonstrated that vegetarians and vegans, when given carnitine supplements, did not produce TMAO. Thus, TMAO production may have to do with microbes that populate the gut of those who consume red meat. This is a preliminary study, mind you, but it makes you wonder if it is the carnitine or the red meat that may be promoting the development of TMAO and the potential for increased atherosclerosis. Carnitine by itself did not cause increased risk of heart disease, but rather the metabolite TMAO did.

In the second study, a meta-analysis (a group of studies) showed those patients given L-carnitine supplements after a heart attack had a statistically significant reduced risk of death from all-causes by 22 percent in 11 trials, ventricular arrhythmias by 65 percent in five trials and chest pain (angina) by 40 percent in two trials (Mayo Clin Proc Online. 2013 April 15).

These were randomized controlled trials (RCTs), the gold standard of studies. The benefits may have been derived from containing the amount of infarct, or dead tissue, in the heart, as well as by increasing the amount of energy in cardiomyocytes (the muscle cells of the heart). In some of the studies, L-carnitine supplements were given for as long as six to 12 months.

Thus, the authors concluded that L-carnitine may be important for those suffering a heart attack, but also in the secondary prevention of a recurrent heart attack. The authors postulated that the mechanism by which L-carnitine derived its beneficial effects was through the improvement in glucose (sugar) utilization in the mitochondria. However, even though it was a meta-analysis, the population size was not large. According to the authors, the patients who might be candidates for carnitine supplementation are those who have had a heart attack and can’t take beta blockers or ACE inhibitors.


Type 2 diabetes

In a meta-analysis (a group of four studies), those given L-carnitine saw an improvement in parameters associated with type 2 diabetes (Exp Clin Endocrinol Diabetes Online. 2013 Feb. 2). There was a significant decrease in fasting glucose (sugar) levels of 14.3 mg/dL and in LDL “bad” cholesterol levels of 8.8 mg/dL. The patients who received L-carnitine were those who were deficient. These studies were RCTs, though they were not large in size.


Role in high blood pressure

In a study involving rats, the results ultimately showed that L-carnitine reduced oxidative stress on the kidneys and helped reverse hypertension-induced kidney damage (Eur J Nutr Online. 2012 Dec. 6). The impact is most likely from the downregulation, or decrease, in inflammatory factors, such as NF-kB, and the upregulation of anti-inflammatory factors, such as NRF2 and PPAR alpha. Thus, L-carnitine may have antioxidant properties that help protect the kidney against damage produced by high blood pressure. These results are exciting, but they are preclinical, or animal-based, and need studies in humans to confirm the results.


Fatty liver disease

As I discussed in last week’s article, fatty liver is a pervasive disease that is benign most of the time, but not always. In a RCT, L-carnitine reduced the liver enzymes significantly (Am J Gastroenterol. 2010;105:1338-1345). These patients had the complication of hepatitis, which was induced by non-alcoholic fatty liver disease. So these were patients on a potentially dangerous road to cirrhosis and, ultimately, to hepatocellular carcinoma (cancer of the liver). In 24 weeks, L-carnitine supplementation not only decreased the liver enzymes, but also cholesterol, glucose and insulin levels. Thus, as the authors concluded, L-carnitine supplementation seemed to improve the overall liver functioning in patients with complications of fatty liver disease.

Though these studies are early or small and more study is warranted, this may be a valuable substance. Thus, it may be worth having your L-carnitine blood levels checked if you have a chronic disease where there might be a deficiency, such as in type 2 diabetes. Check with your physician first, but patients could take L-carnitine supplements if their levels were low or for a protective effect. In cases of heart attacks, high blood pressure and fatty liver disease, carnitine supplementation may decrease organ damage, regardless of your levels.

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 and/or consult your personal physician.

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Future results and discoveries may help stave off the symptoms of Alzheimer’s

Like other parts of the body, the brain produces waste that needs to be cleared away. Through the so-called glymphatic system, the brain uses a type of water channel to remove tau proteins and other products.

When the glymphatic system isn’t functioning properly, these proteins do not clear correctly from the brain. From this research, scientists believe a breakdown may lead to or exacerbate problems related to the development of Alzheimer’s or chronic traumatic encephalopathy, a progressive degenerative disease that is often caused by multiple concussions.

“Normally, we produce proteins and peptides that are getting excreted,” explained Helene Benveniste, a professor in the Department of Anesthesiology and Radiology at Stony Brook University’s School of Medicine. It’s not under a lot of pressure, so it’s a slower process, but it’s like taking a water hose to a dirty street, she said. “If this system doesn’t work, compounds may build up and could lead to diseases.”

While scientists and medical researchers knew a defect in the clearing system could lead to neurological problems, they weren’t sure how to track the clearing process in real time.

That’s where Benveniste — who works one day a week in the operating room as a clinical anesthesiologist and the rest of the time in research — entered the picture. Using magnetic resonance imaging, she was able to use two different contrast agents to map this pathway, where she also found important clearance pathways for brain waste. The studies were done on an animal model.

The contrast approach is “a common way of detecting leaks,” she explained.

By using this same technique, she and her team were able to follow the glymphatic process, which often operated in parallel to major arteries.

Using these imaging techniques, doctors may be able to monitor the human brain to determine disease susceptibility. Through several MRI views over time, doctors might be able to detect signs of problems with the glymphatic system before a patient shows any symptoms of Alzheimer’s.

She hopes one day that doctors will track individuals who “may be susceptible” to Alzheimer’s.

“Anything we can do now to understand how a pathological process is building or is imminently developing in a human with the end result of Alzheimer’s is incredibly valuable,” said Benveniste.

While there is no cure for Alzheimer’s, tracking it before an intellectual slide into a potentially irreversible course of the disease may provide some effective preclinical intervention.

If doctors could slow down Alzheimer’s by 20 to 30 percent, they might not prevent people from getting the disease, but they might extend the time period during which individuals can live independent lives, she suggested.

“The impact on health costs and society is tremendous,” Benveniste said. “Do I think this is just a diagnostic tool or could it teach us something about how we might treat Alzheimer’s? The answer is yes, this might be important for that purpose.”

The challenge, and it’s significant, is to understand how the glympathic system works in the human brain, so that doctors can manipulate it.

There are also studies that show that some people have tau and amyloid in their brains who don’t show signs of Alzheimer’s. However, she said, there are pathological diagnostic criteria which can quantify the impact of the proteins present and often, the severity of the pathology correlates with the cognitive decline.

If, as Benveniste believes, these channels become critically important early signs of a susceptibility to disease or a preclinical state for the disease, researchers would also need to develop more therapies.

She doesn’t have any direct family experience with Alzheimer’s. She feels blessed that her 93-year-old mother is still sharp mentally.

A native of Copenhagen, Benveniste came to the United States in 1989, where she worked at Duke for 11 years. She came to Stony Brook in 2000.

She travels regularly back to Denmark. Those trips may prove especially valuable because Stony Brook is obtaining a PET/MRI machine, which is expected to be installed in the summer. In Copenhagen, they have had this same system up and running for over a year and she plans to travel in the next few months to Copenhagen to see how they are running their machine.

She and her husband, Peter Huttemeier, a retired anesthesiologist, met in Copenhagen. They live in Northport, where being so close to the water reminds them of Denmark.

As for her work, Benveniste hopes that the ability to track the glymphatic system leads to considerably more research from her colleagues in and out of Stony Brook.



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The disease is much more common than you might expect; lifestyle modifications help

When we think of the most prevalent chronic diseases, heart disease, stroke, cancer, diabetes and others come to mind. However, there is also a chronic liver disease — nonalcoholic fatty liver disease — a conglomeration of fats, including triglycerides.

The problem with this disease is that it could lead to nonalcoholic steatohepatitis (fatty liver hepatitis), fibrosis (too much connective tissue due to repair) and eventually cirrhosis, which might ultimately result in cancer (hepatocellular carcinoma).

Fortunately, the risk of going down this dangerous path is relatively small. Most of the time, it remains a mild fatty liver disease.

Although it is rare, a study presentation in 2012 at the American Association for the Study of Liver Diseases suggested that NAFLD was the third most common risk for hepatocellular carcinoma behind infection and alcohol abuse (AASLD. 2012 Nov. 11; Abstract 97). Some study patients with hepatocellular carcinoma progressed to this level without first having cirrhosis. Those patients who developed liver cancer but did not have cirrhosis were more likely to have diabetes, obesity, high blood pressure and/or a high cholesterol profile. NAFLD occurs more frequently in males than females, and it needs to be taken very seriously.

The prevalence of NAFLD, which is benign in most cases, is relatively high, with estimates ranging from 10 to 46 percent (Gastroenterology. 2011; 140:124-131). In fact, a recent study shows that adolescents between the ages of 12 and 18 have seen a threefold increase in NAFLD, from 3.3 percent to almost 10 percent, in the last 20 years, according to data from the National Health and Nutrition Examination Survey (DDW. 2012 May 18; Abstract 705). This correlated primarily with obesity, but the rise outstrips the rate of increase in obesity in this adolescent population.


How is it diagnosed?

When liver enzymes are elevated, usually two to five times normal, then it tends to be more commonly diagnosed (Hepatology. 2003; 37:1286-1292). These liver enzymes include aspartate aminotransferase and alanine aminotransferase. What makes this disease diagnosis more difficult is that patients without elevated liver enzymes may have the disease and, in most cases, they have no symptoms.

The gold standard of diagnosis is through a liver biopsy, though this is invasive and thus has its dangers. Another method is through ultrasound, a first-line diagnosis method. Ultrasound is 60 to 94 percent sensitive and 66 to 95 percent specific (J Hepatol. 2009; 51:433–445). Though it is not the most accurate, it has the fewest side effects. Ultrasound is also technician-dependent in terms of grading the amount of fatty infiltrates in the liver — mild, moderate and severe. Unfortunately, the milder the amount of fatty infiltrates, the less accurate the reading. Other methods for diagnosis include transient elastography, computed tomography and magnetic resonance.


What might be the cause?

What is the potential cause? One theory is that intraperitoneal fat (visceral fat or central obesity) infiltrates the liver through the portal vein, resulting in insulin resistance and fatty liver (Arterioscler Thromb Vasc Biol. 1990; 10:493-496). Therefore, it is not surprising that, along with insulin resistance, there is glucose intolerance. High triglycerides and low HDL (“good”) cholesterol are also commonly associated with the disease (Gastroenterology. 1999; 116:1413–1419).


How can we alter this disease?

The good news is that NAFLD is potentially reversible through lifestyle modifications, including changes in diet and an increase in exercise.

With exercise, the premise is that the more activity a patient gets, the higher the probability of metabolizing the liver fat.

In an epidemiologic study of over 3,000 patients using data from NHANES, results showed that those with NAFLD are significantly less active than those without the disease. It did not matter the type of activity, NAFLD patients did less of it. In fact, patients who had both diabetes and NAFLD were found to do the least amount of physical activity (Aliment Pharmacol Ther. 2012; 36:772-781). The scary aspect is that patients with NAFLD have a significant eight times increased risk of cardiovascular death between the ages of 45 and 54 (Am J Gastroenterol. 2008; 103:2263–2271). And we know activity improves cardiovascular results.

In a meta-analysis (a group of 23 studies ranging from one to six months in duration) that used the Cochrane database, the results showed a significant reduction in fat content in the liver and a decrease in liver enzymes when lifestyle modifications were employed (J Hepatol. 2012 Jan.; 56:255-266). Reduction in weight had the most substantial correlation with the results. Of the 23 studies, five that looked at liver cells on a microscopic level showed a reduction in inflammation that occurred with lifestyle changes. In addition, there were also improved glucose levels and sensitivity to insulin after the modifications.

Benefits of coffee

In yet another study, coffee was shown to reduce the risk of NAFLD developing into fibrosis, a more advanced stage liver disease, by a substantial 36 percent (AASLD. 2012 Nov. 11; Abstract 99). However, weaknesses in this trial were that it was unclear how many cups of coffee were needed to have this effect and whether the coffee needed to include caffeine. The researchers theorize that there are hundreds of compounds in coffee, such as vitamins, minerals, phenolic compounds, lignans and quinides that may have this effect, not just caffeine.

In my practice, I have seen several patients with liver enzymes elevated to at least twice normal levels. After following a nutrient-dense, plant-rich diet, they saw their liver enzymes significantly reduced or returned to normal levels within a few months. One patient’s liver enzymes had been raised for 20 years without a known cause, and a first-line relative had recently been diagnosed with liver cancer.

If you have risk factors for nonalcoholic fatty liver disease, such as obesity, diabetes, high blood pressure and high cholesterol, I recommend having your liver enzymes checked on a regular basis. Those with family histories of elevated liver enzymes and hepatocellular carcinoma (liver cancer) may also want to get a scan, at least with ultrasound.

The best way to treat NAFLD is with lifestyle modifications, and while it is never too late to treat NAFLD, it is better to discover the disease earlier to reduce your risk of complications. If you are obese, NAFLD is one more important reason to transform your body composition by reducing fat mass.

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 and/or consult your personal physician.

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A protected species in the Bahamas, whitetips are hunted elsewhere for their fins

Demian Chapman has one of those jobs that turns heads at social gatherings: he’s a shark biologist. The New Zealand native, who is also an assistant professor in the School of Marine and Atmospheric Sciences at Stony Brook University, is in the middle of studying the oceanic whitetip sharks.

Known for living far from land, the whitetips, which eat tuna, mahi mahi, marlin and squid, have declined precipitously in numbers in the last few decades, in part because some people consider their fins a delicacy.

Chapman, his wife Debra Abercrombie — also a shark biologist — and several other researchers recently published results of a study on the whitetips. Starting in 2011, Abercrombie and other field biologists went to the Bahamas, where the waters are aggressively patrolled and the sharks are actively protected, to fit some sharks with pop-up satellite tags that could track their location.

As Chapman explained it, the researchers put bait in the water near the Bahamas at a time when the sharks are closer to land. If it’s alone, the first shark won’t typically approach a piece of bait. Once other sharks arrive for a meal, however, the shark’s competitive instincts take over and it becomes easier — albeit still a struggle — to reel them in.

The researchers slip a rope around the tail of the shark and then drive the boat slowly while they outfit the cartilaginous fish with a tag. Chapman said the tags, which weigh only a few grams, are probably barely noticeable to the sharks, which can be as long as eight feet and can weigh about 150 pounds.

What the tags showed was that one of the sharks traveled about 2,000 kilometers, or over 1,200 miles, in under a year. Five of the sharks traveled outside the exclusive economic zone (or EEZ) for the Bahamas, where they are better protected. This suggests that more countries might need to safeguard these sharks.

This March, the Convention on International Trade in Endangered Species of Wild Fauna and Flora is meeting in Bangkok, where representatives from several countries will consider whether to list this species. Such a listing would mean that permits would be required to trade the species across international boundaries. People caught trading the species without those permits would face penalties.

The sharks “do spend a lot of time in the Bahamas, where they are well protected,” Chapman said. “The fact that they do leave raises concerns. If you don’t have some parallel measures outside the Bahamas, that may undermine what the Bahamas has done.”

Chapman hopes that this paper, along with further research, helps to raise awareness of the delicate state of the shark population.

Countries vote to determine which species make it to different protected lists. A species has to get two-thirds of the vote.

“It’s difficult to get,” Chapman said. “Some countries that are pro-shark trade — if they consume fins — will never vote for a shark to be” on the list.

There’s definitely politicking at these meetings, he said, where some countries vote to list species in exchange for the votes of other countries on other organisms.

Chapman went to Asia in late February to help train customs agents to recognize the fins of different sharks.

Unusual for his combined expertise in DNA analysis and field work, Chapman made a remarkable find in 2005. A female hammerhead shark had been in an aquarium without any access to males for about three years. After all that time in isolation, it gave birth. The aquarium sent a copy of the mother and pup’s DNA to Chapman. He concluded that the shark had given a so-called virgin birth.

While impossible in mammals, animals like sharks, snakes and turkeys can somehow combine an unfertilized egg with the genetic code of a polar body, which essentially acts like a sperm.

The polar bodies are “cells that could have been an egg” but were produced during the production of eggs, he said.

Residents of Miller Place, where they recently purchased a house, Chapman and Abercrombie, who is originally from South Carolina and is a consultant for the New York Department of Environmental Conservation, met when they were at a field station in the Bahamas.

Chapman tries to avoid the “Shark Week” series on the Discovery Channel because of the frequent recreations of shark attacks.

“They try to add a conservation message,” Chapman said, “but it’s difficult to reconcile how the sharks need to be protected” after people have watched them attack swimmers.

As for working with sharks, he said he’s never had a “bad experience with them.”

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Salt is also necessary, but most people consume far too much sodium

One of the most popular spices is also one of the most dangerous: salt. We need salt, but not in excess. On the other hand, potassium is beneficial in our diet. However, we have the opposite problem with potassium: It is underconsumed.

More than 90 percent of people consume far too much sodium, with salt being the primary culprit (Am J Clin Nutr. 2012 Sep;96(3):647-57). Sodium is found in foods that don’t even taste salty.

Bread and rolls are the No. 1 offenders, since we eat so much of them. Other foods with substantial amounts of sodium are cold cuts and cured meats, cheeses, pizza (which has both bread and cheese), fresh and processed poultry, soups, meat dishes, pastas and snack foods. Foods that are processed and those prepared by restaurants are where most of our consumption occurs (

By contrast, only about 2 percent of people get enough potassium from their diets (Am J Clin Nutr. 2012 Sep;96(3):647-57). According to the authors of the study, we would need to consume about eight sweet potatoes or 10 bananas each day to reach appropriate levels.

Why is it important to reduce sodium and increase potassium? A high sodium-to-potassium ratio increases the risk of cardiovascular disease by 46 percent, according to a study looking at over 12,000 Americans over almost 15 years (Arch Intern Med. 2011;171(13):1183-1191). In addition, both may have significant impacts on blood pressure and cardiovascular disease, while sodium may also impact multiple sclerosis and potentially other autoimmune diseases.

To improve our overall health, we need to tip the sodium-to-potassium scales, consuming less sodium and more potassium. Let’s look at the evidence.


Reduced sodium

There are two recent studies that illustrate the benefits of reducing sodium in high blood pressure and normotensive (normal blood pressure) patients, ultimately preventing cardiovascular disease: heart disease and stroke.

The first study used the prestigious Cochrane review to demonstrate that blood pressure is reduced by a significant mean of -4.18 mm Hg systolic (top number) and -2.06 mm Hg diastolic (bottom number) involving both normotensive and hypertensive participants (BMJ. 2013 Apr 3;346:f1325). When looking solely at hypertensive patients, the reduction was even greater with a systolic blood pressure reduction of -5.39 mm Hg and a diastolic blood pressure reduction of -2.82 mm Hg.

This study was a meta-analysis (a group of studies) that evaluated data from randomized clinical trials, the gold standard of studies. There were 34 trials reviewed with more than 3,200 participants. Salt was reduced from 9-12 grams per day to 5-6 grams per day. These levels were determined using 24-hour urine tests. The researchers believe there is a direct linear effect with salt reduction. In other words, the more we reduce the salt intake, the greater the effect of reducing blood pressure. The authors concluded that these effects on blood pressure will most likely result in a decrease in cardiovascular disease.

In the second study, a meta-analysis of 42 clinical trials, there was a similarly significant reduction in both systolic and diastolic blood pressures (BMJ. 2013 Apr 3;346:f1326). This meta-analysis included adults and children. Both demographics saw a reduction in blood pressure, though the effect, not surprisingly was greater in adults. Interestingly, an increase in sodium caused a 24 percent increased risk of stroke incidence, but more importantly, a 63 percent increased risk of stroke mortality. The risk of mortality from heart disease was increased as well, by 32 percent.

In an epidemiology modeling study, the researchers projected that either a gradual or instantaneous reduction in sodium would save lives (Hypertension. 2013; 61: 564-570). For instance, a modest 40 percent reduction over 10 years in sodium consumed could prevent 280,000 premature deaths. These are only projections, but in combination with the above studies may be telling.


Potassium’s positive effects

When we think of blood pressure, sodium comes to mind, but not enough attention is given to potassium. The typical American diet is lacking in enough of this mineral.

In a recent meta-analysis involving 32 studies, results showed that, as the amount of potassium was increased, systolic blood pressure decreased significantly. When foods containing 3.5 grams to 4.7 grams of potassium were consumed, there was an impressive -7.16 mm Hg reduction in systolic blood pressure with high blood pressure patients. Anything more than this amount of potassium did not have any additional benefit. Increased potassium intake also reduced the risk of stroke by 24 percent. If this does not sound like a large reduction, consider that, by comparison, aspirin has been shown to reduce the risk of stroke by 20 percent.

This effect was important: The reduction in blood pressure was greater with increased potassium consumption than with sodium restriction, although there was no head-to-head comparison done. The good news is that potassium is easily attainable in the diet. Foods that are potassium rich include bananas, sweet potatoes, almonds, raisins and green leafy vegetables such as Swiss chard.

Multiple sclerosis

There are several recent, very preliminary studies that suggest higher levels of salt may increase the risk of multiple sclerosis.

One study showed that salt seems to increase the levels of interleukin-17-producing CD4 helper T cells(Th17) that are potentially implicated in autoimmune diseases, such as multiple sclerosis (Nature. 2013 Mar 6). The researchers used mice to show feeding them high levels of salt resulted high levels of Th17 cells and, as a result, a severe form of multiple sclerosis.

Lowering sodium intake may have far-reaching benefits, and it is certainly achievable.

Dr. Kirsten Bibbins-Domingo, associate professor of Medicine at UCSF, who is published extensively on heart disease, commented in Jane Brody’s New York Times article dated April 1 that once we lower sodium intake, our taste buds tend to adapt to the change in about six weeks by expecting less salty foods.

We need to reduce our intake and give ourselves a brief period to adapt. We can also improve our odds by increasing our potassium intake, which also has a substantial beneficial effect, striking a better sodium-to-potassium balance.


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 and/or consult your personal physician.

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Keeping a lab humming when working with nanomaterials

Aaron Stein was hired to work at a place that existed only on paper. About a decade ago, the physicist agreed to work at Brookhaven National Lab’s Center for Functional Nanomaterials, even though BNL hadn’t started construction on the cutting edge facility.

“I see something that went from an idea to a hole in the ground to a place where lots of science is being done,” Stein said.

Indeed, Stein, who earned a Ph.D. in physics from Stony Brook University, was the first official hire at the CFN, which is one of only five nanoscale science research centers funded by the Department of Energy’s Office of Science.

The study of nanomaterials involves examining how to exploit or understand physical and chemical changes that occur at an incredibly small scale. While construction of a skyscraper follows certain laws of physics — such as how much weight a load-bearing wall can support — the manufacture of objects, such as fuel cells or computer parts, is guided by other forces and interactions.

“There are certain things you’d never see otherwise if not for shrinking them down to that size scale, either due to quantum effects, size effects — you have more surface area — or other things,” Stein explained. “Everything changes and gets weird and interesting on the nano scale.”

Stein has worked in nanomagnetism, X-ray optics and photovoltaics, among many others.

Working with nanomagnets isn’t all that different, he explained, from using the bar magnets children use in middle school, except that the scale, functionality and experiments are considerably altered.

“The side I’m on is in making these magnets,” he said. “We make millions of these magnets at a time and play with the physics. We’re building our own little playground to test theories and observe” the results.

Stein has worked with Kenneth Evans-Lutterrodt, a staff scientist at BNL, since his days as a Ph.D. candidate at Stony Brook. The two have worked for years developing and honing miniature lenses that could have applications ranging from creating higher resolution and better contrast diagnostic X-ray images all the way to looking at the stress, on an atomic level, of a helicopter bearing.

“We have spent many years developing the ideas behind this,” Evans-Lutterodt said. “We look at what new design to try. He does the e-beam lithography.”

In e-beam lithography, a tiny piece of silicon is coated with a material called a resist. The material scientists like Stein uses varies, depending on what they are trying to manufacture. The researcher shoots an electron beam at the resist. The resist is sensitive to electrons in the same way that film is sensitive to light: after exposure, it is developed and the contrast can be used to create structures or finely crafted objects that are of almost any shape and size, Stein said.

Evans-Lutterodt uses the lenses Stein makes in collaborations with other scientists. The lenses themselves, he said, are not like the ones that sit in prescription glasses: they have considerably more curvature.

“The shape is quite asymmetric,” Evans-Lutterodt said. “It’s very difficult to bend X-rays. The lenses are also made out of silicon, which is opaque to visible light, but somewhat transmissive to X-ray.”

As far as a commercial application, Evans-Luterrodt said he would expect it to take about three years, optimistically, before he and Stein had developed a commercial application from their research.

Stein’s goal is to “enable science.”

As for his own work, much of it is in understanding the limits of the tools and the materials he is employing.

“A big part of the job,” he said, “is to keep the lab humming.” That includes making sure the equipment is maintained, the supplies are available, and the tools are in the same condition for everyone.

Stein also spends considerable time focusing on the environmental components of nanofabrication, ensuring that everyone who comes into the lab goes home safely.

A resident of Huntington, Stein is married to Sasha Abraham, who is a member of an advocacy group that works on prostate awareness and screening. They have an 11-year-old daughter, Lily, and a 9-year-old son, Henry.

Stein grew up in Syracuse and said he never imagined coming to Long Island to build his life and career.

“There are a narrow set of places I could work,” he explained. “Probably, where I am now, is really an ideal situation for me.”


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The Mediterranean diet reduces cardiovascular disease significantly

We have made great strides in the fight against heart disease, yet it remains the No. 1 cause of death in the United States. Approximately one-third of Americans over the age of 35 will die of heart disease (Circulation. 2008;117(4):e25). I hope this statistic has captured your attention, because it should.

What is causing or contributing to such high numbers of heart disease deaths: genetics, environment or both? Many of us have the propensity toward heart disease. Can we alter this course or is it our destiny?

A recent study, involving the Paleo-type diet and other ancient diets, suggests that there is a significant genetic component to cardiovascular disease, while another study looking at the Mediterranean-type diet implies that we may be able to reduce risk factors greatly. Most of the risk factors for heart disease, such as high blood pressure, high cholesterol, sedentary lifestyle, diabetes, smoking and obesity are modifiable (see Let’s look at the evidence.


Genetic components

In a study published online in The Lancet, researchers used computed tomography scans to look at 137 mummies from ancient times across the world, including Egypt, Peru, the Aleutian Islands and Southwestern America (The Lancet. 2013;Mar 11). The cultures were diverse, including hunter-gatherers (consumers of a Paleo-type diet), farmer-gatherers and solely farmers. Their diets were not vegetarian, but rather involved significant amounts of animal protein: fish and/or cattle.

Researchers found that one-third of these mummies had atherosclerosis (plaques in the arteries), which is a precursor to heart disease. The ratio should sound familiar. It seems to coordinate with modern times.

Interestingly, but not surprisingly, the average age of death was 43. The authors concluded that atherosclerosis could be part of the aging process in mankind. In other words, it may be a result of our genes. Being human, we all have a genetic propensity toward atherosclerosis and heart disease — some more than others — but many of us can reduce our risk factors significantly.

I am not saying that the Paleo-type diet specifically is not beneficial compared to the standard American diet. Rather, that we do not know it based on this study, which was not meant to provide the validity of the Paleo-type diet but whether atherosclerosis is part of the normal aging process. However, other studies demonstrate that we can reduce our chances of getting heart disease with lifestyle changes, potentially by following a Mediterranean-type diet with an emphasis on a plant-rich approach (see my article, “Seven highly effective habits for preventing heart disease,” March 15, 2012).


Mediterranean-type diet

A study about the Mediterranean-type diet and its potential positive impact on cardiovascular disease risk was recently published in the New England Journal of Medicine (N Engl J Med. Online 2013;Feb 25). Here, two variations on the Mediterranean-type diet were compared to a low-fat diet. People were randomly assigned to three different groups. The two Mediterranean-type diet groups both showed about a 30 percent reduction in the risk of cardiovascular disease, with end points including heart attacks, strokes and mortality, compared to the low-fat diet. This improvement in risk profile occurred even though there was no significant weight loss.

The Mediterranean-type diets both consisted of significant amounts of fruits, vegetables, nuts, beans, fish, olive oil and potentially wine. I call them “the Mediterranean diet with opulence,” because both groups consuming this diet had either significant amount of nuts or olive oil and/or wine. If the participants in the Mediterranean diet groups drank wine, they were encouraged to drink at least one glass a day.

The study included three groups: a Mediterranean diet supplemented with mixed nuts (almonds, hazelnuts or walnuts); a Mediterranean diet supplemented with extra virgin olive oil (at least four tablespoons a day); and a low-fat control diet. The patient population included over 7,000 participants in Spain at high risk for cardiovascular disease. The high-risk population included those with high blood pressure (80 percent of the population), diabetes and those who were overweight and/or were smokers.

The strength of this study, beyond its high-risk population and its large size, was that it was a randomized clinical trial, the gold standard of trials. However, there was a significant flaw, and the results need to be tempered. The group assigned to the low-fat diet was not, in fact, able to maintain this diet throughout the study. Therefore, it really became a comparison between variations on the Mediterranean diet and the standard American diet.

What do the leaders in the field of cardiovascular disease and integrative medicine think of the Mediterranean diet study? Interestingly there are two diametrically opposed opinions, split by field. You may be surprised by which group liked it and which did not. Cardiologists hailed the study as a great achievement. They included Henry Black, M.D., who specializes in high blood pressure, and Eric Topol, M.D. They emphasized that now there is a large RCT measuring clinical outcomes, such as heart attacks, stroke and death.

On the other hand, the integrative medicine physicians, Caldwell Esselstyn, M.D., and Dean Ornish, M.D., both of whom stress a plant-rich diet that may be significantly more nutrient dense than the Mediterranean diet in the study, expressed disappointment with the results. They feel that heart disease and its risk factors can be reversed, not just reduced. Both clinicians have published small, well-designed studies showing significant benefits from plant-based diets (J Fam Pract. 1995;41(6):560-8; Am J Cardiol. 2011;108:498-507). Dr. Ornish actually showed a reversal of atherosclerosis in one of his studies (JAMA. 1998 Dec 16;280(23):2001-7).

So which group of physicians is correct about the Mediterranean diet? Each opinion has its merits. The cardiologists’ enthusiasm is warranted, because a Mediterranean diet, even one of “opulence,” will appeal to more participants, who will then realize the benefits. However, those who follow a more strict diet, with greater amounts of nutrient-dense foods, will potentially see a reversal in heart disease, minimizing risk — and not just reducing it.

Thus, even with a genetic proclivity toward cardiovascular disease, we can very much alter our destinies. The degree depends on the willingness of the participants. Potentially, we can have an impact that ranges from reduction to reversal.



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 and/or consult your personal physician.