Monthly Archives: February 2014

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Stephen Nash’s world is populated by the bushiness of eyebrows, the length of tails, and the exact color of skin or fur. An award-winning illustrator, Nash has spent over 30 years at Stony Brook, where he has honed his craft of creating artistic renderings of gibbons, monkeys, apes, gorillas, and numerous others.

British-born and trained, Nash, who is a visiting research associate in the Department of Anatomical Sciences at Stony Brook, came to Long Island in 1982 at the request of Russell Mittermeier, the president of Conservation International. The combination has become a force in conservation, raising awareness of, and potential threats to, numerous primates, as well as other species, such as tree kangaroos in Papua, New Guinea and baobab trees in Madagascar.

Nash provided illustrations, compiled over the course of his career, for a book published last spring called “Mammals of the World: Primates.” At 10.5 pounds, the hard-cover book, which Mittermeier and others edited, is equal to the weight of about 67 mouse lemurs.

Animals are often not cooperative when it comes to posing for pictures, especially when a scientist would like to take a photo that reflects something unique about its physical appearance.

Illustrators like Nash, whose wife Lucille Betti-Nash shares the same profession and works at Stony Brook, use a combination of photos and videos, descriptions from available literature and discussions with current scientists to create images that most closely resemble animals that sometimes rely on staying away from human, and other mammalian, eyes to survive.

He starts by sending an email sketch to scientists all around the world. These researchers appreciate the attention Nash pays to details to make sure he creates an image that illustrates the unique differences among species.

“His care in the posing and portrayal of nonhuman primates communicates the beauty and splendor” of these animals, explained Jeffrey French, a psychology professor at the University of Nebraska, Omaha. French said Nash’s work is “unexcelled by anyone else in the business,” and scientists and conservationists “value the opportunity to have [him] produce artwork for their books, articles and press releases.”

Nash said his job is to be a “servant of science.” If, for example, one gibbon species looks different from another by the bushiness of its eyebrows, he will “do my best to produce illustrations of that.”

Technology has enabled the process to become more efficient. In the earlier days, after he graduated from the Royal College of Art in London, where he studied natural history illustration, he might have started with a preliminary version of a gorilla that needed a longer neck or a darker back. “That might have required starting a new drawing,” he said. “Nowadays, I can make changes and send back a new version, virtually within minutes.”

Nash said he loves working with colored pencils. He appreciates how he can buy colored pencils that have hundreds of colors, although he still finds he has to apply some color alchemy to create an exact visual match. He wets a paintbrush and brushes over the pencil strokes, uniting the colors.

“All sorts of special structures in nature — the iridescence of a butterfly’s wing or the special shine on a snake’s scale — might require special blending or a special treatment,” he said.

Nash has a favorite primate: the cotton-top tamarin, which was one of the first he drew. The matamata turtle is his favorite animal, while the fern is his favorite plant, and Darwin’s frog is his favorite reptile.

“Everyone should have these favorite natural phenomena,” he suggested. “Ideally, you get involved and you find out all you can about them.”

Residents of Stony Brook, Nash and his wife have a few of their illustrations on the walls of their home. They also have images of primates from the 1800s and early 1900s on their walls. The couple has dug ponds and planted native plants to maximize biodiversity in their backyard.

Nash’s wife, a birdwatcher who gets up at 4 am each year as a part of the Christmas Bird Count, has seen more than 100 bird species in their yard. “Our house and garden is an expression of us,” he said.

The couple hasn’t done illustrations of each other. While that might be something they’d consider if and when they retire, Nash doesn’t expect to slow down any time soon, especially since his longtime colleague Mittermeier remains active. “While [Mittermeier] is working, he’ll be doing wonderful things I want to illustrate.”

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Certain kinds of fruit may reduce the risk of diabetes

We should all reduce the amount of added sugar we consume, because of its negative effects on our health. It is recommended that we get no more than 5 to 15 percent of our diet from added sugars and solid fats, combined. (1) However, approximately 13 percent of our diet is from added sugars alone. (2)

Is all sugar bad for us? The answer is not straightforward. It really depends on the source, and when I mention source, my meaning may surprise you.

We know that white, processed sugar is bad. But, I am constantly asked which sugar source is better: honey, agave, raw sugar, brown sugar or maple syrup? None are really good for us; they all raise the level of glucose (a type of sugar) in our blood. Two-thirds of our sugar intake comes from processed food, while one-third comes from sweetened beverages, according to the most recent report from the CDC. (2) Sweetened beverages are defined as sodas, sports drinks, energy drinks and fruit juices. That’s right: even 100 percent fruit juice can raise our glucose levels. Don’t be deceived because it says it’s natural and doesn’t include “added” sugar.

These sugars increase the risk of, and may exacerbate, chronic diseases, such as diabetes, heart disease, high blood pressure, cancer and obesity. This is such a significant problem that California’s legislature is considering adding warning labels to sweetened drinks. (3) The label would indicate that added sugars can increase the risk of diabetes and obesity, as well as tooth decay.

However, I did say that sugar’s source impacts its effect. Most fruits have beneficial effects in preventing disease, including diabetes, and do not raise sugar levels, even in patients with diabetes. It is a myth that whole fruit raises your sugar levels. However, dried fruits, fruit juice, and fruit concentrate do raise your sugar levels. Note that sugar extracted from fruit has an effect similar to that of sugar added to foods and sweetened beverages. Let’s look at the evidence.

Heart disease

When we think of sugar’s effects, heart disease is not usually the first disease that comes to mind.

However, results from a 20-year study of 31,000 U.S. adults showed that, when comparing those who consumed the least amount of added sugar (less than 10% of calories daily), with those who consumed 10-25% and those who consumed more than 25% of daily calories from sugar, there were significant increases in risk of death from heart disease, 30% and a 275%, respectively (4). The added sugar was from foods and sweetened beverages, not from fruit and fruit juices.

This was not just an increased risk of heart disease, but an increased risk of cardiovascular death. This is a wake-up call to rein in our sugar consumption.

Obesity and weight gain

Does soda increase obesity risk? A recent assessment published in PLoS One, a highly respected, peer-reviewed journal, showed that it depends whether studies were funded by the beverage industry or had no ties to any lobbying groups.(5) Study results were mirror images of each other: studies not affiliated with the industry show that soda may increase obesity risk, while studies funded by the beverage industry show there may not be any association.

In studies without beverage industry funding, greater than 80 percent (10 of 12) showed associations between sugary drinks and increased weight or obesity, whereas with the beverage industry-funded studies, greater than 80 percent of them did not show this result (5 of 6). The moral of the story is that patients must be diligent in understanding studies’ funding, and if the results sound odd, they probably are. If this is the case, make sure to ask your doctor about the studies’ findings. Not all studies are equally well-designed.

Diabetes and the benefits of fruit

Diabetes requires the patient to limit or avoid fruit altogether, correct? This may not be true. Several recent studies may help change the long-standing, commonly held paradigm that fruit should be restricted in patients with diabetes and to prevent development of diabetes.

One study found that whole fruit may reduce the risk of diabetes by reducing inflammation and reducing insulin resistance. (6) Specifically, results demonstrated a reduction in the inflammatory biomarker hsCRP. Ultimately, this may result in better glucose control. A potential reason for these impressive results may be the high levels of flavonoids, specifically anthocyanins and flavones. Flavonoids, as a class, are phytochemicals (plant nutrients) that provide pigment to fruits and vegetables and may have substantial antioxidant activities. Substances that are high in these two flavonoids include red grapes, berries, tea and wine.

Another study, a meta-analysis that looked at three large studies, including the Nurses’ Health Study, NHS II, and the Health Professionals Follow-up Study, showed that those who consumed the highest amount of anthocyanins were likely to experience a 15 percent reduction in the development of type 2 diabetes. (7) Researchers compared those in the highest quintile of anthocyanin consumption with those in the lowest quintile.

Specifically, at least two servings of blueberries per week were shown to reduce the risk of diabetes by 23 percent, and at least five servings of apples and pears per week were also shown to reduce the risk by 23 percent. These were compared to those who consumed less than one serving per month. This is a small amount of fruit for a significant reduction.

From the same three studies, it was also shown that grapes, bananas and grapefruit reduce the risk of diabetes, while fruit juice and cantaloupe may increase risk. (8)

In still another diabetes study, involving those who were newly diagnosed with type 2 diabetes, the risk of increasing glucose levels was no greater in those who consumed more than two servings of fruit per day compared to those who consumed fewer than two servings per day. (9) For more details on this study, please review my March 14, 2013, article, “Diabetes: looking beyond obesity to other factors.”

The properties of flavonoids, for example found in whole fruit, may also result in anticancer and anticardiovascular disease properties, the opposite of added sugars. (10)

Chronic disease incidence and complications from these diseases have skyrocketed in the last several decades. Therefore, any modifiable risk factor should be utilized to decrease our risk. By keeping added sugar to a minimum in our diets, we could make great strides in the fight to maintain our quality of life as we age.

We don’t have to avoid sugar completely; we still can satiate a sweet tooth by eating ripe fruits. Our access to fruit, even off-season, has expanded considerably. The most amazing thing is that fruit may actually reduce the risk of diabetes, something for years we thought might exacerbate it.

References: (1) 2010 Dietary Guidelines for Americans. (2) cdc.gov. (3) reuters.com. (4) JAMA Intern Med. online February 03, 2014. (5) PLoS Med. 2013 Dec;10(12):e1001578. (6) J Nutr. 2014 Feb;144(2):202-8. (7) Am J Clin Nutr. 2012 Apr;95(4):925-33. (8) BMJ. online August 29, 2013. (9) Nutr J. published online March 5, 2013. (10) Plant Foods Hum Nutr. 2004 Summer;59(3):113-22.

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 medicalcompassmd.com or consult your personal physician.

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Stony Brook doesn’t just use bacteria, viruses, and DNA in its research. The university also seeks human volunteers, for studies in areas ranging from cancer and HIV to sociology.

Currently, the university has about 1,000 active projects that involve volunteers, including a study on obese individuals who are insulin-resistant and are prone to developing type 2 diabetes.

The human subjects are people, not data, and “without them, we don’t have advances in medicine at this campus,” said Judy Matuk, the assistant vice president for research compliance at Stony Brook. “There’s a big respect issue on this campus.”

Indeed, for 26 years, Matuk has been in charge of human subject compliance, assuring that the process of including people in studies meets various standards and includes informed participants. “We want to have the community know research goes on,” she said. Her office also wants to make sure “folks are aware of their rights.”

Matuk said humans don’t waive any right as test subjects. She also emphasized that the consent process requires scientists to spell out exactly what’s involved in each experiment.

“At the end of a discussion” about the research, “if the potential subject says, ‘What do you think I should do?’ then that process failed. The process should have all the information they need to make a decision on their own.”

When she speaks to researchers who are planning to use humans in their studies, she emphasizes that each person is “somebody’s somebody” whether that’s an aunt, a mother, a sister, or a brother. She wants to make sure people aren’t data points, the way temperature and humidity readings might be for someone studying the weather.

Stony Brook is well aware of research horror stories. One of the most famous was the Tuskegee syphilis experiment, in which the U.S. Public Health Service studied syphilis in African-American men between 1932 and 1972. During the study, people who had syphilis did not receive treatment that had become available during that time.

After that study, the National Research Act passed, Matuk said, which established the National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research. This group, which met in the Belmont Conference Center of the Smithsonian Institute, created a code, called the Belmont Report, that outlined a set of ethical principles that guides research involving human subjects.

The research review process in place at Stony Brook meets and exceeds federal requirements by using best practices. Colleagues at Stony Brook consider Matuk “tough but fair,” said Harold Carlson, a professor of medicine and chairman of one of the two institutional review boards at Stony Brook.

Carlson, who has known Matuk for 26 years, described her as an “extremely effective” leader, as an educator of the faculty and an enforcer of the rules and regulations with human subjects in research.

Researchers, who receive approval for a maximum of one year, are required to notify a review board if something unanticipated happens. With all the safeguards in place, Matuk said she is proud of the contributions Stony Brook has made to research fields. That includes work with drug trials on the human immunodeficiency virus.

At the same time, Matuk wants anyone participating in these studies, especially of drugs that might help treat a chronic condition or illness, to understand that “this is not clinical care. This is research. We don’t know the answer” about whether the treatment will prove more effective than the current standard of care.
Members of the Long Island community can help out with research, even if they don’t have a chronic condition.

A resident of Miller Place, Matuk lives with her husband, Jay Matuk, the principal of Cold Spring Harbor Junior/Senior High School. The couple have three children: Katie, 27, Zachary, 22 and Paige, 18.
Aside from family, Matuk said she is an active member of her temple, Beth Emeth in Mount Sinai, where she was president for five and a half years.

“When you talk about people volunteering, you always think the next guy will do it,” she said. ‘That’s a dangerous attitude to have. You want to know you can make a difference.”

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By Linda M. Toga, Esq.

The Facts: My mother recently died. In her Will she left her entire estate to me. If I had died before my mother, her estate would have passed to my children in equal shares. I would like my inheritance from my mother to pass to my children.

The Question: Is there a way I can accomplish that? If so, what is involved?

The Answer: You can certainly arrange for your inheritance under your mother’s Will to pass directly to your children by renouncing or disclaiming your interest in your mother’s estate. To do so you must use a qualified disclaimer.

How it Works: A qualified disclaimer is a writing in which you identify the assets you do not wish to receive. In this case, you would indicate that you are renouncing your interest in all assets passing under your mother’s Will. The disclaimer does not have any effect on assets such as jointly held property in which your mother may have had an interest or assets that pass according to a beneficiary designation form such as IRAs and life insurance.

The disclaimer must be delivered to the executor of the estate and filed with the surrogate’s court that issued letters testamentary to the executor.

Since your mother’s Will names your children as the contingent beneficiaries in the event you predeceased her, disclaiming your interest in her estate will result in her entire probate estate passing directly to your children. However, if other contingent beneficiaries had been named, your share of the estate would pass to the individuals named in the Will and not your children. That is because a beneficiary who renounces their interest in an estate cannot choose who will receive the disclaimed probate assets. This is true not only when there is a Will, but also when a person who is in line to inherit from an estate where the decedent died without a Will wishes to renounce that inheritance. Where there is no Will, the intestacy statute which dictates which family members are entitled to a share of an estate will govern how assets in the estate are distributed if someone renounces.

Beyond disclaiming your inheritance, there are other strategies that may be used to accomplish your stated goal of having your children receive the assets in your mother’s estate. As with all estate issues, it is important to consult with an attorney with experience in estate administration before filing a disclaimer to make sure the filing will not result in any unintended consequences.

Linda M. Toga, Esq. provides legal services in the areas of litigation, estate planning and real estate from her East Setauket office.

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Sgt. Bradford comes home to cheers and a hug from his family. Photo by Elana Glowatz

Sgt. Robert Bradford came home to a sea of red, white and blue last Friday afternoon, as local members of motorcycle charity Patriot Guard Riders lined Brookhaven Boulevard in Port Jefferson Station outside his home to welcome him and thank him for his service to the United States.

Sgt. Bradford comes home to cheers. Photo by Elana Glowatz
Sgt. Bradford comes home to cheers. Photo by Elana Glowatz

Bradford, 24, was returning after seven months in Afghanistan on his first deployment with the U.S. Army.

Terryville Fire Department trucks draped an American flag over Route 112 and set off sirens as the minivan Bradford rode in made its way down the street and turned onto his block. The roughly 15 members of the Patriot Guard Riders raised their own flags and stood at attention as the van entered the driveway of the Bradford family’s home.

When the soldier stepped out of the car, the guard erupted in cheers and claps and shouted, “Thank you for your service.”

Bradford showed his appreciation for the gesture, going up to each member to shake hands and share a hug.

“I appreciate all you guys,” he told the guard, before sharing a group hug with his family in the middle of the road.

His mother, Pat, said the Port Authority police escorted the family to the gate at LaGuardia Airport to meet the sergeant, and there was an announcement on the loudspeaker for everyone who wanted to greet him. The people “came in droves from everywhere,” she said.

When she saw her son again, “My heart was beating.” Asked to describe what it was like, the mother said, “Every good word in the book.”

Sgt. Bradford comes home to cheers. Photo by Elana Glowatz
Sgt. Bradford comes home to cheers. Photo by Elana Glowatz

She turned to Pete Jepson, an East Moriches resident leading the guard, and said, “I have my son home.”

According to Jepson, the welcoming group was made up of volunteers, some of whom are veterans. Local members of the national nonprofit Patriot Guard Riders attend similar homecoming events as well as funerals for fallen military members, first responders and veterans.

“We love doing it. It’s an honor for us to do it,” Jepson said.

Bradford, who is with the 338th Military Intelligence Battalion based in Shoreham, said everyone from his squad came back, which is good because “I wasn’t going to leave without all of them.”

He said, “It’s very exciting, overwhelming and weird” to be home. “It’s a whole different lifestyle.”

There’s not as much to worry about at home, he explained, adding with a laugh that the air is fresher on Long Island.

One thing that’s already different is that while he was overseas, he carried his rifle with him everywhere, including to the bathroom, to “chow” and to sleep. When he was on the plane to LaGuardia, he said, he fell asleep and when he woke up, someone’s phone rang and it sounded like “the alarm for incoming,” and he jumped and didn’t have his gun.

Bradford, who first enlisted in 2008 and re-enlisted on Veterans Day, said he is proud to serve his country.

“It’s nothing special that I did.”

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Many of his colleagues are focused on the instructions the factory has to follow. Chang-Jun Liu, however, is more concerned with the on and off switch. The factory, in this case, is a plant cell’s genes, and the on and off switch are the signals that indicate when to start and stop production of a class of chemicals called phenols that are used in everything from flavoring foods to promoting cardiovascular health.

Liu, a scientist in the Department of Biosciences at Brookhaven National Laboratory and an adjunct professor in biochemistry and cell biology at Stony Brook, looked at a process in which a key enzyme, called phenylalanine ammonia lyase, gets removed or broken down, slowing or even stopping the process of producing phenols. He and his research group are exploring ways to fine-tune the concentration and activity of PAL. With less PAL, plants, in this case an Arabidopsis plant that is widely found in backyards around Long Island, produces less phenol.

“You can enhance the final production or reduce the final production” depending on “the application” scientists or industry are seeking, Liu said. “We know how this process works. We can turn down those kinds of proteins, and prevent the degradation of a key enzyme or we can increase the activity.”

How much phenol scientists or businesses desire in plants depends on the application. Phenols are a part of a large class of compounds that are made of both small molecule chemicals and larger polymers. The smaller phenolics are used in foods, beverages and cosmetics, providing fragrances and flavors. The typical example of this is vanillin.

Most phenolics have antioxidant properties and can potentially prevent cardiovascular disease, treat cancer or prevent obesity, Liu said.

Other scientists praised Liu’s ability to apply his basic research into a range of other arenas. “What’s really remarkable about his work is he does a lot of things that have fundamental basic importance in science and takes them to translational situations,” said Brenda Winkel, professor and head of biological sciences at Virginia Tech. “He’s able to take [his research] and find the practical uses of these new insights. That is really unusual.”

Liu, who worked with postdoctoral research associates Xuebin Zhang and Mingyue Gou, said other researchers have exerted considerably more energy in developing a gene regulation approach. Liu, however, worked at the protein level, exploring how to use the cell’s own recycling system, either to keep a protein that encourages the production of phenols in place, or encouraging its removal, and decreasing the manufacture of phenols.

Plants use these phenols for a variety of purposes, most notably to react to changes in its environment, either from variation in its habitat or an attack by a fungus or bacteria. “If you manipulate those phenolic compounds” Liu said, “it will increase the resistance of a plant to environmental stress and therefore increase the ability of plants to live” in harsh conditions.

Liu’s next steps are to apply this understanding of how to alter phenol synthesis to other plants, including in horticulture. Increasing phenols can increase coloration intensity among different flowering plants, he said, which might be a desirable trait for people looking for a particular hue.

He also wants to expand his study to other crops like poplar trees. Taking lignin out of poplar trees to generate paper currently requires “harsh chemicals that are bad for the environment,” said Winkel.
Winkel said Liu’s work with biofuels is a crowded field and “big deal folks have been in it forever” but Liu is “right in there with the giants of the field, making unique contributions.”

A resident of Rocky Point, Liu lives with his wife, Yang Chen, a teacher’s aid at Rocky Point Middle School, and their two children, 14-year-old Allen and 12-year-old Bryant. Liu, who grew up in China, said he has gradually started to learn to ski.

He’s been to Blue Mountain and Shawnee in the last few years and calls himself “still a learner” on skis. “It is extremely exciting when you challenge yourself and do something a bit beyond your ability,” he said.
As for his work, Liu said he feels a satisfaction about his findings. “I’m pretty excited,” he said. “We continually want to look for more potential applications.”

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Potential increased risk of cardiovascular disease

Testosterone is a hot topic in the news lately. Men are going through andropause or have unusually low testosterone (hypogonadism), or as it is most recently referred by the pharmaceutical industry: “Low T.” We are bombarded continually with ads suggesting that men should talk to their doctors about Low T. The formal name for treatment is androgen replacement therapy.

Is this all hype, or is this a serious malady that needs medical attention? The short answer is it depends on the candidate. The best candidates have deficient testosterone levels and are symptomatic.

The greatest risk factor for lower testosterone is age. As men age, the level of testosterone decreases. Respectively, 20, 30 and 50 percent of those who are in their 60s, 70s and 80s have total testosterone levels of less than 320 ng/dL. 1 However, some of the pharmaceutical ads would have you think that most men over 40 should seek treatment. Treatments include gels, transdermal patches and injections.

While real estate is all about “location, location, location,” with testosterone “caution, caution, caution” should be used.

Who are the most appropriate candidates for therapy? Those who have symptoms including lack of sexual desire, fatigue and lack of energy. However, what is scary is that around 25 percent of patients are getting scripts for testosterone without first testing their blood levels to determine if they have a deficiency.2 A simple blood test can measure total testosterone, as well as free and weakly bound levels at mainstream labs.

The number of testosterone scripts has increased threefold from 2001-11 for men more than 40 years old.3 Either we have discovered vast numbers of men with low levels or, more likely, marketing has caused the number of scripts to outstrip the need.

What are the risks and benefits of treating testosterone levels?

Is testosterone treatment really the fountain of youth?

There are benefits reported for those who actually have significantly deficient levels. Benefits may include improvements in muscle mass, strength, mood and sexual desire.4

However, several studies have recently suggested that testosterone therapy may increase the risk of cardiovascular disease, including stroke, heart disease and even death. These are obviously serious side effects. It also may cause acquired hypogonadism by shrinking the testes, resulting in a dependency on exogenous, or outside, testosterone therapy.

When testosterone is given, it may be important to also test PSA levels.5 If they increase by more than 1.4 ng/ml over a three-month period, then it may be wise to have a discussion with your physician about considering discontinuing the medication. You should not stop the medication without first talking to your doctor, and then a consult with an urologist may be appropriate. If the PSA is greater than 4.0 ng/ml initially, treatment should probably not be started without a urology consult.

How can you raise testosterone levels and improve symptoms without hormone therapy? Lifestyle changes, including losing weight, exercising and altering dietary habits, have shown promising results.

Let’s look at the evidence:

Cardiovascular risk

In the newest study, results showed that men were at significantly increased risk of experiencing a heart attack within the first three months of testosterone use.6 There was an overall 36 percent increased risk. When stratified by age, this was especially true of men who were 65 and older. This population had a greater than twofold risk of having a heart attack. The risk may have to do with an increased number of red blood cells with testosterone therapy. Those who were younger showed a trend toward increased risk, but did not meet statistical significance.

However, if the patient was younger than 65 and had heart disease, there was a significant twofold greater risk, but those without did not show risk. This does not mean there is no risk for those who are “healthy” and younger, it just means the study did not show it. This observational study compared over 50,000 men who received new testosterone scripts with over 150,000 men who received scripts for erectile dysfunction drugs: phosphodiesterase type 5 (PDE5) inhibitors, including tadalafil (Cialis) and sildenafil (Viagra). PDE5 inhibitors have not demonstrated this cardiovascular risk.

Unfortunately, this is not the only study that showed potential cardiovascular risks. Another recent study reinforces these results. In 2013, results showed that there was an increased risk of stroke, heart attack and death after three years of testosterone use.7 Ultimately, it found a 30 percent greater chance of cardiovascular events.

What is worse is that risk was significant in both those with a history of heart disease and those without. This was a retrospective study involving 1,200 men with a mean age of 60.

We need randomized controlled trials to make a more definitive association. Still, these are two large studies that suggest increased risk.

If you already have heart disease, be especially careful when considering testosterone therapy.

FDA response

As of Jan. 31, the FDA, which approved testosterone therapy originally, will now investigate the possible cardiovascular risk profile based on the above two studies.8 The FDA doesn’t suggest stopping medication if you are taking it presently, but it should be monitored closely. The agency, in the meantime, has issued an alert to doctors about the potential dangerous side effects of androgen replacement therapy. The FDA says that the use of testosterone therapy is for those with low levels and other medical issues, such as hypogonadism from either primary or secondary causes.

Obesity and weight loss

Not surprisingly, obesity is an important factor in testosterone levels. In a study that involved 900 men with metabolic syndrome — borderline or increased cholesterol levels, sugar levels and a waist circumference greater than 40 inches — those who lost weight were 50 percent less likely to develop testosterone deficiencies. Those who participated in lifestyle modification had a highly statistically significant 15 percent increase in testosterone.9 Also, when men increased their physical activity and made dietary changes, there was an almost 50 percent risk reduction one year out, compared to their baseline at the start of the trial.

Interestingly, metformin had no effect in preventing lower testosterone levels in patients with abnormal sugar levels, but lifestyle modifications did. These patients were relatively similar to the average American biometrics with prediabetes: HbA1c of 6 percent and glucose of 108 mg/dL; a mean of 42-inch waists; and a BMI that was obese at 32 kg/m2. The mean age was between 53 and 54.

If there is one thing that you get from this article, I hope it’s that testosterone is not something to be taken lightly. You can improve testosterone levels if you’re overweight by losing fat pounds. If you think you have symptoms and you might need testosterone, talk to your doctor about getting a blood test before you do anything. It may be preferable to try alternate medications that improve erections such as sildenafil and tadalafil.

References:

1 J Clin Endocrinol Metab. 2001 Feb;86(2):724. 2 J Clin Endocrinol Metab. Online 2014; Jan 1. 3 JAMA Intern Med. 2013 Aug 12;173(15):1465-6. 4 J Clin Endocrinol Metab. 2000 Aug;85(8):2839. 5 UpToDate.com. 6 PLoS One. 2014 Jan 29; 9(1):e85805. 7 JAMA. 2013;310:1829-1836. 8 FDA.gov. 9 ENDO 2012; Abstract OR28-3.

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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Michael Villaran has been able to maintain his own energy levels while he’s running long distances. The 64-year-old electric power engineer and principal engineer at Brookhaven National Laboratory has completed 10 marathons.

Villaran, who has been at BNL for 27 years, knows a thing or two about other forms of energy as well: the kind that heats houses and provides electricity.

He is a staff engineer in the Sustainable Energy Technology Department, a group that started in 2010. BNL created the group when the campus became a host site for the Long Island Solar Farm, which delivers about 32 megawatts of peak alternating-current power to the Long Island Power Authority substation.

Some of the research at the station has included looking at how changes in weather affect the plant. Additionally, researchers are exploring the long-term effects the area climate has on the plant parts and system.

As a part of the solar farm agreements, BNL is building the Northeast Solar Energy Research Center. Construction of the first portion of the NSERC is expected to be completed by the middle of this month. The NSERC will support research on grid integration, energy storage and distributed energy, among other areas.
For the Long Island Solar Farm, Villaran “came up with the concept of the electric power instrument monitoring system,” he said. He has also contributed to a design with the new research facility that uses a similar electric power instrument monitoring system.

Villaran’s colleagues appreciate his contribution. He is “absolutely essential in this capacity because he can manage from a business and engineering perspective simultaneously,” said Paul Giannotti, a senior electrical engineer at BNL.

Giannotti said he has been assisting Villaran in working on the NSERC, which is “a very exciting project because it will answer many questions on the future viability of solar power stations, especially in the more cloudy regions of the northeast.”

Electrical engineers often work closely with meteorologists, hoping to get a better read on when a significant change in the weather might knock out parts of the system. An upstate partner of BNL has successfully used historical data to predict the outcome of an approaching storm on their power grid.

When he worked for Lilco, Villaran said everyone needed to provide an emergency response, because “it’s not a question of are we going to have ice storms and hurricanes,” it’s a matter of when.

Indeed, recently, BNL organized a series of utility workshops, one of which focused on applying risk techniques to utility planning, which included weather effects. That was postponed twice, once for Hurricane Sandy and again for Winter Storm Nemo.

“By looking at historical data and where and when and how severely it affects the system, they can get resources in place that could minimize the number of outages,” he said.

Villaran said BNL is working with a partner to create a high-speed monitoring system for the grids that would come at a low price, which would greatly improve the operation of the system by telling utilities when the system is in trouble and by reducing inefficiencies.

Villaran and his wife, Denise, who works in the administrative office at the Rocky Point School District, live in Rocky Point. Villaran has three sons from a previous marriage: Michael, 35, Tim, 34, and Kevin, who will be 30 this year.

After his divorce from his first wife, Villaran had sole custody of his children for several years, which meant he “had to be a wiz at scheduling. There were some days when three people were playing in three different sports in three different locations.” One Saturday, he said, he was in and out of the car 30 times. He appreciates the support of his parents, who pitched in regularly.

Villaran has been an active participant since around 1999 in a mentoring program for the Longwood School District for children with various difficulties and hardships. “Now that I have no children around, it’s fun to work with these kids,” he said.

Villaran said his team, and utilities experts, are excited about the creation of the new NSERC. “Electric utilities are interested in trying out ideas for the operation of their distribution systems,” he said. “They’ll try some ideas in a setting like we’ll make available here, before deploying [them] in the field.”

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Age-related cognitive decline may not be as prevalent

The brain has to be the most important and complex organ, yet what we know about the brain is inverse to its prominence. In other words, our knowledge only scratches the surface. While other organs can be transplanted readily, it is the one organ that can’t, at least not yet.

The brain also has something called the blood-brain barrier. This is an added layer of small, densely packed cells, or capillaries, that filter what substances from the blood they allow to pass through from the rest of the body (1). This is good, since it protects the brain from foreign substances; however, on the downside, it also makes it harder to treat, because many drugs and procedures have difficulty penetrating the blood-brain barrier.

Unfortunately, there are many things that negatively impact the brain, including certain drugs, head injuries and lifestyle choices. There are also numerous disorders and diseases that affect the brain, including neurological (dementia, Parkinson’s, stroke); infection (meningitis); rheumatologic (lupus and rheumatoid arthritis); cancer (primary and secondary tumors); psychiatric mood disorders (depression, anxiety, schizophrenia); diabetes; and heart disease.

These varied diseases tend to have three signs and symptoms in common: they either cause an alteration in mental status; cognitive decline, weakness or change in mood; or a combination of these.

Probably our greatest fear regarding the brain is cognitive decline. We have to ask ourselves if we are predestined to this decline, either because of the aging process alone or because of a family history, or if there is a third option, a way to alter this course. Dementia, whether mild or full-blown Alzheimer’s, is cruel; it robs us of functioning. We should be concerned about Alzheimer’s because 5.2 million Americans have the disease, and it is on the rise, especially since the population is aging (2).

Fortunately, there are several studies that show we may be able to choose the third option and prevent cognitive decline by altering modifiable risk factors. They involve rather simple lifestyle changes: sleep and exercise and possibly omega-3s. Let’s look at the evidence.

The impact of clutter

The lack of control over our mental capabilities as we age is what frightens us the most since we see friends, colleagues and relatives negatively affected by it. Those who are in their 20s seem to be much sharper and quicker. But are they really?

In a recent study, German researchers found that educated older people tend to have a larger mental database of words and phrases to pull from since they have been around longer and have more experience (3).  When this is factored into the equation, the difference in terms of age-related cognitive decline becomes negligible.

This study involved data mining and creating simulations. It showed that mental slowing may be at least partially related to the amount of clutter or data that we accumulate over the years. The more you know, the harder it becomes to come up with a simple answer to something.

We may need a reboot just like a computer. This may be possible through sleep and exercise and omega-3s.

Sleep

I have heard people argue that sleep gets in the way of life. Why should we have to dedicate 33% of our lives to sleep? There are several good reasons. One involves clearing the mind, and other involves improving our economic outlook.

For the former, a recent study shows that sleep may help the brain remove waste, such as those all-too-dangerous beta-amyloid plaques (4). When we have excessive plaque buildup in brain, it may be a sign of Alzheimer’s. This study was done in mice. When mice were sleeping, the interstitial space (the space between brain gyri, or structures) would increase by as much as 60 percent.

This allowed the lymphatic system, with its cerebrospinal fluid, to clear out plaques, toxins and other waste that had developed during waking hours. With the enlargement of the interstitial space during sleep, waste removal was quicker and more thorough because cerebrospinal fluid could reach much further into the spaces. When the mice were anesthetized, a similar effect was seen as with sleeping. Interestingly, the follow-up study may be done in collaboration with Helene Benveniste, M.D., an anesthesiologist at Stony Brook University Hospital.

In the second study, done in Australia, results showed that sleep deprivation may have been responsible for an almost 1 percent decline in gross domestic product for the country (5). The reason is obvious: people are not as productive at work when they don’t get enough sleep. Their attitude tends to be more irritable, and concentration may be affected. We may be able to turn on and off sleepiness on an acute, or short-term, basis, depending on the environment, but it’s not as if we can do this continually.

According to the Centers for Disease Control, 4 percent of Americans have fallen asleep in the past month behind the wheel of a car (6). I hope this hammers home the importance of sleep.

Exercise

How can I exercise, when I can’t even get enough sleep? Well there is a study that just may inspire you to exercise.

In the study, which involved rats, those that were not allowed to exercise were found to have rewired neurons in the area of their medulla, the part of the brain involved in breathing and other involuntary activities. There was more sympathetic (excitatory) stimulus that could lead to increased risk of heart disease (7). In those rats that were allowed to exercise regularly, there was no unusual wiring, and sympathetic stimuli remained constant. This may imply that being sedentary has negative effects on both the brain and the heart.

This is intriguing, since we used to think that our brain’s plasticity, or ability to grow and connect neurons, was finite and stopped after adolescence. This study’s implication is that a lack of exercise causes unwanted new connections. Of course, these results were done in rats and need to be studied in humans before we can make any definitive suggestions.

Omega-3 fatty acids

In the Women’s Health Initiative Memory Study Magnetic Resonance Imaging Study, results showed that those postmenopausal women who were in the highest quartile of omega-3 fatty acids had significantly greater brain volume and hippocampal volume than those in the lowest quartile (8). The hippocampus is involved in memory and cognitive function.

Specifically, the researchers looked at the level of omega-3 fatty acids, called eicosapentaenoic acid and docosahexaenoic acid, in red blood cell membranes. The source of the omega-3 fatty acids could either have been from fish or supplementation. This was not delineated. The researchers suggest eating fish high in these substances, such as salmon and sardines, since it may not even be the omega-3s that are playing a role, but some other substances in the fish.

It’s never too late to improve brain function. You can still be sharp at a ripe old age. Although we have a lot to learn about the functioning of the brain, we know that there are relatively simple ways we can positively influence it.

References: (1) medicinenet.com. (2) alz.org. (3) Top Cogn Sci. 2014 Jan.;6:5-42. (4) Science. 2013 Oct. 18;342:373-377. (5) Sleep. 2006 Mar.;29:299-305. (6) cdc.gov. (7)J Comp Neurol. 2014 Feb. 15;522:499-513. (8) Neurology. 2014;82:435-442.

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 medicalcompassmd.com and/or consult your personal physician.

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