Monthly Archives: October 2014

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This is the second article in a two-part series on salt.

Last week, we discussed the potential negative effects of high sodium levels and low sodium levels, or the extremes. As I mentioned in last week’s article, the “extremes” of greater than 6,000 mg and less than 3,000 mg per day may increase the risk of cardiovascular events and all-cause mortality. However, the Prospective Urban Rural Epidemiology study on which these conclusions are drawn was significantly flawed. So don’t start using the salt shaker just yet without impunity. The bigger picture is that high sodium levels are dangerous and the low sodium levels used in this study likely are not.

Ironically, the sodium guidelines from a variety of health organizations range from recommendations of less than 1,500 mg per day to recommendations of less than 2,300 mg per day. Still, the average American takes in over 3,300 mg per day, with potentially disastrous health consequences. Theoretically, very low sodium levels – there’s no consensus on what those levels would be and the previous study does not help to shed light on that level – could potentially be harmful, but less than 1 percent of 100,000 people reached even the strictest of sodium levels (<1,500 mg per day). What we do know is the potential impact of higher levels. This week, we will continue to examine the latest research on sodium intake, in light of recent headlines that highlight disparities in medical opinions on sodium intake.

Blood pressure effect

Last week, we introduced the PURE study, which examined sodium intake by analyzing estimates of daily urinary sodium excretion extrapolated from once-a-day morning excretions. In another analysis involving the PURE study, results showed that those who excreted higher levels of sodium, greater than 5,000 mg a day in this case, had a substantially greater risk of high blood pressure (1).

Meanwhile, those who excreted 3 to 5 grams had a modest risk increase, and those who excreted the lowest amount, less than 3,000 mg, had no increased risk. This also involved over 100,000 participants. Potassium showed a positive impact; the greater amount of excretion, the lower the systolic (top number) blood pressure. The researchers concluded that those who were older, those who consumed more sodium and those with hypertension (high blood pressure) were more likely to experience a rise in their blood pressure.

Cardiovascular impact

However, in the NUTRICODE study, a meta-analysis (a group of 103 studies), results showed that there were over 1.5 million cardiovascular deaths in 2010 that were associated with higher sodium consumption (2). In this study, higher consumption meant greater than 2,000 mg of sodium per day. This number of deaths is based on a global scale involving 66 countries. The reason the cutoff for high sodium was lower than the other studies was that the researchers used the World Health Organization criteria. They calculated that nearly 1-in-10 cardiovascular deaths could be attributed to sodium intake. This is a sobering study that follows others showing similar results with sodium intake and cardiovascular disease.

Effects of reducing sodium

What happens when we reduce salt? Do we have Armageddon? Not quite. In fact, in a recent British analysis of the Health Survey for England, the results showed that reducing sodium by 1,400 mg per day significantly reduced the risk of cardiovascular events (3). The number of deaths from stroke decreased by 42 percent. There were also significant reductions in blood pressure and ischemic heart disease. The term ischemic heart disease is an umbrella term that means reduced blood supply to the heart, usually caused by atherosclerosis, or plaque in the arteries. It is the most common form of heart disease.

This study used 24-hour urinary excretion rates, the gold standard for estimated sodium consumption. Unlike studies mentioned previously, these rates were not estimated. However, there were issues with confounding factors (uncontrolled variables) not being taken into account. This was not a study without flaws, either. Having said this, decreasing sodium intake by a significant amount in the diet might actually have positive benefits. We need a randomized controlled trial to confirm this.

Sodium impact on children

Sodium may have deleterious effects in children. In a recent report from the Centers for Disease Control, 90 percent of kids take in too much salt. These children are between the ages of 6 and 18. Almost 17 percent, or 1 in 6 kids ages 8 to 17, have high blood pressure. This does not mean sodium is directly correlated, since it is not a study. However, it is likely to be a contributor. A handful of foods including chicken nuggets, chips, breads, cold cuts, sauces and soups. contribute 40 percent of our sodium intake. The good news is that the government is going implement sodium reduction in school food 50 percent by the year 2022. However, much of the problem also occurs at home.

Sodium-potassium ratio

You may not be able to look at sodium alone without considering the sodium-potassium ratio. In an observational study, results showed that those with a high sodium-to-potassium ratio had an almost 1.5 times greater probability of all-cause mortality and cardiovascular disease-related death than those with a much lower sodium-to-potassium ratio (5). The group that had higher sodium-to-potassium ratios also had a two-times increased risk of having ischemic heart disease. The duration was a strong point of this study, with almost 15 years of follow-up data. There were over 12,000 patients. It is believed that potassium gets its beneficial effects by activating nitric oxide, which causes vasodilation of arteries and, thus, may lower blood pressure.

While it is possible to get too little salt, it is rather unlikely and rare, especially with a plant-based diet. A diet rich in leafy green vegetables provides about 600-700 mg of sodium by itself, as well as high amounts of potassium. Low sodium is less than 140 mg per serving. But caveat emptor (buyer beware): serving sizes on labels can be deceiving, especially when you might eat more than one serving.

Reducing sodium is an easy way of helping to reduce acute (short-term) symptoms, such as dehydration, bloating and weight gain, while decreasing the risk of many diseases in the long term. Focus on decreasing the sodium, as the British study showed the positive impact on cardiovascular disease. And, if you have adolescents, preteens and teens, try to help reduce their sodium intake as well. Concentrate on increasing potassium intake and decreasing the sodium intake to optimize your sodium-to-potassium ratio.

References:

(1) N Engl J Med. 2014;371:601-611. (2) N Engl J Med. 2014;371:624-634. (3) BMJ Open. 2014;4:e004549. (4) www.cdc.gov. (5) Arch Intern Med. 2011;171:1183-1191.

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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Robert Lofaro drives a Prius, recycles his trash, and uses the air conditioning sparingly during the summer. These decisions reflect not just who he is, but also what he does.

The group leader of the Renewable Energy Group at Brookhaven National Laboratory, Lofaro leads the development of the applied research programs for solar energy. He also was the project manager for the development of the Northeast Solar Energy Research Center, a source of solar energy to the BNL campus that provides field testing and research.

Lofaro’s research addresses questions such as how to deal with the variability in power that comes from the sun due to cloud cover during the day and darkness at night. When solar energy comes to the electrical grid, this inconsistent production can cause problems with controlling the power quality on the grid, which has to supply power at a stable voltage and frequency.

This summer, BNL awarded Lofaro an annual engineering prize. The award, which includes a $10,000 prize, is the highest distinction given to members of the staff at BNL.

“It was quite an honor,” Lofaro said.

Researchers in Lofaro’s group will study energy storage systems, which could provide a buffer between the solar panels and the grid, and the use of “smart inverters,” which can control the grid voltage and frequency. BNL will test these system at NSERC.

“We’re interested in increasing the use of renewable energy throughout the country and in the Northeast,” Lofaro said. The uncertainty in the amount of power can cause problems with control of the grid, he said.

Once any new system is installed and operating, Lofaro seeks to explore how long the system can last.

“That goes towards the cost- effectiveness of installing the technology,” he said. “We’re doing field tests to understand how well they perform.”

Many states have targets for increasing the use of renewable energy. New York plans to increase solar, hydroelectric and wind energy sources to 30 percent of electric generation by next year, up from 22 percent in 2010.

As the cost of solar panels has dropped, the bigger expenses for utilities have been installation, labor, permitting, site preparation, and installation hardware, among others. Researchers are looking to reduce these costs and make solar energy more cost-competitive.

The staff in Lofaro’s department is “focused on grid integration,” he said. “There’s a lot of work to do in helping develop technologies that would enable the next generation” for a system that would enable real-time interactions between pieces of equipment in the grid, coupled with automatic controls, to provide a more efficient, reliable and resilient power delivery system.

Most grids are designed to send energy one way, from a central power station to customers. When some of their customers produce their own solar energy and sell it back to the utility, these two-way energy flows can trigger protective relays that interpret the flow of energy back from the customer as a fault, causing the grids to open the circuit to shut off the power.

New smart grids will need new monitoring, control and communication technologies to operate properly, Lofaro said.

Through automated switching, areas that have lost power through severe weather events, like Superstorm Sandy, might re-establish power more quickly.

Utilities could take portions of the grid and operate them as small parts of the network, with their own supply of power that would operate on its own if necessary, or as an integrated part of the larger grid.

“You’d need a number of control technologies and they’d have to be able to have special switching – through smart switches – that could synchronize” the smaller units with the larger energy source, Lofaro said. He said the grid today will require years to update.

Michael Villaran, who has known Lofaro since they started a month apart at BNL in 1987, describes his group leader as a “hands-on manager” who is “very involved” in the details of his work.

Lofaro is “well thought of in the solar energy research community,” Villaran said. “Getting the NSERC funded and constructed” is a “major accomplishment.”

Lofaro and his wife Nancy, who works in business operations at BNL, live in East Moriches. Lofaro plays on BNL’s golf league. He describes his golf game as “mediocre.”

As for his work, Lofaro is a firm believer of solar energy,

“Renewable energy will play an important part of meeting the nation’s energy needs for many years to come,” he said.

 

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The Facts: I have two dogs that I consider part of my family. I want to be sure they are cared for after I die. Someone suggested that I include a Pet Trust in my Will

The Question: Do you think this is a good approach?

The Answer: Yes, I do. However, in addition to the Pet Trust, which will not exist until after your Will is admitted to probate, it is important to make temporary arrangements for the care of your dogs that can be in place immediately upon your death.

When thinking about the provisions to include in the Pet Trust, you must not only consider who will care for your dogs, but also whether the appointed caregiver has the resources to cover the costs associated with pet ownership. Even if money is not an issue, you need to confirm in advance that the caregiver’s living arrangements are suitable for the dogs. As much as a potential caregiver may want to care for your pets, some apartment buildings and residential communities do not permit residents to own pets. If the caregiver of choice lives in such a community, or lives in a setting that is not large enough for the dogs, it is best to name someone else to adopt your pets after your death.

Once you have settled on a caregiver, you should consider including in your Pet Trust a description of the care you want your pets to receive. For example, if your dogs are groomed once a month, have an annual check-up by the vet and have their teeth cleaned three times a year, this schedule can be set forth in the trust. You can also name the groomer and vet that have taken care of your dogs in the past so that the caregiver can continue to use people with whom your dogs are familiar. Alternatively, you can prepare a letter to the caregiver in which you provide the caregiver with this information.

While the purpose of the Pet Trust is to insure that your dogs will be cared for after you die, it can also serve as a vehicle for providing your caregiver with instructions with respect to the handling your dogs’ remains after they die. This information is important and useful to the caregiver who will certainly want to honor your wishes.

In addition to setting forth in the Pet Trust provision of you Will the name of the caregiver and the type of care you wish your dogs to receive, both during their lives and after their deaths, you will need to allocate a certain amount of money to the trustee of the Pet Trust. The job of the trustee is to distribute the funds to the caregiver as needed to be used for the benefit of your dogs. Some people name the caregiver as the trustee but, you may have different people in those roles if you wish.

A final decision that you will have to make in connection with the Pet Trust is what happens to any of the funds left in the trust after your dogs pass away. Many people who have a Pet Trust direct that any money left in the trust after the death of the pet goes to the caregiver. Another popular arrangement is for the money to be donated to an organization that cares for abandoned and/or abused animals.

In light of the number of issues to be considered when creating a Pet Trust, and the fact that it will be part of your Will, you should discuss your ideas and concerns with an experienced estate planning attorney. That is the best way to insure that your dogs will be cared for in accordance with your wishes.

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