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Monthly Archives: January 2015

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Fat in the diet is a highly complicated issue. For decades, we have adopted the notion that fat may be the enemy and, therefore, we should eat a low-fat diet. But is this really true? The answer is that we all need fat, but the sources are important.
The cover of Time magazine’s June 23 edition exclaimed in big yellow letters to “Eat Butter. Scientists labeled fat the enemy. Why they were wrong” (1). It also included a picture of a curl of butter, in case you had forgotten what butter looked like. This cover is provocative and tantalizing. However, it does a disservice to the article itself and to the general population who may have seen it.
The article, itself, is well written. Its focus is not mainly on butter, but rather on different types of fats, saturated and unsaturated. The author Bryan Walsh does make salient points, but my objection is mainly that many of these points are buried deep within a five-page, three-column, single-spaced article among comments that are not necessarily substantiated. You have to wade through paragraph after paragraph to get to some these points. Reading the first page is not good enough.
Let’s look at a few studies presented in the article.
Study: Different types of fat — saturated and unsaturated with heart disease.
There was a recent meta-analysis (a group of 72 studies including both observational and randomized controlled trials) that looked at whether different types of fat had an impact on cardiovascular health (2). The results showed that saturated fats, omega-6 polyunsaturated fats and monounsaturated fats were most likely not harmful and that omega-3 polyunsaturated fats were potentially beneficial. However, trans fatty acids were shown to be potentially harmful, with a 17 percent increased risk of cardiovascular disease outcomes such as heart attacks and heart disease.
While this is an interesting study, there are some significant flaws that need to be highlighted.
1. The conclusions in the study don’t match or only partially match. Let me explain. There is a conclusion in the abstract (a synopsis or summary of the study) and a conclusion in the body of the study. The abstract concludes that polyunsaturated fats, including omega-3 fatty acids, are not necessarily beneficial while saturated fat may not be harmful. In the body of the study, the authors conclude that omega-3 fatty acids significantly reduce cardiovascular events. Why is this important? Many physicians are bombarded by studies and may only have time to read the abstract. Thus, this could wrongly influence the physician.
2. The source of fat is never differentiated in the study. In other words, the saturated fats which are deemed harmless may be from foods or supplements that contain both unsaturated fats and saturated fats or from foods that contain only saturated fats. We see benefit in plant-based foods that have multiple types of fats — saturated and unsaturated — such as olive oil, nuts, seeds and avocado. However, most animal fats, like red meat, pork and chicken, contain only saturated fats. The exception is fish, which contains multiple types of fats.
Also, unlike the Time cover story, the study NEVER mentions butter, cheese or red meat. Therefore, the commentary by the press is based on an extrapolation that cannot and should not be made: that eating butter, cheese and red meat maybe harmless and possibly beneficial.
3. The populations of the studies differed at the starts of the different trials. In other words, some were healthy participants, some were high-risk patients and some already had cardiovascular disease. The main thing these studies had in common was that cardiovascular disease outcomes were an endpoint, but it did not have to be the primary, or main, endpoint. Thus, cardiovascular disease outcomes may not have been the main thrust of all the studies that made up the meta-analysis.
4. A meta-analysis by definition is difficult to perform because researchers combine results from studies that were designed and performed differently from one another. In this meta-analysis, the authors combine the results of observational trials that may have used different types of fat intake from food or from supplements. Usually, supplements, like fish oil, involve both saturated and unsaturated fats, and they may have different effects than food.
5. Finally, the study does not tell us what those who ate lower saturated and unsaturated fats ate instead. For example, it compared those who ate high saturated fats to those who ate low saturated fats. What did the group who ate lower saturated fat eat instead of fat? Was it carbohydrates? If so, were they fries, whole grains or sweet potatoes?
The Time cover article goes on to mention the Mediterranean diet and its beneficial effects with heart disease. There was a recent randomized controlled study, the gold standard of studies, called the
PREDIMED trial, with results that showed that participants who ate a Mediterranean diet with added olive oil or mixed nuts had a 30 percent decreased risk of cardiovascular disease than those in the control arm who were advised to follow a “low-fat” diet (3).
The Mediterranean diet emphasizes vegetables, fruits, whole intact grains, beans, legumes and fish, as well as olive oil and nuts. This was not a low-fat diet. It contained both saturated and unsaturated fats, including polyunsaturated and monounsaturated fatty acids. The caveat to these results is that the “low-fat” group was not actually able to maintain a low-fat diet, but instead ate more like the standard American diet with no restrictions.
Interestingly, researchers using the same Mediterranean diet study, PREDIMED, showed that higher dietary intake of magnesium reduced the risk of cardiovascular mortality risk by 34 percent (4). They compared those in the highest intake of dietary magnesium with those in the lowest. These participants had a high risk of cardiovascular disease. Foods rich in magnesium include dark green leafy vegetables, such as spinach, as well as nuts, seeds, fish, beans, lentils and avocados.
In conclusion, the sources of fats matter. To run out and eat a cheeseburger, without the bun of course, would be to have misunderstood this article and the flaws in the meta-analysis and to have focused only on the cover of the Time magazine article.
The take-home message should be that we need some fats in our diet, but that the sources of these fats are critical. Diet quality is of the utmost importance in reducing disease (5), so put that cheeseburger out of your mind. Many studies have shown that the Mediterranean diet helps reduce the risk of cardiovascular events. For some, this may include the addition of more olive oil and nuts.
References:
(1) Time.com. (2) Ann Intern Med. 2014;160:398-406. (3) N Engl J Med. 2013;368:1279-1290. (4) J Nutr. 2014;144:55-60. (5) Lancet. 2014;383:1999-2007.

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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They help start car engines, provide light in the darkness, keep music playing as joggers circumnavigate their towns, and help send signals to hearts that might otherwise have irregular beats. They are, of course, batteries.

The fact that they work is something everyone understands as soon as they flip a switch. What no one can see completely yet, though, is what happens on a small scale as a battery discharges.

Mostly encased in stainless steel, the inner workings of a battery have been difficult to measure directly. A much-heralded hire from two years ago, who divides her time between Stony Brook and Brookhaven National Laboratory, Esther Takeuchi has teamed up with several other scientists to gather new clues about the changes in a battery as it discharges.

“We’re looking at the internal anatomy of a battery without taking it apart,” said Takeuchi, a distinguished professor with an appointment in the department of chemistry and the department of materials Science and engineering at Stony Brook and a chief scientist at BNL’s Basic Energy Sciences Directorate.

Takeuchi and her team worked at BNL’s National Synchrotron Light Source, where they stopped batteries at various times and measured them with the kind of x-rays that penetrate the steel casing. These provide a resolution on the scale of 20 microns, which is about 1/4 the width of a human hair.

By understanding on a more precise level what happens inside a battery, scientists may provide insight that enables a greater understanding of the best architecture or design for a battery.

“The way we understand a battery could change dramatically,” said study co-author Amy Marschilok, a research associate professor in materials science and engineering at Stony Brook. “We’re taking” the inner workings of a battery “from black box science to more [open] science, where we can see and understand what’s happening. We’re on the verge of that type of discovery right now.”

In general, Takeuchi said batteries may work at about 80 percent efficiency, depending on the type of battery or its use. That, she said, could increase with a design that makes best use of the developing environment in the battery as it functions.

The results of the study, which included Takeuchi’s husband Kenneth, who is a distinguished teaching professor at Stony Brook, Marschilok, BNL scientist Zhong Zhong, BNL postdoc Kevin Kirshenbaum and Stony Brook graduate student David Bock, were published in the prestigious journal Science.

The research team used these bright x-ray beams to study lithium batteries that have a special silver material at the cathode, the place from which current departs, that has high stability, high voltage and spontaneous matrix formation.

As the batteries, which Bock created, discharge, lithium ions from the anode travel to the cathode, displacing silver ions in the process. Coupling with free electrons and unused cathode material, the displaced silver forms a conductive silver metal matrix that enables electrons to flow.

The research demonstrated that a slow discharge rate early in the battery’s life creates a more uniform network.

“When we started activating the battery, the cathode spontaneously, within its own structure, starts forming small parts, or ions, of silver metal,” Takeuchi said. “The silver ions are reduced to silver metal. What’s really interesting is that, because we’re forming silver metal, we have something we can measure.”

The results of the experiment provided a clearer understanding of the steps the battery goes through. The last part of the battery to activate is the center.

In some batteries, the flow of electrons may just reach the edges and never have access to the middle.

Takeuchi, who left the University at Buffalo to come to Long Island, said she is excited by the opportunities at Stony Brook and BNL. This past June, Stony Brook led a multi-institution group that received a $10 million Energy Frontier Research Center Award from the Department of Energy.

Takeuchi is convinced she made the right decision to move to Long Island.

“The willingness of Stony Brook and BNL to commit to this field was appealing to me,” Takeuchi said. “They recognize how important it is, to Long Island, nationally, and globally. We have the opportunity to make a difference.”

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By Linda M. Toga, Esq.

The Facts: My mother’s Will contains provisions that are inconsistent with other documents she has signed and with what she told my sister about the distribution of her estate.

The Question: Are the Will provisions void or are the other documents unenforceable?

The Answer: Unfortunately, the situation you’ve described is quite common and often creates a great deal of tension between family members. While it is too late to avoid the problems caused by the inconsistent documents if your mother has already passed, if she is still alive, an experienced estate planning attorney can work with your mother to eliminate the inconsistencies and avoid the resulting problems. As for which of your mother’s documents and agreements now in existence will control the distribution of her estate, that will depend on the types of documents at issue and the provisions of those documents.

A Will only controls the distribution of assets that are owned by the decedent at the time of her death. For example, if your mother left her car to you in her Will but, signed the title to the car over to your sister before she died, you are out of luck. As long as transfer of the title took place during your mother’s lifetime, the provision in the Will is unenforceable because the car was not owned by your mother at the time of her death.

On the other hand, if your mother signed an agreement with your sister stating that her house was to be sold upon your mother’s death and that the proceeds would be divided between you and your sister but, her Will gives you the right to live in the house until you are forty, the Will controls. Unless your sister can demonstrate that your mother lacked capacity to execute her Will or that you unduly influenced your mother and caused her to sign the Will containing the provision that was contrary to her agreement with your sister, your sister will likely have to wait until you turn forty before the house can be sold and the proceeds divided. The reason for this is that agreements generally die with the parties to the agreement. Unless an agreement specifically states that it is binding upon the heirs, successors, assigns and executors of the parties signing the agreement, the agreement is not enforceable after one of the parties dies.

If the inconsistent documents you are concerned about are a Will and a beneficiary designation form signed by your mother, the terms of the beneficiary designations will control. For example, if your mother signed a form stating that her IRA was to pass to your sister but, her Will stated that her entire estate was to be divided equally between you and your sister, the funds in the IRA will pass to your sister. The balance of her estate will pass in equal shares to you and your sister. The same is true with jointly held property and bank accounts that provide for the right of survivorship. In that case, upon the death of one of the joint owners, the property or the funds in the account automatically belong to the surviving joint owner, regardless of any provisions in the deceased joint owner’s Will.

Because of the complexities surrounding the distribution of a decedent’s assets and the issues that arise when there are inconsistencies between various documents relating to estate planning, it is important to review with an experienced estate planning attorney all of the documents and agreements, oral and otherwise, that you may have in place relating to asset distribution. Engaging in estate planning gives you the opportunity not only to learn about the consequences of signing various types of documents and agreements, but also to look at your assets, consider your ultimate goals and take the steps to insure that those goals are met. Only by understanding the relationship between different estate planning strategies and the documents designed to implement those strategies can you be sure that the documents you sign and the agreements you make are consistent and will result in your wishes being honored.

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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Singer/songwriter Sophie Hintze. Photo by Michael Rosengard, North Island Photography

By Sue Wahlert

2014 was a fabulous year for 17-year-old Setauket resident Sophie Hintze. After a culmination of artistic sufferings and successes, the Ward Melville High School senior was recently courted and signed as a singer/songwriter by BMG Chrysalis, an international company focusing on the management of music publishing and recording rights.

“Sophie is the youngest person that I have committed to. This girl has it!” said Kris Muñoz, senior director, business & legal affairs for BMG Chrysalis. Muñoz continued, “We need to have folks with drive, energy and work ethic. Sophie has all of this and more!” Through a journey that began at home in Setauket, continued at school, and branched out into the world of theater and jazz performances in New York City, Hintze has reached a place most 17-year- olds only dream of.

With the loving support of her parents, sister and others, she began her job with BMG, a company that will nurture her full potential as a songwriter and singer. Dina LaPolt, of LaPolt Law in Los Angeles, who represents Hintze and artists such as Steven Tyler, Mick Fleetwood and Deadmau5, brought Hintze to the attention of music companies after hearing her song, “Better Off Alone.” LaPolt remarked upon meeting Hintze, “She has a star quality that is not something that comes lightly. It has only happened a few times in my career,” similar to when she met Stacy Ann Ferguson, better known as Fergie.

Lise Hintze, Sophie’s mother, recollects, “Being a singer was her dream since she was a little girl.” Sophie talked about her early beginnings with music, “When I was in elementary school, I would secretly write songs in a book, which I still have. I would sing these songs to my dog, Maybelle and my family. I wouldn’t tell them it was mine, and if they reacted, I knew it was something good. To this day, I still do this. Great songs demand attention.”

With her passion for writing, she was already laying the path for her future successes. However, the beginning did not go smoothly for Hintze. In junior high, she was rejected from a school play and it was devastating, albeit a blessing in disguise. Hintze said, “I felt like a failure, but I believed I had the talent and I wasn’t going to let anyone stop me.”

So with the support of her mom and dad, she turned to theater workshops in New York City to keep her dream alive. Her first stop was Broadway Workshop, a company that develops and produces educational workshops and full-scale productions.

Her first audition with Broadway Workshop, for “Legally Blonde,” was met with immediate success. Hintze recalls, “It was insane. They asked if I was free the next day for a callback!” This encouraged Hintze and she continued with Broadway Workshop into 10th and 11th grades, playing Calliope in the musical comedy “Xanadu” and Miss Gardner in “Carrie.” With a dedicated spirit, Hintze’s mother drove her to New York City every Saturday and Sunday. “Being around the caliber of talent in New York City fueled me. Their support has been overwhelming,” said a grateful Hintze.

During her time with Broadway Workshop, Hintze cemented her desire to become a performer. She also began singing with the Matt Baker Trio at Le Cirque, Somethin’ Jazz Club and the Metropolitan Room, starting at the age of 15. Additionally, she took on the role of Rapunzel in “Into the Woods” at her high school.

Then, in the summer of 2013, she was singing at Frank Melville Memorial Park during one of its Wind Down Sundays concerts, and songwriter/producer Anthony D’Erasmo approached Hintze and asked if she would be interested in recording some of her music. It was during this time she wrote and recorded “Better Off Alone,” a song that became the catalyst for her new career.

This valuable song, which Hintze copyrighted, became the center of a dispute with a music library. The Hintzes reached out to LaPolt for guidance. LaPolt gave them advice, and as an aside, Sophie e-mailed her the recording of “Better Off Alone.” That was the spark that ignited all that was to follow. LaPolt said, “I was like, this is an amazing song!” After sending the song to a few colleagues in the business, it landed in the hands of Kris Muñoz, who said to LaPolt, “Don’t send that song to anyone else!” While LaPolt had other offers for Hintze, a choice was made and Thomas Scherer, executive vice president of writer services at BMG, flew out to the BMG offices in New York City to meet with Hintze.

Scherer echoed the thoughts of both LaPolt and Muñoz, “She has tremendous star quality!” BMG was ready to make a commitment to this young songwriter, to work with her to develop her talents. In August of 2014, Hintze found herself at the offices of BMG in Los Angeles overlooking the Hollywood Hills, where she signed her contract as both a songwriter and an artist.

“We want Sophie to develop into a normal human being,” said Muñoz, referring to Hintze finishing high school and attending college in September at the Clive Davis Institute of Recorded Music at NYU’s Tisch School of the Arts.

BMG’s Muñoz said, “We want to take Sophie’s existing talent and see how she blossoms.” The process involves introducing her to writers and producers to see what kind of music she can produce for other artists. Hintze reiterated BMG’s support, saying, “They are very supportive of me, and I couldn’t ask for a better team.

They are home to some of my biggest inspirations in the industry and I feel honored to be a part of the BMG family. My goal isn’t to be famous — it is to be successful.”

2015 holds great promise for Hintze, with amazing opportunities for learning, creating, and making her mark in the music industry. Check her out at www.sophiehintze.com.

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Lottery winners don’t get to keep all their money — they have to pay a sizable federal tax. Similarly, solar energy involves a tax, albeit a very different kind. The light that becomes heat in solar cells doesn’t make its way into homes or stores.

Employing a new polymer, however, scientists at Brookhaven National Laboratory and Columbia University have started a process that may enable them to keep more energy from sunlight.

Using something called “singlet fission,” they figured out a way to cut down on solar energy lost as heat.

Through a multiplication process, one absorbed unit of light creates two electrical charge carriers.

Other researchers had produced materials that benefited from singlet fission. They hadn’t, however, created a substance that works while dissolved in liquids, which creates the potential for industrial-scale manufacturing.

“Not many materials do singlet fission,” said Matthew Sfeir, a scientist at BNL and one of the leaders on the project. The material Sfeir and co-investigator Luis Campos of Columbia University used can be made through solution processing, which includes material such as ink.

Sfeir explained that the discovery of this polymer was something of a fortunate accident. Campos, whom he describes as a “great organic chemist,” was attempting to create a molecule for an application that did not work. “It failed spectacularly,” Sfeir recalled.

Campos and Sfeir took a closer look at what was happening. As it turns out, by examining the materials with a strobe laser at the Center for Functional Nanomaterials at BNL, Sfeir and Campos recognized that this polymer was “behaving like nothing else with this class of organics.” They were, indeed, creating singlet fission.

Campos and Sfeir tested how well their sensitizer might work to tap into the heat energy. “A failure in one context [was turned into] a spectacular success in another,” Sfeir said.

Sfeir and Campos, along with John Miller at the Laser-Electron Accelerator Facility and postdoctoral student Erik Busby in Sfeir’s lab and postdoctoral student Jianlong Xia in Campos’s lab, started these experiments in September, 2013. They recently published their results online in the journal Nature Materials.

Sfeir explained that the technology at BNL enables scientists to test materials and ideas. “My research lab uses ultrafast lasers to evaluate how well materials might perform in actual devices, without building actual devices,” Sfeir explained.

Using lasers, he puts light energy into a system and then tries to measure where the energy goes and how fast it gets there.

Sfeir and Campos are looking at a material that works even better than the one for which they published their recent results. The original polymer included a small amount of a minority project that they are trying to minimize.

A resident of Bethpage, Sfeir lives with his wife Margot, their 6-year-old daughter Katy and their son Jonah, who will be 2 in a few months.

Sfeir was born in Buffalo while his wife was born in Minnesota. When they first met in Chicago, he said Margot would only use a scarf and mittens instead of a winter coat, even in cold weather. Living in the New York City area since 2000 has reduced their resistance to frigid temperatures.

When he was younger, Sfeir learned some lessons in a seemingly unrelated field when he worked at Hector’s Hardware, a small chain owned by his father Ken’s extended family. While he did other jobs like unloading concrete bags, mixing paint and cutting and threading pipe, Sfeir developed an expertise in window and screen repair.

In college, Sfeir discovered a passion for quantum mechanics and was fascinated by light and the way it interacts with matter.

In Sfeir’s first job at a research lab, one of his first responsibilities was fixing the water cooling lines on a laser. “I called my dad right away to thank him for the lessons about compression fittings,” Sfeir said.

As for his work, he said he thoroughly enjoys the opportunities. “I love working at BNL because its mission resonates strongly with me,” he said. “Sometimes, this research evolves into readily identifiable technological applications and sometimes it evolves our understanding of some of the most basic questions about our world. Both are very important to me.”

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Acute pancreatitis increases the risk of mortality and diabetes

Everyone has heard of pancreatic cancer, but pancreatitis is a significantly more common disease in gastroenterology and seems to be on an upward projection. Ironically, this disease gets almost no coverage in the general press. In the United States, it is among the top reasons for patients to be admitted to the hospital (1).

Now that I have your attention, let’s define pancreatitis. A rudimentary definition is an inflammation of the pancreas. There are both acute and chronic forms. We are going to address the acute – abrupt and of short duration – form. There are three acute types: mild, moderate and severe. Those with the mild type don’t have organ failure, whereas those with moderate acute pancreatitis experience short-term or transient (less than 48 hours) organ failure. Those with the severe type have persistent organ failure. One in five patients present with moderate or severe levels (2).

What are the symptoms?
In order to diagnosis this disease, the American College of Gastroenterology guidelines suggests that two of three symptoms be present. The three symptoms include severe abdominal pain; increased enzymes, amylase or lipase, that are at least three times greater than normal; and radiologic imaging (ultrasound, CT, MRI, abdominal and chest X-rays) that shows characteristic findings for this disease (3). Most of the time, the abdominal pain is epigastric, and it may also present with pain in the right upper quadrant of the abdomen (4). Approximately 90 percent of patients may also experience nausea and vomiting (5). In half of patients, there may also be pain that radiates to the back.

What are the risk factors?
There is a multitude of risk factors for acute pancreatitis. These include gallstones, alcohol, obesity and, to much lesser degree, drugs. Gallstones and alcohol may cause up to 75 percent of the cases (2). Many of the other cases of acute pancreatitis are considered idiopathic (of unknown causes). Although medications are potentially responsible for between 1.4 percent and 5.3 percent of cases, making it rare, the number of medications implicated is diverse (6) (7). These include certain classes of diabetes therapies, some antibiotics – Flagyl (metronidazole) and tetracycline – and immunosuppressive drugs used to treat ailments like autoimmune diseases. Even calcium may potentially increase the risk.

Obesity effects
When given a multiple-choice question for risk factors that includes obesity as one of the answers, it’s a safe bet to choose that answer. Pancreatitis is no exception. However, in a recent study, using the Swedish Mammography Cohort and the Cohort of Swedish Men, results showed that central obesity is an important risk factor, not body mass index or obesity overall (8). In other words, it is fat in the belly that is very important, since this may increase risk more than twofold for the occurrence of a first-time acute pancreatitis episode.
Those who had a waist circumference of greater than 105 cm (41 inches) experienced this significantly increased risk compared to those who had a waist circumference of 75 to 85 cm (29.5 to 33.5 inches). The association between central obesity and acute pancreatitis occurred in both gallbladder-induced and nongallbladder-induced disease. There were 68,158 patients involved in the study with a median duration of 12 years. Remember that waistline is measured not from the hips, but rather from the navel. This may be a surprising wake-up call for some.

Mortality risks
What makes acute pancreatitis so noteworthy and potentially dangerous is that the rate of organ failure and mortality is surprisingly high. One study found that the risk of mortality was 5 percent overall. This statistic broke out into a smaller percentage for mild acute pancreatitis and a greater percentage for severe acute pancreatitis, 1.5 percent and 17 percent respectively (9). This was a prospective (forward-looking) observational trial involving 1,005 patients.
However, in another study, when patients were hospitalized for this disease, the mortality rate was even higher at 10 percent overall (10).

Diabetes risks
The pancreas is a critical organ for balancing glucose (sugar) in the body. In a recent meta-analysis (involving 24 observational trials), the results showed that more than one-third of patients diagnosed with acute pancreatitis went on to develop pre-diabetes or diabetes (11). Within the first year, 15 percent of patients were newly diagnosed with diabetes. After five years, it was even worse; the risk of diabetes increased by 2.7-fold. This is scary, considering that diabetes has become a pandemic. If we can reduce the risk of pancreatitis, we may also help to reduce the risk of diabetes.

Surgical treatments
Gallstones and gallbladder sludge are major risk factors, accounting for 35 to 40 percent of acute pancreatitis incidence (12). Gallstones are thought to cause pancreatitis by temporarily blocking the duct shared by the pancreas and gallbladder that leads into the small intestine. When the liver enzyme ALT is elevated threefold (measured through a simple blood test), it has a positive predictive value of 95 percent that it is indeed gallstone-induced pancreatitis (13).
If it is gallstone-induced, surgery plays an important role in helping to resolve pancreatitis and prevent recurrence of acute pancreatitis. In a recent study, results showed that surgery to remove the gallbladder was better than medical treatment when comparing hospitalized patients with this disease (14). Surgery trumped medical treatment in terms of outcomes, complication rates, length of stay in the hospital and overall cost for patients with mild acute pancreatitis. This was a retrospective (backward-looking) study with 102 patients.

Can diet have an impact?
The short answer is: yes. What foods specifically? In a large, prospective observational study, results showed that there was a direct linear relationship between those who consumed vegetables and a decreased risk of nongallstone acute pancreatitis (15). For every two serving of vegetables, there was 17 percent drop in the risk of pancreatitis. Those who consumed the most vegetables – the highest quintile (4.6 servings per day) – had a 44 percent reduction in disease risk, compared to those who were in the lowest quintile (0.8 servings per day). There were 80,000 participants involved in the study with an 11-year follow-up. The authors surmise that the reason for this effect with vegetables may have to do with their antioxidant properties, since acute pancreatitis increases oxidative stress on the pancreas.

References:
(1) Gastroenterology. 2012;143:1179-1187. (2) www.uptodate.com. (3) Am J Gastroenterol. 2013;108:1400-1415. (4) JAMA. 2004;291:2865-2868. (5) Am J Gastroenterol. 2006;101:2379-2400. (6) Gut. 1995;37:565-567. (7) Dig Dis Sci. 2010;55:2977-2981. (8) Am J Gastroenterol. 2013;108:133-139. (9) Dig Liver Dis. 2004;36:205-211. (10) Dig Dis Sci. 1985;30:573-574. (11) Gut. 2014;63:818-831. (12) Gastroenterology. 2007;132:2022-2044. (13) Am J Gastroenterol. 1994;89:1863-1866. (14) Am J Surg online. 2014 Sept. 20. (15) Gut. 2013;62:1187-1192.

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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What better way to start an article, but with a pretest?
1) What minimum amount of exercise will reduce cardiovascular disease risk?
a. 5-10 minutes per day
b. 30 minutes most days
c. 60 minutes most days
d. I don’t care; I don’t like pretests
2) How does inactivity affect menopausal symptoms?
a. Increases hot flashes
b. Worsens risk of anxiety and depressive moods
c. Decreases memory and concentration
d. B and C
3) Exercise may have an impact on the following:
a. Changing gene expression
b. Metabolic aging
c. Weight management
d. All of the above
I would be remiss if I didn’t write an article about exercise for the new year. Exercise, like diet, is on the top of most resolution lists. The answers to the quiz are: 1) a, 2) d, 3) d. How did you do?
Before we go further, let’s differentiate between physical activity and exercise. Physical activity involves skeletal muscle contraction. It’s an umbrella term that includes exercise, but it also includes housework, yard work, movement on the job, etc. Exercise involves repetitive movements, structure and goal orientation such as walking, running, resistance training or playing sports (1). While you want to be physically active, exercise has more benefit.
We have long-held paradigms in medicine that may or may not be accurate. Medicine is always changing with the evolution of evidence-based research. We know that exercise has benefits for helping to prevent and possibly reverse some chronic diseases, but it also may have benefit for menopausal symptoms, slowing the metabolic aging process, and even changing our genes, or at least gene expression. In fact, it may even have effects on weight loss, something that I recently wrote about in an article titled, “Exercise: Medical Benefits versus Weight Loss,” stating that exercise may not be beneficial for weight loss. I might have to amend this conclusion.

THE FOUNTAIN OF YOUTH
Ponce de Leon sought a physical fountain of youth. While we tend to chuckle at that thought, metaphorically there may be at least some truth to the mythical fountain. Exercise may be a step toward reversing the metabolic clock. Until recently, we thought that when we hit 40 years old, we should expect a decline in physical abilities, with each new year raising the probability of greater muscle atrophy. This may not actually be the case. Just because a paradigm has been around a long time does not make it correct.
In a new small observational study, results showed that the participants, spanning ages 55 to 79, were unable to be differentiated based on age for the majority of tests (2). In other words, those who were in their 70s performed similarly to those in their 50s for many, but not all, parameters. It would be impossible to tell who was what age based purely on the data. Participants were also compared to standards related to typical aging in each group, such as comparing 70-year-old cyclists versus inactive 70-year-olds. The ones who were cyclists were metabolically much younger. Thus, the researchers concluded that activity, rather than chronological age, may play a more important role in the aging process. The cyclists were not professional athletes, though they were required to pass a cycling endurance test prior to being accepted into the study. To at least some degree, we are more in control of our aging than we had thought. This is good news; we would all like to turn back the physical clock.

CAN WE REALLY CHANGE GENES?
One of the greatest achievements of modern medicine has been mapping the human genome. However, gene therapy mostly has lagged. Well, there is a field called epigenetics. This word literally means “above” or “on” the gene. Epigenetics explores how to alter which genes get expressed and how. How can we do this? Methyl groups, one of the most basic groups of atoms in organic chemistry, latch on to genes and help to turn on and off their expression. Lifestyle modifications, like exercise, influence methylation groups to affect genes.
In a recent small study, results showed greater than 5,000 alterations in the genes of muscle cells such that there were different patterns of methyl groups that occurred in exercised legs compared to inactive legs (3). The genes that were affected are known to be involved in insulin sensitivity and inflammation. Let me explain further. The researchers had 23 healthy volunteers use a stationary bike for 40 minutes, four times a day, for three months. Here is the catch: participants only used one leg and did not exercise the other leg, limiting confounding variables. In the same participant, the leg that was exercised had dramatic changes in gene expression whereas the other leg did not.
MENOPAUSE SYMPTOMS
Although menopause is a rite of passage for women, not a disorder, there are symptoms that may negatively impact quality of life. Exercise may help alleviate menopausal symptoms. In a recent study, women who exercised regularly (resistance training twice weekly, plus either 150 minutes weekly of moderate activity, like walking, or 75 minutes weekly of intense exercise, like jogging or running) had a better overall sense of well-being and fewer symptoms during menopause compared to their less active counterparts (4). Those who were less active were more likely to be in depressed/anxious moods, have “brain fog,” difficulties with memory and concentration, and experience increased vasomotor symptoms. Interestingly though, there was no change in hot flashes between the two groups.
I DON’T HAVE TIME TO EXERCISE!
There have been several studies that have shown that you can have obscenely short intervals of exercise and still get significant benefit. In one study, a one-minute intensive interval was broken into 20-second intervals within 10 minutes of exercise three times a week (5). Overweight participants had improved blood pressure and endurance capacity, as well as beneficial gains among other parameters.
In another study, as little as five to 10 minutes of running a day reduced the risk of dying from any cause by 30 percent and dying from heart disease by 45 percent (6). The best part of the results was that there was a significant difference between runners and non-runners, but not between those who ran at a less-than-six-minute-mile pace and those who ran at a slower-than-10-minute-mile pace.
EFFECT OF TEMPERATURE
In a recent small study, those who exercised (walked) in the cold burned fewer calories, yet were more likely to consume greater amounts of calories, especially carbohydrates, after exercise than those who exercised in moderate temperatures (7). All the participants were overweight and considered sedentary prior to the study. Cold was defined as 46 degrees, whereas a moderate temperature was 68 degrees. There was also an increase in the hormone ghrelin, which stimulates hunger, in those who exercised in cold temperatures. Working out in moderate temperatures before eating may help control appetite.
Therefore, there is no reason not to exercise; the time commitment can be extremely short and the benefits considerably large.

REFERENCES:
(1) uptodate.com. (2) J Physiol. online Jan 6, 2015. (3) Epigenetics. December 7, 2014. (4) Maturitas. 2015 Jan;80(1):69-74. (5) PLoS One. 2014;9(11):e111489. (6) J Am Coll Cardiol. 2014;64(5):472-481. (7) Med Sci Sports Exerc. 2015;47(1):49-57.

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Two groups lived at about the same time. At around 40,000 years ago, one of them died off, while the other grew, changed and developed, becoming individuals who build airplanes, send text messages instantaneously over thousands of miles and harvest and replant crops that become high fructose corn syrup.

The winner was Homo sapiens, or wise man. Neanderthals, with their muscular frames, prominent brows and wide noses, came up short. Scientists on the winning team have been asking everything from how Neanderthals and Homo sapiens coexisted to why one group is still around, while the other left clues including fossils, cave drawings and genetic evidence.

Using mathematical and computational techniques to study DNA sequences, Adam Siepel, a professor at Cold Spring Harbor Laboratory, teams up with numerous collaborators to paint a clearer picture of what happened all those years ago.

“We try to reconstruct aspects of human history by comparing these sequences,” said Siepel, who joined CSHL this summer as chair of the new Simons Center for Quantitative Biology. The center, which started with a $50 million donation from the Simons Foundation, uses a combination of applied mathematics, computer science, theoretical physics and engineering to make sense of the explosion of data produced in labs on Long Island and throughout the world.

In his research, Siepel is trying to “make sense of how much gene flow” there was between Neanderthals and Homo Sapiens, he said. He is reconstructing models of ancient human demography based on a joint analysis of genome sequences from the two groups. He is currently seeing signatures of gene flow in both directions.
Scientists have been finding that the size of the Neanderthal population declined steadily over time. By using statistical models, researchers can look at patterns of genetic variation and can reconstruct the size of the population.

“There is a clear signal of the population shrinking over time, reaching precipitously low levels in anticipation of extinction,” Siepel said. This can be interpreted as signaling a steady decline, arguing against a cursory event where Neanderthals suddenly all died out.

In building these statistical models to reconstruct the Neanderthal story, scientists recognize numerous challenges. Researchers try to consider as many model violations as possible and cross check their results carefully, he added.

Siepel also conducts research into gene transcription, or the process through which DNA is copied into RNA, which is needed for a wide range of assembly and regulatory functions.

About a month ago, in conjunction with John Lis, a professor and former colleague of Siepel’s at Cornell University, Siepel published a paper in Nature Genetics in which the team showed that the first steps in transcribing genes and their regulatory elements are highly similar. This, he said, suggests that the differences between promoters and enhancers must occur downstream through mechanisms that cause an abrupt termination of transcription at enhancers.

This research and Siepel’s work on Neanderthals underscores the two major focuses of his lab: the process of transcriptional regulation and natural selection and human evolution. These disciplines “intersect in various ways,” Siepel said. He has, for example, studied the “influence of natural selection on transcription factor binding sites in the human genome.”

Siepel and his wife Amber bought a Victorian house in Huntington that has become a “fun project” for the family, which includes their 12-year-old daughter Ella and their 9-year-old son Charlie.

Siepel said he had never planned on living on Long Island, where he had a “vision of a big strip mall,” but he’s been “pleasantly surprised by Huntington” where he and the family can walk their two labradoodles along the streets by the harbor and visit nearby parks.

Siepel has enjoyed his first few months at Cold Spring Harbor Laboratory, where he said it is easy “to make changes.” The group has promoted Justin Kinney to assistant professor and Michael Schatz to associate professor. Siepel is also reviewing applications of researchers who are seeking to fill an open assistant professor job.

As for his work, Siepel said he is “fascinated by the idea of being able to reconstruct the past through the analysis
of present-day and fossil
genome sequences.”

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With almost 70 percent of the U.S. population overweight or obese, it’s no surprise that the number one New Year’s resolution each year is to lose weight. Now that you or someone you know has made this resolution, what are you going to do about it?
Roughly 50 percent of people make New Year’s resolutions, and 71 percent of people maintain their resolve for the first two weeks. In six months, about half are still working toward their goals, at least to some degree. So about half of us make resolutions and about half of us stick to them at least halfway through the year (1). The good news is that people who make resolutions are about 10 times more likely to reach their objectives than those who don’t (2). So don’t give up!
Wouldn’t it be nice if we had a silver bullet that would help us lose weight without much thought? Are diet pills at least part of the answer? Diet pills, both medications and supplements, have a checkered past. But don’t despair, the armament of diet pills is beginning to grow. Two drugs were approved in 1999: Xenical (orlistat) and Meridia (sibutramine). Meridia was subsequently withdrawn due to side effects. Since then, the options have expanded with the 2012 approval of two additional drugs: Qsymia (phentermine-topiramate combination) and Belviq (lorcaserin). And finally, we have two new medications, approved in the latter half of 2014: Contrave (naltrexone-buproprion) and Saxenda (liraglutide). At this point, you need a playbook to keep them straight.
How do we evaluate weight-loss drugs? There are two important parameters: effectiveness in weight loss and impact on health. Drugs considered modestly effective cause at least 5 percent weight loss. Those that cause 10 percent weight loss are considered very good. Those that cause over 15 percent weight loss are considered excellent.
Let’s look at the history of diet drugs, along with evidence on the two newest entrants.
DIET PILL’S BLACK EYE
Unfortunately, diet pills’ track records have made both the medical community and the population at large leery. One of the most notorious medications was Fen-phen (fenfluramine-phentermine combination). While this drug combination helped people lose weight, it also had some serious side effects, pulmonary hypertension and heart valve defects resulting in serious adverse events and even mortality in some patients who took the drug. It was withdrawn from the market in 1997 by the FDA (3). Fenfluramine was blamed for causing these side effects, not phentermine. The reason I highlight this is that another more recent combination uses phentermine.
In terms of supplements, green coffee bean extract had been touted for its weight-loss capabilities based on a small 2012 study funded by the manufacturer (4). However, the FTC took this study to task, noting that the lead investigator changed the weights of patients, altered the length of the trial and could not determine which patients actually took supplement or placebo. In 2014, the journal responsible for publishing the research retracted the results (5).
This brings up another point. Green coffee bean supplements were promoted on a TV medical talk show. A recent study looked at the validity of advice given on these shows. Research evidence that supported the shows’ claims was found only half the time, and it was usually only from small studies or case studies. Unfortunately, the magnitude of benefit, the side effects, conflicts of interest and costs were highlighted on the shows no more than 20 percent of the time (6). So caveat emptor or, as “The Doctors” show says many times, consult your physician.
DRUGS WITH LONGER
TRACK RECORDS
There have been two established drugs since 1999: Xenical (orlistat) and Meridia (sibutramine). In a meta-analysis (a group of 14 randomized controlled trials, 11 with orlistat and 3 with sibutramine), results showed that there was a mean reduction in weight of 2.9 percent with orlistat and 4.6 percent with sibutramine (7). Also, there were only 12 percent of patients on orlistat and 15 percent of patients on sibutramine who achieved greater than 10 percent body weight reduction when compared to placebo. To boot, both drugs have side effects. Orlistat is known for causing gastrointestinal (GI) side effects.
Another smaller trial with Alli (orlistat over the counter) found that those who followed diet and exercise regimens while taking the drug saw a median 5 percent reduction in weight over a two-month period. The patients were satisfied or very satisfied with the results, despite GI side effects after three months of study duration (8).
Orlistat assessment: modest efficacy and mild-to-moderate side effect profile.
Sibutramine was taken off the market in 2010 due to increased risk of cardiovascular events (3).
NEWLY APPROVED DRUGS BETTER?
Two drugs are recent enough that they don’t have track records in the marketplace. In September 2014, Contrave (naltrexone-bupropion) was approved by the FDA (3). In a large randomized controlled phase 3 trial, naltrexone-bupropion demonstrated significant effectiveness over placebo (9). The mean weight lost was 5.0 percent in the low-dose drug and 6.1 percent in the high-dose drug, whereas the placebo demonstrated a 1.6 percent reduction. These results were seen over 56 weeks. Nausea was the most common side effect, occurring in 30 percent of patients. The drug did also raise blood pressure 1.5 mmHg initially. There is an ongoing study intended to demonstrate no increased risk of heart attack, and interim results have been good.
There is a black box warning that patients may have suicidal thoughts because of bupropion, an antidepressant. Ultimately, Contrave reduces weight by an additional 4.1 percent over placebo (3). This medication can be used for those who are obese (BMI>30 kg/m2) or who have a BMI>27 kg/m2 with an additional weight-related disease, such as diabetes or high blood pressure.
Naltrexone-bupropion assessment: modest effectiveness and mild-moderate potential side effect profile. If the drug does not reduce the weight when using maintenance dose by at least 5 percent in 12 weeks, it should be discontinued according to the FDA (3).
The latest drug, Saxenda (liraglutide), was approved in December 2014. In a randomized controlled trial with a 56-week duration, liraglutide resulted in a 6.2 percent reduction in weight, whereas the placebo had 0.2 percent reduction in weight (10). Interestingly, the researchers required that all participants have a pre-trial period of lifestyle modifications, which resulted in a 6 percent weight loss prior to the trial. The treatment population is the same as for naltrexone-bupropion, either obese (BMI>30 kg/m2) or a BMI>27 kg/m2 with an additional weight-related disease, such as diabetes or high blood pressure. Liraglutide is an injectable diabetes drug in the class referred to as GLP-1 agonists. The dose is higher for weight-loss patients. The side effect profile was mainly associated with GI distress.
Liraglutide assessment: modest effectiveness and mild side effect profile.
Interestingly, metformin has been used as an off-label weight-loss drug as well, meaning not approved by the FDA for that use, but at the discretion of the physician.
Your best recourse is always lifestyle changes, but a diet drug could help jump start your resolution to lose weight. The medications have very similar modest effectiveness and mild-to-moderate side effect profiles. However, the newer drugs do not have post-marketing safety data yet. Even if you start a diet medication, diet and exercise are highly recommended or else the results may not be achieved with medication alone. I can’t stress it enough: always consult your doctor before starting a weight-loss drug.
REFERENCES:
(1) statisticbrain.com. (2) J Clin Psychol. 2002 Apr;58(4):397-405. (3) FDA.gov. (4) Diabetes Metab Syndr Obes. 2012;5:21-7. (5) Diabetes Metab Syndr Obes. 2014;7:467. (6) BMJ. 2014;349:g7346. (7) Int J Obes Relat Metab Disord. 2003;27:1437-1446. (8) Obesity (Silver Spring). 2008;16:623-629. (9) Lancet. 2010;376:595-605. (10) Int J Obes (Lond). 2013;37:1443-1451.

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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When he was 15, Raju Venugalapan spent what was then a considerable sum of money to buy three books on what his parents thought was an obscure subject. Living in India, where he was born and raised, Venugalapan bought the Feynman lectures, books that were based on lectures delivered to students at the California Institute of Technology by Nobel laureate Richard Feynman. These lectures were designed to make physics more vibrant and inspirational.

The books worked for Venugalapan, who was determined to enter the field of physics. The would-be physicist, however, had a problem — his parents weren’t sure this represented a viable career choice. For them, studying physics was like writing poetry, he said. While it might have value, it could be difficult to earn a living and support a family.

His parents’ opinion changed, however, when he received a full scholarship to study physics at the University of Chicago.

Over a quarter of a century later, Venugalapan is a senior scientist and group leader of the Nuclear Theory Group in the Physics Department at Brookhaven National Laboratory.

“I love getting up in the morning and going to work,” said Venugalapan. His daily pursuits are something that are “very natural to me, like breathing.” What makes his work so exciting, Venugalapan said, is that he can address questions about some of the unknown structural elements of matter.

“I see various data as pieces of a jigsaw puzzle that, together with theoretical insight, can provide a larger picture of the sub-nuclear scale matter,” he explained.

Larry McLarren, a senior scientist and a group leader at the Riken BNL Center, said Venugalapan’s approach and theories have proven successful.

“He’s developed many of the ideas that are hot right now,” he said. Venugalapan is “somebody who has done a lot of good work and is full of energy.”

Venugalapan studies data that comes out of the Relativistic Heavy Ion Collider at BNL, where scientists collide protons and neutrons almost to the speed of light. The heat generated from these collisions is 100,000 times hotter than the center of the sun, although they last for an unimaginably small amount of time.

Feynman — the physicist who inspired Venugalapan — described this process as being similar to smashing two Swiss watches together. At this point, he said, “we don’t have the luxury of taking apart” subatomic particles such as gluons and quarks.

A few years ago, he and his colleagues had developed a theory about the correlations of gluons and how they would behave. One of the team members made a prediction for proton-proton collisions at the Large Hadron Collider near Geneva, Switzerland.

Because the signal was too small, the group published its result as a curiosity in a conference proceeding rather than in a scientific journal. When the LHC experimentalists found this phenomenon, Venugalapan and his team were able to put out a paper within a week of the announcement.

The event they described was about a one in a million occurrence in a proton-proton collision. “It was extremely exciting,” he recalled. “It was the biggest high you can imagine.”

After the original result, the science progressed as it often does in the face of new information and a new theory: Other researchers performed similar experiments to confirm the data — and to test the idea behind it.

“I’d go to bed at night with a mixture of anticipation and trepidation,” Venugalapan said. There might be a new paper out that “either killed or confirmed our idea.”

Venugalapan and his colleagues believed there could be two phenomena that could cause the effect: One was hydrodynamics and the other was a so-called quantum synchronicity of gluons.

A resident of Riverhead, Venugalapan enjoys sailing with his family on Peconic Bay. As for his work, Venugalapan said he still marvels at how the theories he and his colleagues create might describe events at a subatomic level.

“When you’re making up these mathematical edifices, there’s a certain level of disbelief that this can describe the world,” he said. “We’re playing with paper and equations and, on the other side of the world, there’s a 15-ton detector” that’s running experiments. He wonders: “What do my scribbles have to do with what they see there?”

As for his parents, he said they had a point: “The creative process in science and theoretical physics in particular is not unlike that in poetry.”

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