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Chicken Satay with Peanut Sauce

By Barbara Beltrami

Ah, consider the lowly peanut relegated in most culinary estimations to its more popular descendant, peanut butter. True, you seldom see it on a restaurant menu or even in a cookbook. In western cultures it hardly bears mentioning unless you’re talking about something to munch with your martini. In eastern cultures, however, the peanut, also called the ground nut, plays a larger role in native cuisine.

The recipes below will give you a taste (pun intended) of how the peanut figures into both the western and eastern food cultures and exhibit its versatility according to traditional preferences.

Chicken Satay with Peanut Sauce

Chicken Satay with Peanut Sauce

YIELD: Makes 4 servings

INGREDIENTS:

For the marinade:

½ cup coconut milk

1 teaspoon curry powder

2 teaspoons fresh minced garlic

2 level teaspoons brown sugar

½ teaspoon salt

½ teaspoon freshly ground black pepper

²⁄₃ pound boneless, skinless chicken breasts, cut into 2-inch strips

For the peanut sauce:

1 cup coconut milk

1 tablespoon curry powder

½ cup peanut butter

²⁄₃ cup chicken broth

¼ cup brown sugar

2 tablespoons freshly squeezed lime juice

1 teaspoon soy sauce

½ teaspoon cayenne pepper

Salt to taste

DIRECTIONS:

For the marinade: Stir together the first six ingredients. In a medium bowl, toss with chicken, cover and refrigerate for two hours. If using wooden skewers, soak in hot water until ready to use.

For the sauce: In a small-medium saucepan over medium-high heat, stirring frequently, combine coconut milk, curry powder, peanut butter, chicken broth and brown sugar. Bring to a simmer and cook for 5 minutes until heated through. Remove from heat and stir in lime juice, soy sauce, cayenne pepper. Add salt to taste (You probably won’t need much). Set aside to keep warm.

Meanwhile heat grill to medium high, remove skewers from water and wipe dry, then thread marinated chicken onto them. Grill 5 minutes per side or until golden brown and cooked through. Remove to platter and ladle warm peanut sauce over them. Serve with rice and vegetable slaw.

Peanut, Carrot and Mango Salad

YIELD: Makes 4 servings

INGREDIENTS:

2 cups grated carrots

½ cup chopped roasted salted peanuts

3 tablespoons lemon juice

1-2 teaspoons sugar

One green chile pepper, seeded and diced

¼ cup red or yellow bell pepper, minced

2 tablespoons finely chopped cilantro

Salt, to taste

One mango, peeled and diced

DIRECTIONS: In a medium bowl, combine the carrots and peanuts. In a separate small bowl, whisk together the lemon juice, sugar, chile pepper, bell pepper and cilantro. Combine with peanut and carrot mixture. Add salt and mix again. Fold in mango. Serve immediately with chicken or lamb.

Peanut Brittle

Peanut Brittle

 

YIELD: Makes one pound

INGREDIENTS:

Butter for greasing pan

2 cups sugar

2 cups roasted salted peanuts

DIRECTIONS: Grease low-rimmed baking sheet. In a heavy skillet combine sugar with 2 tablespoons water. Cook over medium heat, stirring frequently, until mixture boils. Steadily, continue to cook, stirring occasionally, until mixture turns golden (it happens pretty quickly!). Stir in peanuts and immediately pour and spread mixture onto greased baking sheet. Allow to cool half an hour, until hard. Then break into uneven, asymmetrical pieces before serving with coffee or tea.

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By Linda Toga

Linda Toga, Esq.

THE FACTS: My friend Joe, a New York State resident, was never married, but he and his on-again off-again girlfriend had a son together. The child was 14 months old when Joe died without a will. Before his death, Joe spent most of his free time with his son who lives with the girlfriend in New York. My friend’s parents live in Ohio and did not know about the girlfriend, much less the baby. They were shocked to learn that a baby they did not even know existed was the sole heir to Joe’s estate. They are now insisting on a DNA test.

THE QUESTION: Can Joe’s parents insist that a DNA test be done to prove paternity?

THE ANSWER: Whether or not a DNA test is appropriate will depend on what steps Joe may have taken to establish paternity. If, for example, Joe signed a paternity acknowledgment, the Surrogate’s Court will not order a genetic marker test or DNA test.

Under Public Health Law 4135-B, the father of a child can establish paternity by signing a paternity acknowledgment immediately before or after an in-hospital birth of a child to an unmarried woman. The acknowledgment must be signed by both parents and witnessed by two people who are not related to either parent. The acknowledgment must be filed with the registrar along with the child’s birth certificate.

If neither parent rescinds the acknowledgment within 60 days of signing it, the acknowledgment is deemed conclusive evidence of paternity. While challenges to a paternity acknowledgment based upon fraud or duress can be brought, the burden of proof is very high.

Another way the paternity of a child born out of wedlock can be established is through an Order of Filiation. A proceeding to establish paternity may be brought in Family Court by the mother of the child, a person claiming to be the father, the child or the child’s guardian. Assuming adequate proof is submitted to the court, an order will be issued setting forth the relationship between the father and the child. Just as there is a 60-day period during which the paternity acknowledgment can be rescinded, the court has 60 days in which to vacate an Order of Filiation before it is deemed conclusive evidence of paternity.

If, during Joe’s lifetime, an order of filiation was issued stating that the girlfriend’s son was Joe’s child, Joe’s parents cannot demand a genetic marker or DNA test. If there is no paternity acknowledgment or Order of Filiation, Joe’s parents can insist that proof be presented establishing that Joe is the child’s father. In that case, genetic marker and/or DNA testing would certainly be appropriate.

Other evidence may include proof that Joe was providing child support or that he publicly held himself out as the child’s father. If paternity cannot be established, Joe’s parents are in line to inherit his estate. Such an unfortunate outcome could have easily been avoided if Joe discussed his situation with an experienced estate planning attorney and had a will prepared that expressed his desire to leave his assets to his son.

Linda M. Toga, Esq. provides legal services in the areas of estate planning, probate, estate administration, litigation, wills, trusts, small business services and real estate from her East Setauket office.

Mice are very efficient transmitters of Lyme disease, infecting about 95 percent of ticks that feed on them.

By Matthew Kearns, DVM

I was listening to the radio and a segment was introduced as “How a Mouse Plague Is a Forbidding Forecast for Lyme Disease in the Northeast,” predicting 2017 as a particularly risky year for Lyme disease. I had always focused on how close deer came to a dog owner’s property when discussing the risk of Lyme disease. I realize now that I must also ask about mice.

I decided I need to do some more investigating myself. I started with a little coffee, a doughnut, and started pounding the streets (I pictured myself as a regular “Magnum PI”). OK, back to reality. Coffee yes. Anyone whose seen my waistline would say, “doughnut NO!” Lastly, I only pounded the streets of Bing, Google and the Veterinary Information Network.

The first stage of my investigation was to refamiliarize myself with the life cycle of the deer tick. I learned that there are four stages: egg, larvae, nymph (young adult) and adult. The larval stage is the first stage to feed, so they do not have Borrelia burgdorferi (the bacteria that causes Lyme disease) but can acquire it during their first feeding. The adult stage of the tick prefers deer; however, the larval and nymph stages prefer smaller mammals such as dogs, cats, possums and, most importantly, mice.

Another fun fact I learned is that although other mammals, such as possums, will regularly groom off or kill the ticks on them, mice tolerate these ticks on their bodies. It is estimated that a white-footed mouse can have anywhere from 10 to 50 ticks on its face and ears at a time, and mice are very efficient transmitters of Lyme disease (they infect about 95 percent of ticks that feed on them).

Once the larval and nymph stages have fed (and possibly ingested Lyme disease at the same time), it is off to another host. The next stage of my investigation was to find out why there is an upsurge in the mouse population. Was it weather related? Other environmental factors? Actually it had most to do with a downtick in the population of the natural predators of mice. Many call it “Suburban Sprawl.”

Hawks, foxes and owls are the natural predators of the white-footed mouse and these predators need large forests to survive. Today we have more of a fragmented landscape — plenty of smaller forests that are broken up by small farms, housing developments and roads. Mice are prolific at making babies and actually thrive in these environments. Unlike deer, mice will come right up to (and sometimes into) our homes with all these ticks.

The Centers for Disease Control and Prevention report about 30,000 cases of human Lyme disease annually, but many experts feel that number is not accurate and that there could be as many as 10 times that amount. I would say it is safe to assume that the risk is just as high, if not higher, for dogs. There is no Lyme vaccine currently available for humans, but there has been a safe and effective vaccine for dogs on the market for decades. Please be aware that the canine Lyme vaccine has to be a series of two vaccines three weeks apart, and then once annually to be effective.

So, if you didn’t finish the initial series, or there has been more than a year gap since your dog received the vaccine, please make an appointment with your veterinarian ASAP. I would recommend a discussion about flea and tick preventatives at that same visit.

Dr. Kearns practices veterinary medicine from his Port Jefferson office and is pictured with his son Matthew and his dog Jasmine.

How to defeat ISIS, save the economy and reunite the country

By Michael Tessler

Michael Tessler

Historically speaking, the United States economy tends to thrive in wartime. Americans become patriotic when faced with a great foreign menace. In times of crisis, we tend to buy American products. Our star-spangled workforce works harder and innovates quicker. Our domestic political disagreements seem smaller when we tackle something larger than ourselves. In these moments of dire necessity, we find common purpose. Under that pretense our nation was founded and through the centuries has propelled it to unparalleled success.

Thankfully, we do not need another world war to accomplish this spirit of unity. This may all feel impossible as the gap between our political factions has never felt wider. On every issue it seems partisanship dictates idleness and/or delinquency. So how do we bridge that gap? How do we break the ice? Well the answer is simple — by protecting it.

Climate change is the key to a new era of American greatness. Now, even if you don’t believe in climate change, hear me out. Before we can proceed, please remove the term “climate change” from your mind as some abstract scientific concept. Let’s personalize it, treat it in the same fashion we’d treat any great and terrible foreign power or dictator. It helps to imagine it with an evil little mustache. Envisioning it now? Good.

This Blue Scare (yes, as in excess water) threatens our homes, our livelihoods and our way of life. If we lose this literal “Cold” War, our cities and towns could be decimated not by atomic fire but by superstorms, erosion, dust bowls and flooding. Each day we wait, the Blue Menace grows stronger, melting glaciers and capturing our territory, inch by inch.

Let us form an iron curtain around the ozone layer, protect it from further damage and economically punish those who aide in its destruction. We must establish a great coalition of all civilized nations to combat this threat in an act of global unity, all the while strengthening and cementing our role as an international leader.

This Blue Menace has allied itself with our nation’s greatest physical enemy, ISIS. Their terrorist organization wants nothing more than for us to continue to ignore this mighty faceless foe. According to the United States Treasury and Dubai-based energy analysts, ISIS receives nearly $1 to $3 million a day selling oil. Meanwhile, the United States continues to be the global leader in daily oil consumption accounting for 20 percent of all global use each and every day.

By ending our addiction to oil, we could decimate the so-called Islamic Caliphate without dropping a single bomb. Without the money from that precious resource, they would be unable to remain an effective fighting force. Our nation would no longer have to maintain alliances with false friends, who have used their swaths of oil as leverage over our current state of dependence.

Meanwhile, we can commit that all investments in green energy jobs must be American. We can hire every single unemployed American to help build a modern and green infrastructure. We will see the greatest investment in public works since President Eisenhower built the interstate highway system. We will create a new generation of energy-producing highways (yes, that’s an actual thing), new energy fueling stations, bullet trains, green appliances and the vehicles of tomorrow.

Industry will boom and the workforce will grow as we upgrade and innovate many existing products and power plants. Regardless of how one views climate change, the economic possibility is real and should not be ignored.

One of the biggest concerns I’ve heard is how will communities that produce outdated energy sources be impacted? Though the merits of “clean coal” can be debated, it is simply not a renewable resource. Our economy cannot survive or remain competitive in the 21st century using finite resources.

We cannot and will not abandon those who live in coal and oil country either. We will continue to ensure that their communities thrive by transforming them into clean energy economic hubs, providing not just new jobs, but training and tax subsidies to aide in their transition. Their concerns are genuine and have a right to be heard.

As long as the United States can be fundamentally held hostage by oil, we are at-risk. We owe it to all those who have sacrificed, to our children, born and unborn, to the ideals of America itself, to create a country that relies solely on the ingenuity of its people rather than foreign pipelines and the fuel of a bygone century.

So let’s defeat ISIS, let’s grow the economy, let’s reunite our country, let’s do something bold — we have landed a man on the moon, and with that same American tenacity, we can harness the power of the sun.

In recent studies, whole fruit was shown to actually reduce the risk of type 2 diabetes.
Some surprising results about lifestyle

By David Dunaief, M.D.

Most of us know that type 2 diabetes is an epidemic in America and continues to grow. Type 2 diabetes was thought to be an adult-onset disease, but more and more children and adolescents are affected as well. The most recent statistics show that 50 percent of teens with diabetes between the ages of 15 and 19 have type 2 (1). Thus, this disease is pervasive throughout the population.

Let’s test our diabetes IQ. See if you can determine whether the following items are true or false.

•Whole fruit should be limited or avoided.

•Soy has detrimental effects with diabetes.

•Plant fiber provides too many carbohydrates.

•Coffee consumption contributes to diabetes.

•Bariatric surgery is an alternative to lifestyle changes.

My goal is to help debunk type 2 diabetes myths. All of these statements are false. Let’s look at the evidence.

Fruit

Fruit, whether whole fruit or fruit juice, has always been thought of as taboo for those with diabetes. This is only partially true. Yes, fruit juice should be avoided because it does raise or spike glucose (sugar) levels. The same does not hold true for whole fruit. Studies have demonstrated that patients with diabetes don’t experience a spike in sugar levels whether they limit the number of fruits consumed or have an abundance of fruit (2). In another study, whole fruit actually was shown to reduce the risk of type 2 diabetes (3).

In yet another study, researchers looked at different whole fruits to determine their impacts on glucose levels. They found that berries reduced glucose levels the most, but even bananas and grapes reduced these levels (4) — that’s right, bananas and grapes, two fruits people associate with spiking sugar levels and increasing carbohydrate load. The only fruit that seemed to have a mildly negative impact on sugars was cantaloupe. Fruit is not synonymous with sugar. One of the reasons for the beneficial effect is the flavonoids, or plant micronutrients, but another is the fiber.

Fiber

We know fiber is important in a host of diseases, and it is not any different in diabetes. In the Nurses’ Health Study and NHS II, two very large prospective (forward-looking) observational studies, plant fiber was shown to help reduce the risk of type 2 diabetes (5). Researchers looked at lignans, a type of plant fiber, specifically examining the metabolites enterodiol and enterolactone. They found that patients with type 2 diabetes have substantially lower levels of these metabolites in their urine, compared to the control group without diabetes. There was a linear, or direct, relationship between the amount of metabolites and the reduction in risk for diabetes. The authors therefore encourage patients to eat more of a plant-based diet to get this benefit.

Foods with lignans include: flaxseed; sesame seeds; cruciferous vegetables, such as broccoli and cauliflower; and an assortment of fruits and grains (6). The researchers could not determine which plants contributed the most benefit. They believe the effect is from antioxidant activity.

Soy and kidney function

Soy sometimes has a negative association. However, in diabetes patients with nephropathy (kidney damage or disease), soy consumption showed improvements in kidney function (7). There were significant reductions in urinary creatinine levels and reductions of proteinuria (protein in the urine), both signs that the kidneys are beginning to function better.

This was a small but randomized controlled trial, considered the gold standard of studies, over a four-year period with 41 participants. The control group’s diet consisted of 70 percent animal protein and 30 percent vegetable protein, while the treatment group’s consisted of 35 percent animal protein, 35 percent textured soy protein and 30 percent vegetable protein.

This is very important since diabetes patient are 20 to 40 times more likely to develop nephropathy than those without diabetes (8). It appears that soy protein may put substantially less stress on the kidneys than animal protein. This negative effect with animal protein may be due to higher levels of phosphorus. However, those who have hypothyroidism should be cautious or avoid soy since it may suppress thyroid functioning.

Coffee

Coffee is a staple in America and in my household. It is one thing my wife would never let me consider taking away. Well, she and the rest of the coffee-drinking portion of the country can breathe a big sigh of relief when it comes to diabetes.

There is a meta-analysis (involving 28 prospective studies) that shows coffee decreases the risk of developing diabetes (9). It was a dose-dependent effect; two cups decreased the risk more than one cup. Interestingly, it did not matter whether it contained caffeine or was decaffeinated. This suggests that caffeine is not necessarily the driving force behind the effect of coffee on diabetes.

The authors surmise that other compounds, including lignans, which have antioxidant effects, may play an important role. The duration of the studies ranged from 10 months to 20 years, and the database was searched from 1966 to 2013, with over one million participants.

Bariatric surgery

In recent years, bariatric surgery has grown in prevalence for treating severely obese (BMI>35 kg/m²) and obese (BMI >30 kg/m²) diabetes patients. In a meta-analysis of bariatric surgery (involving 16 RCTs and observational studies), the procedure illustrated better results than conventional medicines over a 17-month follow-up period in treating HbA1C (three-month blood glucose measure), fasting blood glucose and weight loss (10). During this time period, 72 percent of those patients treated with bariatric surgery went into diabetes remission and had significant weight loss.

However, after 10 years without proper management involving lifestyle changes, only 36 percent remained in remission with diabetes, and a significant number regained weight. Thus, whether one chooses bariatric surgery or not, altering diet and exercise are critical to maintain long-term benefits.

There is still a lot to be learned with diabetes, but our understanding of how to manage lifestyle modifications, specifically diet, is becoming clearer. The take-home messages are: Don’t avoid whole fruit; soy is potentially valuable; fiber from plants may play a very powerful role in preventing and treating diabetes; and coffee may help prevent diabetes.

Thus, the overarching theme is that you can’t necessarily go wrong with a plant-based diet focused on fruits, vegetables, beans and legumes. And if you choose a medical approach, bariatric surgery is a viable option, but don’t forget that you need to make significant lifestyle changes to increase the likely durability over 10 or more years.

References: (1) JAMA. 2007;297:2716-2724. (2) Nutr J. 2013 Mar. 5;12:29. (3) Am J Clin Nutr. 2012 Apr.;95:925-933. (4) BMJ online 2013 Aug. 29. (5) Diabetes Care. online 2014 Feb. 18. (6) Br J Nutr. 2005;93:393–402. (7) Diabetes Care. 2008;31:648-654. (8) N Engl J Med. 1993;328:1676–1685. (9) Diabetes Care. 2014;37:569-586. (10) Obes Surg. 2014;24:437-455.

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, visit www.medicalcompassmd.com or consult your personal physician.

'A trip to the American Museum of Natural History was my idea of being in heaven.' - Elof Carlson

By Elof Axel Carlson

The life sciences are vast in the number of specialties that exist for those pursuing a career as a biologist. A majority of college biology majors are premedical or seek some sort of health-related field. As much as possible they hope the biology they learn will find its way into the health field they seek to enter. Persons who want to be scholars in biology are often motivated by a desire to know as much about life as they can. I was one of those from early childhood when a trip to the American Museum of Natural History was my idea of being in heaven.

Elof Axel Carlson

I loved learning about evolution and the diversity of life. I knew I wanted to be a geneticist when I was in ninth grade and learned about Paul Müller’s Nobel Prize work on inducing mutations. Like a duckling, I felt imprinted and wanted to work with Müller someday.

Graduate work was different. As a teaching assistant I got to see about 90 different specimens each week for the various organ systems displayed by students. Unlike the textbook perfect illustrations, veins and arteries could be slightly off in the specimens I looked at. Their colors differed. Their texture differed.

I also learned how much we didn’t know about life. For my specialty of genetics (with Müller, as I had hoped) I felt steeped in experimental design, techniques and ways of thinking. Doing a Ph.D. allowed me to examine a gene using the tools of X-raying to produce mutations of a particular gene and subtle genetic design to combine pieces of a gene — taking it apart and combining pieces that were slightly different. It gave me an insight into that gene (dumpy, in fruit flies) that for a short time (until I published my work) I was the only person in the world that knew its structure.

In my career I have taught biology for majors, biology for nonscience majors, genetics, human genetics and the history of genetics. I have taught lower division and upper division courses, graduate courses and first-year medical classes. I learned that sharing new knowledge with students excited their imaginations. I learned that the human disorders I discussed led to office visits; and if I didn’t know the information they sought, I went with them to the medical library and we looked up articles in the Index Medicus and discussed their significance.

Often that student was married and had a child with a birth defect (born without a thyroid, having a family trait that might appear like cystic fibrosis). I would prepare a genetic pedigree and give it to the student to stick in a family bible for future generations to read. I also delighted in going to meetings to discuss genetics with colleagues whose work I had read.

I was pleased that I shared a body plan with other mammals. I liked comparative anatomy, which taught me how other body plans work (mollusks, arthropods, worms, coelenterates, echinoderms). As a graduate student taking a vertebrate biology course, I went into a cave and plucked hibernating bats from a ceiling.

The world under a microscope is very different. To see amoebas, ciliated protozoans, rotifers and other organisms invisible to the naked eye or as mere dust-like specks is a thrill. I can go back in time and imagine myself as a toddler, a newborn, an embryo in my mother’s uterus or an implanting blastocyst rolling out of her fallopian tube. I can imagine myself as a zygote, beginning my journey as a one-celled potential organism typing this article into a computer. I can go back in time to my prehistoric ancestors and trace my evolution back to the first cellular organism (bacteria-like) more than 3 billion years ago.

I learned, too, that I contain multitudes of ancestors who gave me one or more of their genes for the 20,000 I got from my father’s sperm and the matching 20,000 genes in my mother’s egg nucleus. I contain some 37 trillion (that is, 37,000,000,000,000) cells or 2 to the 45th power, which means some 45 mitotic cell divisions since I was a zygote. I know that the warmth of my body is largely a product of the mitochondrial organelles in my cells that using the oxygen from the air I breathe and converting small molecules of digested food to provide energy that runs the metabolism of my body and disposes carbon dioxide that eventually is expelled from my lungs. This knowledge makes me aware of my vulnerability at the cellular level, the chromosome level and the genetic level of my DNA to the agents around me that can lead to birth defects cancers, and a premature aging.

Knowing my biology allows me to know my risks as well as new ways to celebrate my life.

Elof Axel Carlson is a distinguished teaching professor emeritus in the Department of Biochemistry and Cell Biology at Stony Brook University.

By David Dunaief, M.D.

 

Dr. David Dunaief

Chronic kidney disease (CKD) is much more common than you think. Those at highest risk for CKD include patients with diabetes, hypertension (high blood pressure) and those with first-degree relatives who have advanced disease. But those are only the ones at highest risk. This brings me to my first question.

Why is chronic kidney disease (CKD) a tricky disease?

Unfortunately, similar to high blood pressure and dyslipidemia (high cholesterol), the disease tends to be asymptomatic, at least initially. Only in the advanced stages do symptoms become distinct, though there can be vague symptoms such as fatigue, malaise and loss of appetite in moderate stages.

What are the stages?

CKD is classified into five stages based on the estimated glomerular filtration rate (eGFR), a way to determine kidney function. Stages 1 and 2 are the early stages, while stages 3a and 3b are the moderate stages, and finally stages 4 and 5 are the advanced stages. This demarcation is based on an eGFR of >60 ml/min for early, 30-59 ml/min for moderate and <30 ml/min for advanced. Stage 5 is end-stage kidney disease or failure.

March is National Kidney Month

Why is CKD important?

The prevalence of the disease is predicted to grow by leaps and bounds in the next 15 years. Presently, approximately 13 percent of those over age 30 in the U.S. population are affected by CKD. In a simulation model, it is expected to reach 16.7 percent prevalence in the year 2030. Currently, those who are ages 30 to 49 have a 54 percent chance of having CKD in their lifetimes; those 50 to 64 years of age, a slightly lower risk of 52 percent; and those 65 years and older, a 42 percent risk (1). Thus, a broad spectrum of people are affected. Another study’s results corroborate these numbers, suggesting almost a 60 percent lifetime risk of at least moderate stage 3a to advanced stage 5 CKD (2). If these numbers are correct, they are impressive, and the disease needs to be addressed. We need to take precautions to prevent the disease and its progression.

Who should be screened?

According to the U.S. Preventive Services Task Force, screening for CKD may not be warranted in the asymptomatic “healthy” population (3). This means people without chronic diseases. The studies are inconclusive in terms of benefits and harms. In order to qualify as CKD, there has to be a minimum of three months of decreased kidney function. This appears to be a paradox: Remember, CKD is asymptomatic generally until the advanced stages. However, there are a number of caveats in the report.

Those who are at highest risk should be screened, including, as I mentioned above, patients with diabetes or hypertension. In an interview on www.Medscape.com entitled “Proteinuria: A Cheaper and Better Cholesterol?” two high-ranking nephrologists suggest that first-degree relatives of advanced CKD patients should also be screened and that those with vague symptoms of fatigue, malaise and/or decreased appetite may also be potential candidates (4). This broadens the asymptomatic population that may benefit from screening.

The fix!

Fortunately, there are several options available, ranging from preventing CKD with specific exercise to slowing the progression with lifestyle changes and medications.

Why exercise?

Here we go again, preaching the benefits of exercise. But what if you don’t really like exercise? It turns out that the results of a study show that walking reduces the risk of death and the need for dialysis by 33 percent and 21 percent, respectively (5). And although some don’t like formal exercise programs, most people agree that walking is enticing.

The most prevalent form of exercise in this study was walking. The results are even more intriguing; they are based on a dose-response curve. In other words, those who walk more often see greater results. So, the participants who walked one to two times per week had a significant 17 percent reduction in death and a 19 percent reduction in kidney replacement therapy, whereas those who walked at least seven times per week experienced a more impressive 59 percent reduction in death and a 44 percent reduction in the risk of dialysis. Those who were in between saw a graded response. There were 6,363 participants for an average duration of 1.3 years.

Protein is important, right?

Yes, protein is important for tissue and muscle health. But when it comes to CKD, more is not necessarily better, and may even be harmful. In a meta-analysis (a group of 10 randomized controlled trials, the gold standard of studies), results showed that the risk of death or treatment with dialysis or kidney transplant was reduced by 32 percent in those who consumed less protein compared to unrestricted protein (6). This meta-analysis used the Cochrane database to search for studies. According to the authors, as few as two patients would need to be treated for a year in order to prevent one from either dying or reaching the need for dialysis or transplant. Unfortunately, the specific quantity of protein consumption that is ideal in CKD patients could not be ascertained since the study was a meta-analysis.

Sodium: How much?

The debate roils on: How much do we need to reduce sodium in order to see an effect? Well, the good news is that in a study, results showed that a modest sodium reduction in our diet may be sufficient to help prevent proteinuria (protein in the urine) (7). Different guidelines recommend sodium intake ranging from fewer than 1500 mg to 2300 mg daily. This particular study says that less than 2000 mg is beneficial, something all of us can achieve.

Of course medications have a place

We routinely give certain medications, ACE inhibitors or ARBs, to patients who have diabetes to protect their kidneys. What about patients who do not have diabetes? ACEs and ARBs are two classes of anti-hypertensives — high blood pressure medications — that work on the RAAS system of the kidneys, responsible for blood pressure and water balance (8).

Results of a study show that these medications reduced the risk of death significantly in patients with moderate CKD. Most of the patients were considered hypertensive. However, there was a high discontinuation rate among those taking the medication. If you include the discontinuations and regard them as failures, then all who participated showed a 19 percent reduction in risk of death, which was significant. However, if you exclude discontinuations, the results are much more robust with a 63 percent reduction. To get a more realistic picture, the intention-to-treat result (those that include both participants and dropouts) is probably the response that will occur in clinical practice unless the physician is a really good motivator or has very highly motivated patients.

While these two classes of medications, ACE inhibitors and ARBs, are good potential options for protecting the kidneys, they are not the only options. You don’t necessarily have to rely on drug therapies, and there is no downside to lifestyle modifications. Lowering sodium modestly, walking frequently, and lowering your protein consumption may all be viable options, with or without medication, since medication compliance was woeful. Screening for asymptomatic, moderate CKD may lack conclusive studies, but screening should occur in high-risk patients and possibly be on the radar for those with vague symptoms of lethargy as well as aches and pains. Of course, this is a discussion to have with your physician.

References: (1) Am J Kidney Dis. 2015;65(3):403-411. (2) Am J Kidney Dis. 2013;62(2):245-252. (3) Ann Int. Med. 2012;157(8):567-570. (4) www.Medscape.com. (5) Clin J Am Soc Nephrol. 2014;9(7):1183-1189. (6) Cochrane Database Syst Rev. 2009;(3):CD001892. (7) Curr Opin Nephrol Hypertens. 2014;23(6):533-540. (8) J Am Coll Cardiol. 2014;63(7):650-658.

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, visit www.medicalcompassmd.com or consult your personal physician.

Heirloom tomatoes are grown from the seed of the previous generation. Photo by Ellen Barcel

By Ellen Barcel

Sometimes when we buy seeds or plants there will be terms listed on the label or packaging that tell us that plants are raised in a certain way or have certain characteristics. Many gardeners will seek out special types of plants, such as heirloom or hybrid. What do these terms mean and how can the gardener use them to his or her best advantage?

Heirloom plants

Virtually all veggies are available in the form of heirloom seeds including green beans. Photo by Ellen Barcel

Each autumn when I was a kid, my father used to select the best tomatoes he had grown the past summer and save the seeds. He’d remove them from the tomato and dry them on a paper towel. Come spring, he’d plant the seeds to get the new generation of tomatoes. He didn’t use the term then, but they were what was known as heirloom plants. Heirloom plants are ones grown from seed openly pollinated and produced by the parent plant. In general, heirloom plants breed true to the parent. We generally think of heirloom plants in terms of tomatoes, but the term refers to any older varieties of plants, generally passed down through the generations.

Hybrids

Hybrids are crosses between two different varieties of a plant in an attempt to get the best qualities of both. Seeds from hybrid plants do not breed true, so saving them for future generations is not really an option. Gardeners therefore must buy the hybrid seeds (or plants grown from them by plant breeders) each year.

Sports

Sports are unexpected mutations of a plant. Saving the seeds from sports is iffy at best. The seeds might not be viable, could produce the new characteristics or could produce the original plant. Generally, if a sport has desirable qualities, like an apple tree with a branch that produces larger, sweeter apples, the plant is reproduced vegetatively by cuttings since cuttings will breed true.

GMOs

GMOs are genetically modified organisms. A scientist in a laboratory has taken genes from one organism and added it to another. The foreign genes could come from any type of organism, other plants or even animals. Supporters of GMOs say that the resulting product is safe and has superior qualities, such as it may be more disease resistant, have a longer shelf life or the plant may produce a heavier crop. Opponents are concerned about unexpected consequences — is the product safe? What are the long-term results? You may see products in the supermarket marked non-GMO because of these concerns. Legislation passed last summer in the U.S. will require foods with GMOs to be labeled. Some foods that have been genetically modified include soybeans, corn and tomatoes.

Organic gardening

Organic gardening refers to any plant — heirloom, hybrid, sport or GMO — raised without the use of chemical pesticides and fertilizers. Organic gardeners use compost or other nonchemical fertilizers like compost tea, bone meal, holly tone, etc. To avoid pesticides, organic gardeners will sometimes hand pick pests like slugs, encourage birds to nest in the garden (to eat insects) and use companion planting, for example, surround tulips with daffodils, to keep the squirrels away. For farms to be certified organic, chemical pesticides and fertilizers cannot be used on the land for a number of years before the beginning of organic gardening.

Ellen Barcel is a freelance writer and master gardener. To reach Cornell Cooperative Extension and its Master Gardener program, call 631-727-7850.

At the ribbon cutting of the Kavita and Lalit Bahl Center for Metabolomics and Imaging last December, from left, Lina Obeid; Yusuf Hannun; Kavita and Lalit Bahl; Samuel Stanley, President of Stony Brook University; and Kenneth Kaushansky, dean of Stony Brook University’s School of Medicine. Photo from SBU

By Daniel Dunaief

Many ways to kill cancer involve tapping into a cell’s own termination system. With several cancers, however, the treatment only works until it becomes resistant to the therapy, bringing back a life-threatening disease.

Collaborating with researchers at several other institutions, Dr. Lina Obeid, the director of research at Stony Brook University School of Medicine, has uncovered a way that cancer hides a cell-destroying lipid called ceramide from treatments. The ceramide “gets co-opted by fatty acids for a different species of fats, namely acylceramide, and gets stored side by side with the usual triglycerides,” Obeid explained in an email about her recent finding, which was published in the journal Cell Metabolism. “It makes the ceramide inaccessible and hence the novelty.” The ceramide gets stored as a lipid drop in the cell.

“We describe a completely new metabolic pathway and role in cell biology,” Obeid said. Other researchers suggested that this finding could be important in the battle against cancer. “That acylceramides are formed and deposited in lipid droplets is an amazing finding,” George Carman, the director of the Rutgers Center for Lipid Research, explained in an email. “By modifying the ceramide molecule with an acyl group for its deposit in a lipid droplet takes ceramide out of action and, thus, ineffective as an agent to cause death of cancer cells.”

Carman said Obeid, whom he has known for several years, visited his campus in New Jersey to share her results. “All of us at Rutgers were so excited to hear her story because we knew how important this discovery is to the field of lipid droplet biology as well as to cancer biology,” he said. Obeid conducted some of the work at the Kavita and Lalit Bahl Center for Metabolomics and Imaging at Stony Brook University. The center officially opened on Dec. 1 of last year on the 15th floor of the Health Sciences Center and will move to the Medical and Research Translation Building when it is completed next year. “This study is exactly the kind of major questions we are addressing in the center that [the Bahls] have generously made possible,” she explained.

Obeid discovered three proteins that are involved in this metabolic pathway: a ceramide synthesizing protein called CerS, a fatty acyl-CoA synthetase protein called ACSL and an enzyme that puts them together, called DGAT2, which is also used in fatty triglyceride synthesis. Her research team, which includes scientists from Columbia University, Northrop Veterans Affairs Medical Center and Mansoura University in Egypt is looking into implications for the role of this novel pathway as a target for cancer and obesity.

Indeed, obesity enables more frequent conversion of ceramide into acylceramide. “Fats in cells and in diets increase and predispose to obesity,” Obeid suggested. “This new pathway we found occurs when fatty acids are fed to cells or as high-fat diets are fed to mice.” In theory, this could explain why obesity may predispose people to cancer or make cancer resistance more prevalent for some people. According to Obeid, a high-fat diet can cause this collection of proteins to form in the liver of mice, and she would like to explore the same pathways in humans. Before she can begin any such studies, however, she would need numerous approvals from institutional review boards, among others.

Obeid and her collaborators hypothesize that a lower-fat diet could reduce the likelihood that this lipid would be able to evade cancer therapies.

These kinds of studies “provide the justification for looking at the effect of diet on acylceramide production,” Daniel Raben, a professor of biological chemistry at Johns Hopkins University School of Medicine, explained in an email. Further research could include “isocaloric studies with [high-fat diets] and [low-fat diets] in animals that are age and gender matched.”

Obeid was a part of the first group to describe the lipid’s role in cancer cell death in 1993. “We have been studying its metabolism and looking at how it’s made and broken down,” she said. “We found recently that it associates with these proteins to metabolize it.”

While the lipid provides a way to tackle cancer’s resistance to chemotherapy, it also has other functions in cells, including as a membrane permeability barrier and in skin. A therapy that reduced acylceramide could affect these other areas but “as with hair loss [with chemotherapy treatment], this will likely be easily managed and reversible,” Raben explained.

Obeid and Yusuf Hannun, the director of the Cancer Center at Stony Brook, are searching for other scientists to work at the Kavita and Lalit Bahl Center for Metabolomics and Imaging. “We are actively recruiting for star scientists” at the center, Obeid said. Other researchers suggested that the history of the work Obeid and Hannun have done will attract other researchers.

Hannun and Obeid are “considered the absolute leaders in the area of sphingolipid biochemistry and their clinical implications,” Raben said. “Simply put, they are at the top of this academic pile. Not only are they terrific scientists, they also have an outstanding and well-recognized reputation for training and nurturing young investigators.” Carman asked, “Who wouldn’t want to be associated with a group that continues to make seminal contributions to cancer biology and make an impact on the lives of so many?”

As for the next steps in this particular effort, Carman foresaw some ways to extend this work into the clinical arena. “I can imagine the discovery of a drug that might be used to combat cancer growth,” Carman said. “I can imagine the discovery of a drug that might control the acylation of ceramide to make ceramide more available as a cancer cell inhibitor. Clearly, [Obeid’s] group, along with the outstanding colleagues and facilities at Stony Brook, are positioned to make such discoveries.”

Image courtesy of Disney Dan Stevens as the Beast and Emma Watson as Belle star in Disney’s ‘Beauty and the Beast.’ Image courtesy of Disney

By Daniel Dunaief

The latest version of “Beauty and the Beast,” which broke box office records when it opened last weekend, offers a visually stunning montage, as one magnificent set blends into the next in a familiar story that, not much of a spoiler here, tracks the well-known story.

The sets, cinematography and songs take center stage in this live-action remake, as Disney spared no expense to make the enchanted castle, the quiet village where every day is like the one before, and the journey through the forest between them as detailed and lavish as the animated version. The script and main actors, including Emma Watson as Belle and Dan Stevens as the Beast, are fine, but not extraordinary.

Disney may not have wanted to tinker too much with a classic film and its well-known dialog, leaving the original script largely unchanged. That is both for the better and the worse, as this current incarnation lacks a novel flavor, a new Disney humor and charm, or the opportunity to explore much more about the characters. There are a few welcome moments when the audience learns more about unfortunate events in Belle and the Beast’s past, but those are short-lived in a film that is over two hours.

Luke Evans does a serviceable job as Gaston, conveying the narcissistic brute who seems more in love with his own reflection than he is with Belle or anyone else. The charm or the irresistibility the villagers feel for him is not evident to Belle or to the audience.

Josh Gad provides welcome comic relief as Gaston’s companion LeFou, fawning over him and calming him down when things don’t go his way. Gad takes his character further than the animated version of LeFou, becoming impish and playful.

Like the Broadway version of the classic animated film “Aladdin” and its “Never Had a Friend Like Me” song, “Beauty and the Beast” somehow equals and, in some ways, exceeds the original film with its “Be Our Guest” feature. While Belle prepares for her meal, the creatures of the castle surround her with food, song and spectacle.

While the script and the characters stay true to the Broadway and animated versions of the story, the visual details truly make the film memorable. The finale in the castle looks like the kind of details an eager bride would include if she had an unlimited budget, with symmetrical floral arrangements, magnificent lighting, perfectly spaced dancers and a cast of characters delighted to share in the space.

For parents, the scenes of peril with the wolves outside the Beast’s castle are familiar and filled with the same kind of potential for danger. Young children will likely be as concerned for the welfare of Belle and the Beast in the wolf scenes of this film as they would be watching the animated version.

The fight scene between the Beast and Gaston also involves some peril, with Gaston displaying a combination of cowardice and villainy. At the same time, the fight scene between the villagers incited by Gaston to battle and the members of the enchanted castle who are defending themselves also contains some of the few moments of humor in a film that otherwise takes its tale and the retelling of it seriously.

Some of the other cast members, including Emma Thompson as Mrs. Potts, have a tough act to follow, repeating familiar phrases and songs from Angela Lansbury. Thompson holds her own, regaling the audience with the lyrics from a tale as old as time.

The three-dimensional version of the film included a few noticeable effects, including when Belle and the Beast engage in a snowball fight. It also adds some depth to the image of the castle and the trek through the woods. The additional expense, however, didn’t seem especially necessary, given an elaborate attention to other visual details.