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The Barnes Foundation

By Leah S. Dunaief

Leah Dunaief

During the recent holiday break, we took advantage of the free time to visit two delightful museums in Philadelphia: The Barnes Foundation and the Museum of the American Revolution. The Barnes is home of a huge collection of Impressionist paintings, among many other treasures, and the Museum of the American Revolution, not quite 2 years old, is dedicated to telling the story of our evolution from the historic center of America’s founding.

The Barnes started as the remarkable personal collection of Dr. Albert C. Barnes. Born in Philadelphia in 1872 into a working class family, he graduated from the University of Pennsylvania medical school and went off to Germany to study chemistry. From his work there, he made his fortune by co-inventing a silver nitrate antiseptic, called Argyrol, with a German colleague Hermann Hille. 

Buying out Hille, he ran the A.C. Barnes Company from 1908-29 and in the process started to collect art. Ironically he didn’t much care for the Impressionists until his high school friend and artist, William Glackens, persuaded him otherwise. He sent Glackens off to Paris to buy some paintings, and when the artist returned with 33, Barnes became serious about collecting art and took over the purchasing himself, housing the works at his estate.

Barnes started the Barnes Foundation in 1922, a nonprofit cultural and educational institution to “promote the advancement of education and appreciation of fine arts and horticulture.” The foundation oversees the art, and since 2012 the collection has been located on Benjamin Franklin Parkway in a splendid compound that honors both the founder and the masters whose works lie within its walls and in its gardens. There is even a parking lot on the premises that makes a visit so much easier.

The Barnes boasts the world’s single largest collection of paintings by Pierre-Auguste Renoir, with 181, and ditto for those by Paul Cézanne with 69. There are also 59 by Matisse, 46 by Pablo Picasso, as well as art by Modigliani, van Gogh, Seurat and Barnes’ friend, Glackens. Also in the dazzling museum are paintings by Old Masters El Greco, Peter Paul Rubens, Titian and Veronese. There are sculptures, masks, tools, jewelry, textiles, ceramics, manuscripts and one of the most outstanding collections of wrought iron, some 887 pieces, among so many other multicultural offerings.

A major exhibition, which sadly will end there this Sunday, Jan. 12, is 30 Americans. Featuring works of many of the most important African American artists of the past four decades, according to the museum’s curator, Gwendolyn DuBois Shaw — herself a famous African American professor at the University of Pennsylvania and a top administrator at the Smithsonian — this collection “explores issues of personal and cultural identity against a backdrop of pervasive stereotyping — of race, ethnicity, gender, sexuality and class.” 

The artists include Jean-Michel Basquiat, Mark Bradford, Nick Cave, Mickalene Thomas, Kehinde Wiley and Barkley Hendricks along with 24 others, and some of the paintings are riveting. This is the 10th anniversary of 30 Americans and the first in the Northeast since 2011 when it was in Washington, D.C. Chatting with other visitors, we learned that many came from some distance to catch up with this exhibit of modern artists and their distinct perspectives.

Did I mention that there is also a wonderful restaurant inside the Barnes?

This doesn’t leave me much space to tell you about the Museum of the American Revolution, more the pity, which is also handsomely housed in central Philadelphia. 

Of particular interest is their first international loan exhibition, Cost of Revolution: The Life and Death of an Irish Soldier, which will remain in place until March 17. By focusing on Richard St. George, born in County Galway to Protestant landed gentry and who became a soldier, artist, writer and extensive landowner, the exhibit tells us much about the American Revolution of 1776, the Irish Rebellion of 1798 — and life in the British army, which St. George joined. There are paintings, many sketches that St. George made himself, artifacts and weaponry in a comprehensive display of history from that era.

By the way, it is really easy to get to Philadelphia from here on Long Island with only a stopover in Penn Station if one takes the trains. If only for these two gracious institutions, it is well worth the trip.

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Daniel Dunaief

They are called rubber chicken dinners for a reason. Much of the time, corporate events masquerading as social gatherings offer little in the way of flavor, taste or entertainment.

This one, however, had so much potential. A group invited my wife and me to attend a football game. The connection came through my wife, who interacts regularly with our hosts and received the invitation months earlier. When we read the invitation, we knew she could invite our son, although we also knew he had two midterms the day after the big game, which meant that I could escort her.

I have, on occasion, demonstrated a surprising nimbleness in jamming my foot into my mouth. Unintentional and harmless though the effort may be, I have worked hard to pull back on (a) sharing too many details, (b) making too many jokes and (c) asking anything about controversial topics.

We walked into a suite, where our host immediately caught my wife’s eye and shook her hand. I’d met him several times and he graciously welcomed me as well, although I realize my decidedly unimpressive place in the world.

My wife had given me a rundown of the people we’d likely meet, even as I tried to look over some of their shoulders to watch the football game occurring past the tray of appetizers, the plate of sliders, the collection of untouched cookies and the bowl of half-eaten popcorn.

A woman whose name had made the list shook my hand and smiled at me. I waited the usual three seconds to see whether she was planning to bolt to chat with someone more interesting, more powerful, taller, better dressed or more well versed in the world of football. After all, she was wearing a football jersey and, while my son can name the rosters of most teams because of his fantasy football acumen, I’m much more limited in this sport.

She, however, kept looking me in the eye, encouraging further conversation. We described the lives of our children. That generally constitutes safe topics, so I was on terra firma.

When I asked where she grew up, she said California until she went to high school on Long Island. I’m not sure why I asked because Long Island is truly a huge place, but I wondered what school she attended.

She told me it was in Setauket and it was called Ward Melville.

Wow, I replied, I went there, too. She said she was on the tennis team and we both remembered the name of the coach who had been there years ago, Vicki Goldfarb. My new acquaintance’s father, as it turns out, was a fighter pilot who had moved to Long Island to work for Grumman when he became an engineer.

It became a remarkably detailed conversation. She lived about a mile away from me for five years, until I graduated a few years ahead of her from Ward Melville.

When she excused herself for a moment, I figured that I might have overplayed the conversation. At that point, I tried to get a closer look at the football game, until my wife and I started talking with our hosts about their family’s skiing adventures.

As we started to leave, I once again found myself chatting with the Ward Melville graduate. She shared a few more compelling stories about her family and her life, including an adventurous trip to Green Bay, where her husband celebrated a landmark birthday in the snow and cold.

This was, decidedly, not a typical rubber chicken event for me and one that I hope continues if we follow up and get together some time in 2020. And, in case you are wondering, I don’t think I committed any social faux pas.

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By Elof Axel Carlson

Elof Axel Carlson

Most people are probably unaware that their cells contain ribosomes. They probably know each of their cells has a nucleus and within that nucleus are chromosomes and that the chromosomes contain their genes. 

But most people do not know what other organelles in their cells are present and what they do. One of them is the ribosome. When you look at an electron micrograph of a cell, you see the cytoplasm (the goop between the cell membrane and the nucleus) has many membranous folded sheets called the endoplasmic reticulum on which are thousands of tiny dots. Those dots are the ribosomes. 

In the 1950s, after DNA was shown to be the hereditary material and present in the chromosomes of cells, some biologists began exploring how the structure of DNA is treated to the functions carried out by genes. One of these was how information (the genetic code) was carried by the genes and how that became the traits we see of the organism. 

One theory quickly proven was that DNA made another copy with a slightly different chemical composition, called RNA. In fact, there were three types of RNA − a copy of the gene sequence called messenger RNA, a groups of small RNA molecules that carried one of the 20 different amino acids that compose protein molecules, and an RNA that is present in a molecular machine called the ribosome. 

The ribosome takes the messenger RNA coming from the genes, enters the ribosome and begins plugging amino acids whose tips contain a three-letter sequence corresponding to one of the 20 different amino acids. 

The ribosome is a complex molecule, much bigger than hemoglobin in our cells, and carries out the protein synthesis for the cell, each messenger RNA producing a specific type of protein from a specific gene. 

All that mouthful of scientific events you can translate into this thought. When I eat my three meals a day, how does so much of it become me? Well, one thing to thank is your ribosomes. They take the digested bits of proteins from your foods and convert them into the proteins (enzymes, structural components of your cell organelles, and switches used to turn genes on an off or make fertilized eggs into embryos, fetuses, babies and ultimately you). 

I read an interesting memoir by a Nobel molecular biologist (who started his career as a physicist) who worked on the structure of the ribosome. It has a large and a small protein mass. It also has several ribosomal RNA regions that allow the messenger RNA to enter, the transfer RNAs to deposit their individual amino acids, and the ribosomal RNA to move them along and grow the protein chain. It took about 40 years to work out the details of this molecular machine. 

For science buffs, I recommend reading Venki Ramakrishnan’s 2018 book “Gene Machine: The Race to Decipher the Secret of the Ribosome.” It is a wonderful memoir about the many blind alleys, goofs, luck, hard work, competition and numerous tools used by scientists to bring about the solution to a complex system invisible to the naked eye and it requires the disciplines of physic, chemistry and biology to solve it. 

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

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By Leah S. Dunaief

Leah Dunaief

The year is rapidly coming to a close, and it is leaving us with impassioned thoughts. At this time, probably more than any other in the year, we pray for peace: “on earth peace, good will toward men.” Never in the history of the world were people more united than in this wish. And yet, we are so far from the reality.

Tessa Majors, only 18 years old and on the threshold of adult life, bright with promise, is stabbed to death in Morningside Park in Upper Manhattan. A Barnard College freshman from Virginia, an out-of-towner, was in the park after dark, although it was only 7 o’clock on a Wednesday evening, Dec. 11. Ostensibly the cause was a robbery gone bad. Her death is a personal tragedy for her family, her friends, the neighborhood, the Barnard and Columbia communities and all New York City. I know. I’m a Barnard alumna and my roots are in New York. The murder tugs at my heart. I lived on the Columbia campus for two years, only a short block from the park. One thing I understood: Don’t go into the park at night.

So I have lots of thoughts, lots of questions. Why was she there? Was she not told that simple fact? At the first assembly of my entering class, the president of the college cautioned us about safety in the neighborhood, warned us where to walk and how to be safe. That was a different time, I acknowledge, over a half-century ago, when the city was a more dangerous place. But dark places in any city can be dangerous anywhere in the world. The president was trying to teach us urban smarts. Are the new students still getting that important message on many college campuses? New Haven is not any different, neither is the University of Chicago and wherever there are universities adjacent to neighborhoods that are prone to crime.

“As of Dec.8, there had been 20 robberies inside Morningside Park or on its perimeter this year, compared to seven in the same period last year,” wrote The New York Times. The article continued, “Since June, five people reported being robbed on or near the staircase at 116th Street and Morningside Drive, near the spot where Ms. Majors was killed.” 

Why, then, was the park not better patrolled by the New York City Police Department? That’s what compiling those statistics is for, yes? To send help where help is most needed? This is an issue the NYPD will have to deal with in coming days.

The other metropolitan area tragedy at the top of the news at the moment is the slaughter of four innocent people in Jersey City Dec. 10 by, according to reports, a couple of heavily armed drifters. While those investigating the murders are not saying much while they work on the case, there seems little doubt that this was a hate crime directed specifically against both the police and one segment of the population: Jews. Why do people hate? Particularly why do they hate strangers, people they don’t even know? It’s a question as puzzling as why people would ever want to kill each other. For bigotry to be so strong as to result in violence is unfathomable. For that matter, why conclude that just because people are different, they should therefore be despised? In fact, they might be thought of as more interesting for their differences.

Which brings me back to my original thought. If everyone is praying for peace, why is there war? Why is there violence? Why is there bigotry? Why is peace so elusive? Is peace, real peace, impossible because of the makeup of humans? Will there always be a Hitler and a Stalin, a Napoleon, Vikings and an Attila the Hun?

Still, let us pray for peace, however hard to imagine. Let us keep this idea alive before us as a goal someday to be realized. Let us work to make our world less violent, less filled with hate, less bigoted. Maybe the operative word is “less?” That we surely can do.

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By Bob Lipinski

Bob Lipinski

With just over 275 wineries within seven grape-growing areas, Virginia ranks fifth in the nation for wine grape production.

The first recorded wine production in the United States took place in Virginia soon after the British established a colony there in 1607. However, it wasn’t until 1807, when Thomas Jefferson planted grapes of European descent on his Monticello estate that the industry began. Sadly, Jefferson’s experiment failed because of rot and phylloxera (small root insects).

For a while Virginia was the most important grape-growing state, but Prohibition annihilated the flourishing industry and only in the beginning of the 1970s did local producers make wine again.

At a private tasting/seminar there were over 20 wines to taste and evaluate. Overall, the wines very good with a few excellent ones. Space prevents me from providing tasting notes on all the wines. Here are some highlights:

2017 Barboursville Vineyards Vermentino Reserve: Aroma and flavor of apples, pear, citrus and hazelnuts. Tastes likes it’s from Liguria, Italy.

2010 Barboursville Vineyards Octagon: A blend of merlot, cabernet franc, cabernet sauvignon and petit verdot; dark colored with a powerful, concentrated flavor of blackberry, black currants and cedar; hints of vanilla and smoke.

2017 Linden Vineyards Boisseau Viognier: Light-bodied with a full bouquet of melon, lime, lychee and bitter orange.

2017 Glen Manor Vineyards Petit Manseng: The perfume of orange abounds along with melon, tropical fruit, nutmeg and citrus.

2018 Williamsburg Winery Petit Manseng: Tropical notes of papaya, pineapple and mango with an aftertaste of cinnamon and peaches.

2017 Veritas Vineyard Cabernet Franc Reserve: Enormous wine with black fruit, blueberry, bittersweet chocolate and smoky oak.

2016 Michael Shaps Wineworks Tannat: Flavor of blackberry, black raspberry, cherry, espresso and brown spices. A huge wine that will age another decade.

2016 King Family Vineyards Mountain Plains: A blend of merlot, cabernet franc and, petit verdot; full flavor of dark berries, fig, prunes, blueberry and toasted almonds.

2015 Boxwood Estate Winery Reserve: A blend of cabernet franc, merlot, cabernet sauvignon and petit verdot; closed nose but rich flavors of blackberry, black tea, licorice, spicy vanilla and hazelnuts.

2012 Paradise Spring Vineyards PVT (blend of petit verdot, tannat): I enjoy the flavor of petit verdot and tannat but have never tasted them blended together. Almost black-colored and tannic with flavors of black cherry, blueberry, mint, plums and sage. Worth searching out!

2017 Early Mountain Vineyards Eluvium: A blend of merlot, petit verdot and cabernet sauvignon; elegant, perfumed, dark fruit, plums, jam, anise and smoky oak.

Bob Lipinski is the author of 10 books, including “101: Everything You Need to Know About Whiskey” and “Italian Wine & Cheese Made Simple” (available on Amazon.com). He conducts training seminars on wine, spirits and food and is available for speaking engagements. He can be reached at www.boblipinski.com OR bkjm@hotmail.com.

Michael Tessler

By Michael Tessler

I’m writing this from about 34,000 feet in the air. There’s a great landscape below me: America. This vast and beautiful country feels endless from this vantage point. No matter how old I get or how many times I take the voyage, I’ll never quite get over the fact that you can start your day on Main Street, Port Jefferson and end it on Hollywood Boulevard.

It has been a record amount of time since I’ve had a day off. Not that I’m counting. I’m nearing one month since I’ve had one truly mindless or menial day. I’m not complaining — working in Los Angeles is a blessing. Though it is a constant hustle to survive, this struggle has made me grateful for the many blessings in my life and the many people that have gotten me here. 

It is easy to forget the power of the written word. Being back on Long Island for a few days, I was reminded of its incredible power by my co-worker Liz (you may know her as the bubbly sales representative who is constantly in motion). After reading my column on my weight loss journey, she began a daily routine of walking FIVE MILES every morning. You can imagine my shock, surprise and gratitude when I heard that just a few small printed letters could cause such a positive and lasting impact on someone.

So here I am, hoping I can provide some inspiration to you by sharing some lessons I was reminded of during my few days back with TBR News Media. 

Local news is the beating heart of a community. Most of us take it for granted. Until I worked for the paper, I know I certainly did. That all changed after spending time with our publisher, Leah Dunaief, who at each editorial and sales meeting reminds us of the importance of the work we do and what it means to the community we serve. Leah taught me that anything can become an inspiring and exciting subject, with enough passion and pride. 

There is a sense of belonging and place that comes with the printed word. When we set aside the digital drabble of social media and open the pages of our hometown paper, we’re reminded of how special we are. Whether happy or sad, tragic or celebratory — this publication tells our story and brings us together in the process. 

We write lengthy and ever-amusing responses to the stories we disagree with. With great, rambunctious passion we debate parking meters and zoning laws. It may seem simple or even small, but hovering above the great American landscape I can’t help but think of how beautiful it is, this weekly celebration of us. 

So as I reach the conclusion of an incredibly difficult and humbling stretch of work, riddled with successes, failures, lessons learned both easy and hard, I am reminded of the lessons taught to me by my second family at TBR News Media. Love what you do. Love who you work with. Love the community you call home and love yourself enough to take time off.

To Leah, who has believed in me and provided me with more opportunity than any person I’ve ever known: Thank you. You challenge me constantly to dream bigger, think smarter and cherish the people around me. 

To Kathryn, who taught me the value of hard work and building lasting, meaningful relationships. You gave me my hustle and drive and reminded me to appreciate just how cute the little ones in our life are. 

To Meg, who reminds me that to change a person’s day all you need is a smile and song, you warm every room you enter with your kindness. 

To the entire TBR family, you remind me that home is always waiting for you and filled with love … no matter how far you may roam or how long. 

To the readers who keep this heart beating, I’m thankful. May the love that goes into each page of this paper transcend into your home this holiday season. Merry Christmas, Happy Hanukkah and a Happy New Year from a grateful native son living his Hollywood dream. 

The author is an award-winning film and television producer and CEO of Multihouse Entertainment in Los Angeles.

Daniel Dunaief

By Daniel Dunaief

What is it about “The Play That Goes Wrong” that is just so right for so many people, including me?

My wife and I recently went to this farcical show, where my wife informed me that she, the couple attending the performance with us, and just about everyone around us could tell how much I enjoyed the experience. 

In case you haven’t heard about it and can’t figure it out from the title, “The Play That Goes Wrong” is an absurd show where everything goes so wrong — the props, the actors, the staging, the lighting and the music. Indeed, it’s almost challenging to follow the simple murder mystery plot amid gales of laughter, much of it coming from me.

My family has numerous qualities that we have shared from one generation to the next. My late father laughed so hard at the pratfalls and theater-of-the-absurd dialogue of Danny Kaye movies like “The Court Jester” (1955) that I can still picture him gasping for air as he wiped away the tears slaloming down his face, where they joined the muddy sneaker stains, the dirty paw prints and the soda spills on a white carpet that chronicled our active lives.

The current play follows in the footsteps of Kaye, Benny Hill, the Three Stooges and a host of other characters who do anything for a laugh, stepping on rakes that slam into their heads or interacting in nonsensical ways with other actors as a part of a skit. The show makes the sketch comedy of many of today’s late night shows appear pedestrian by comparison. Granted, the plot follows a singular theme and, once completed, can and does create a full length and ridiculous drama.

Now, some people may find the pedestrian antics of the cast too absurd. I agree that the show isn’t for everyone and doesn’t provide life lessons, memorable songs, gritty entertainment or an insightful view of existence.

And yet, it does offer much needed self-parody and perspective on a country thoroughly divided by events in Washington, D.C. The people who run our country seem intent on making their supporters cheer, while their detractors roll their eyes, shake their heads and seek solace from people who share their beliefs.

Fine, but, the actors in a show written by Henry Lewis, Jonathan Sayer and Henry Shields of the Mischief Theatre Company, seem intent on roping as much of the audience as possible into their shenanigans. 

One of the actors, who plays Cecil Haversham, seems delighted by the presence of the audience. He plays to the crowd so often that he shares in their enthusiasm when he does something well or when the crowd appreciates an ongoing joke.

This intentionally imperfect play isn’t perfectly imperfect, either. Some moments fall flat. The second half of the show, which is shorter than the first, isn’t quite as engaging, entertaining and uproarious.

Knowing the general plot of the story before I attended, I tried to anticipate the wide range of possible intentional stumbles and humorous moments that actors struggling to maneuver through a story might endure. The range of mistakes and blunders exceeded my expectations among numerous welcome and delightful surprises.

A play that delves in the world of funny gaffes takes real work on the part of the writers and the actors. To anyone sick of the political headlines, the conspiracy theories, the name calling, the accusations and counter accusations, this play is a welcome comedic retreat. It’s no wonder it won Best New Comedy at the 2015 Laurence Olivier Awards in London and is now on Broadway.

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By Daniel Dunaief

Daniel Dunaief

I have been working out at a gym, where my routine consists mostly of pushing my body as long as I can on a treadmill, bike or elliptical machine until my sweat has soaked through my T-shirt. I play mind games while I’m running, telling myself that I can take a break once I get to 3 miles, or maybe 4 or closer to 5.

Each time I hit a milestone, I think about how much better I’ll feel if I can go just a bit farther, even as I’m taking an inventory of all the barking body parts, which typically includes my knees and back.

What helps get me over the hump lately, though, is the music I listen to as I work out.

I started with a collection of ’80s songs, hoping, perhaps, that the combination of familiar tunes from my youth would make my body remember the energy that defined this younger period.

As I was running, the songs reminded me of the times I danced with friends at Ward Melville High School, played Uno in a friend’s living room or decorated a Christmas tree with another friend who patiently showed a group of us how to thread popcorn and cranberries through a line.

As I was running, a montage of these images played through my head, making me feel as if my legs were turning back the clock. Fortunately, no one at my gym looks closely at me or my facial expressions, so I could indulge in musical — and life — nostalgia without interruption or without questions from people wondering what I was thinking as I reacted to people who have long since gone their separate ways.

For a few days, I switched to my favorite singer, Billy Joel. Hearing the words from “Only The Good Die Young,” “Piano Man,” and “Movin’ Out,” brought me back to the study breaks I took in high school when I stared out the window between my house and the neighbor’s colorful Santa sleigh down the street, hoping that the snow forecast for that evening was sufficient to close school the next day.

I’m planning to see Billy Joel in concert before too long, so I switched to another genre, playing the soundtrack from the original 1975 version of the musical, “A Chorus Line.” While others rarely cite it as one of their favorite musicals, I know it was the song “Nothing,” in which Diana Morales receives nonstop criticism from her teacher Mr. Karp, that brought to life the magic of Broadway for me. 

I always measured every other performance, including of musicals like “West Side Story” that I supported by playing clarinet in the pit orchestra, against the desperate hopes of each of the cast members in a chorus line to “make it” into the show.

Eventually, I needed a pulsating beat, so I shifted to exercise music, which, of course, included songs from “Rocky the Musical,” as well as other inspirational films. Each time the beat got faster, I found another pocket of energy that helped me conquer the next mile, using the beat as a metronome for my legs.

Music, in all its forms, serves many functions, allowing us to connect with the artist, to travel on an acoustic journey, to remember friends, and to exercise feelings and emotions even as we exercise the rest of our bodies.

I coached many sports when my children were younger. If I could do it over again, I would have added contemporary music to mundane practices to spice up the experience in real time and to inspire me on the nostalgia treadmill.

Mount Vesuvius

By Leah S. Dunaief

Leah Dunaief

Three active volcanoes marked our trip across the Adriatic and then up the Italian coast: Vesuvius, Etna and Stromboli. Mount Vesuvius famously erupted in 79 A.D. and buried at least a thousand people under almost 20 feet of volcanic ash in the towns of Pompeii and Herculaneum. Mount Vesuvius is regarded as one of the most dangerous volcanoes today because it has the potential to wipe out more than 3 million people in the nearby city of Naples and is under 24-hour surveillance. Two of the planet’s tectonic plates are crashing into each other beneath the Earth’s surface, which causes the eruptions. While there were lots of signs that the volcano was about to erupt at that ancient time, not everyone fled. Yet most of the cities’ inhabitants of some 20,000 did flee, to survive and resettle up and down the coast.

Mount Etna is on the east coast of Sicily, between the cities of Catania and Messina. Stromboli is on the small Sicilian island of the same name and is one of the most active on the planet, erupting almost continuously since 1932. We left our dinner halfway through and watched in fascination from the port side of the ship, on our way through the Strait of Messina, as its high intensity fiery plumes shot up into the night sky. Each glowing emission brought an awed chorus from the passengers. The strait’s reputed treacherous conditions may have been the inspiration for the Greek myth of the two sea monsters, Scylla and Charybdis, that gave so much trouble to Odysseus on his way home from the Trojan War. 

For us it was as calm as a lake.

We did spend an afternoon in Sicily and enjoyed the magnificent views from touristy Taormina and Castelmola, the village even higher up the mountain. Souvenir shops were crowded into the narrow, crooked streets, selling everything from ceramic artifacts and tiles to “The Godfather” T-shirts. Our fantastic luck with the weather continued. The days were sunny and in the 70s. 

The next stop, on the west side of the Italian peninsula was Sorrento, facing the Bay of Naples, with more glorious jewel-like views from the top of the cliffs. The Italian towns offered a faster pace and more tourists than those on the Dalmatian Coast. And the seafood was more expensive. We were decidedly now in Italy.

Taking a bus from the port, we rode over the mountains to the fabled Amalfi Coast, where we ate lunch. No matter how many times one might visit this 60-mile stretch of mountainous coastline, the clear blue water and pastel fishing boats, like toys in the sea way below, seductively draw one back for yet another visit. The crowds of whitewashed houses, terraced up the sides of the mountains, the hairpin turns of the coast road that I would never dream of driving on because I would fall off the mountain as I was drinking in the sights, the crooked streets and cantilevered stairways overhanging the gigantic rocks. The place is better than any postcard. We spent a couple of hours in the town of Amalfi, where we exclaimed over the size of the lemons and drank the freshly squeezed lemonade.

All too soon, we had to dash back to catch the tender that returned us to the ship, and we were off to Rome, our final destination. The city is not on the coast, and so we disembarked from the tidy cruise-and-sailing ship and rode the hour-and-a-half trip to the capital of Italy. Rome is one of the oldest cities on Earth that has been populated for about 30 centuries, and one could spend endless days viewing everything from ancient ruins to the Vatican, soaking up the history, art and architecture. But, alas, we had no more time left on our vacation, and managed to enjoy one more bowl of pasta followed by one last round of gelato before we took off from Leonardo da Vinci-Fiumicino Airport for home.

Ciao Bella!

Reducing inflammation can reduce disease risk. Stock photo
C-reactive protein can be measured to identify disease risk

By David Dunaief, M.D.

One of the most widely studied biomarkers for inflammation in our bodies is high-sensitivity C-reactive protein (hsCRP), also referred to as CRP. High sensitivity means that we can measure levels as low as 0.3 mg/L more accurately.

What is the significance of the different levels? Individuals who have levels lower than 1.0 mg/L are in the optimal range for low risk for a host of diseases that are indicated by high inflammation. 

For example, with heart disease, levels of 1 to 3 mg/L represent the average risk range, and greater than 3.0 mg/L is a higher risk profile. Above 10.0 mg/L is more likely associated with other causes, such as infection and autoimmune diseases (1, 2). This biomarker is derived from the liver.

CRP is not specific to heart disease, nor is it definitive for risk of the disease. However, the upside is that it may be helpful with risk stratification, which helps us understand where we sit on a heart disease risk spectrum and with progression in other diseases, such as age-related macular degeneration, diabetic retinopathy, depression and autoimmune diseases. Let’s look at the evidence.

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Age-related macular degeneration

Age-related macular degeneration (AMD) is the leading cause of blindness in patients over the age of 65 (3). Therefore, it is very important to help define risk stratification for this disease. In a prospective study, results showed that hsCRP levels were inversely associated with the risk of developing AMD. The group with an hsCRP greater than 3.0 mg/L had a 50 percent increased risk of developing overall AMD compared to the optimal group with hsCRP lower than 1.0 mg/L. But even more interestingly, the risk of developing neovascular, or wet, AMD increased to 89 percent in this high-risk group.

The significance of wet AMD is that it is one type of advanced-stage AMD that results in blindness. This study involved five studies where the researchers thawed baseline blood samples from middle-aged participants who had hsCRP levels measured. There were more than 2,000 participants with a follow-up as long as 20 years. According to the study’s authors, annual eye exams and lifestyle modifications, including supplements, may be able to stem this risk by reducing hsCRP.

These results reinforce those of a previous prospective study that showed that elevated hsCRP increased the risk of AMD threefold (4). This study utilized data from the Women’s Health Study, which involved over 27,000 participants. Like the study mentioned above, this one also defrosted blood samples from baseline and looked at follow-up incidence of developing AMD in initially healthy women.

The highest group had hsCRP levels over 5.2 mg/L. Additionally, when analyzing similar cutoffs for high- and low-level hsCRP, as the above trial used, those with hsCRP over 3.0 had an 82 percent increased risk of AMD compared to those with an hsCRP of lower than 1.0 mg/L.

Diabetic retinopathy

We know that diabetes affects just under 10 percent of the U.S. population and is continuing to rise. One of the complications of diabetes is diabetic retinopathy, which affects the retina (back of the eye) and is a leading cause of vision loss (5). One of the reasons for the vision loss is macular edema, or swelling, usually due to rupture of tiny blood vessels below the macula, a portion of the back of the eye responsible for central vision.

The Diabetes Control and Complications Trial (DCCT), a prospective study involving over 1,400 Type 1 diabetes patients, showed an 83 percent increased risk of developing clinically significant macular edema in the group with the highest hsCRP levels compared to those with the lowest (6). Although these results were with Type 1 diabetes, patients with Type 2 diabetes are at equal risk of diabetic retinopathy if glucose levels, or sugars, are not well controlled.

Depression

Depression is a very difficult disease to control and is a tremendous cause of disability.

Well, it turns out that inflammation is associated with depression. Specifically, in a prospective observational trial, rising levels of CRP had a linear relationship with increased risk of hospitalization due to psychological distress and depression (7). In other words, compared to levels of less than 1 mg/L, those who were 1 to 3 mg/L, 3 to 10 mg/L and greater than 10 mg/L had increased risk from 30 to 84 to 127 percent, respectively. This study involved over 70,000 patients.

How can you reduce inflammation?

This is the key question, since we now know that hsCRP is associated with systemic inflammation. In the Nurses’ Health Study, a very large, prospective observational study, the Dietary Approaches to Stop Hypertension (DASH) diet decreased the risk of both heart disease and stroke, which is impressive. The DASH diet also decreases the levels of hsCRP significantly, which was associated with a decrease in clinically meaningful end points of stroke and heart disease (8). The DASH diet is nutrient dense with an emphasis on fruits, vegetables, nuts, seeds, legumes and whole grains and a de-emphasis on processed foods, red meats, sodium and sweet beverages.

Conclusion

As the evidence shows with multiple diseases, hsCRP is a very valuable nonspecific biomarker for inflammation in the body. To stem the effects of inflammation, reducing hsCRP through lifestyle modifications and drug therapy may be a productive way of reducing risk, slowing progression and even potentially reversing some disease processes.

The DASH diet is a very powerful approach to achieving optimal levels of hsCRP without incurring potential side effects. This is a call to arms to have your levels measured, especially if you are at high risk or have chronic diseases such as heart disease, diabetes, depression and autoimmune diseases. HsCRP is a simple blood test with easy-to-obtain results.

References:

(1) uptodate.com. (2) Diabetes Technol Ther. 2006;8(1):28-36. (3) Prog Retin Eye Res. 2007 Nov;26(6):649-673. (4) Arch Ophthalmol. 2007;125(3):300-305. (5) Am J Ophthalmol. 2003;136(1):122-135. (6) JAMA Ophthalmol. 2013 Feb 7;131:1-8. (7) JAMA Psychiatry. 2013;70(2):176-184. (8) Arch Intern Med. 2008;168(7):713-720.

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.