If you have been on a distant planet, you may not know that we are in the middle of the flu season. The rest of us by now have had colleagues, friends, family members, and possibly ourselves, who have confronted the influenza virus.

If you think the flu season has been worse than in recent years, you’re right. The centers for disease control preliminary data indicate outpatient visits for the flu have been more than twice the baseline (CDC.gov). The good news is that the most recent comments from the director of the CDC, Dr. Thomas Frieden, suggest that we are over the hump.

According to the CDC the present vaccine is 62 percent effective. The statistic for this year’s vaccine is derived from a case study involving 1155 children and adults (MMWR Morb Mortal Wkly Rep. 2013;62). Though this is moderate, it is still reducing the risk by more than half. However, by no means is the vaccine’s coverage perfect.

I know some have hesitancy toward the vaccine because it contains eggs and thimerosal, a preservative that is organic mercury-based. A concern is that this preservative may increase neurotoxicity risk. There are trace amounts in the flu vaccine. Those with allergies to eggs should also not receive the standard vaccine.

If you are uncomfortable with the egg or thimerosal, there is good news. The FDA has recently approved a flu vaccine, Flublox, that is both eggless and does not contain the preservative thimerosal (www. FDA.gov). It uses a recombinant DNA technology that does not require inactivated virus. It is available this year in limited quantities and will be readily available for next year’s flu season. Currently, Flublox is approved for patients 18 to 49 years old.

So what can we do to decrease the chances of getting the virus following vaccination? Actually, there are several studies that show that exercise helps boost the vaccine’s effects.

Impact of exercise

We know that exercise plays an important role in altering and improving disease processes in general, but did you know that exercise may increase the effectiveness of the flu vaccine? In particular, elderly patients tend to have weaker immune responses to pathogens, such as the flu. In a study looking at the older population, those who walked with alacrity regularly for 10 months demonstrated higher antibody levels 24 weeks after getting the flu vaccine, compared to those who stretched and did balancing exercises (J Am Geriatr Soc. 2009 Dec;57(12):2183-91). This helped boost their immunity and improved the results from the vaccine.

So what if you haven’t exercised for almost a year and are not in cardiovascular shape? Is it too late for this year’s flu season? The answer is a resounding no.

Another study showed that people who did 20 minutes of eccentric exercise using the arm that would receive the vaccine on that same day also had higher titers of antibodies several weeks later, compared to those who were sedentary (Brain Behav Immun. 2007 Feb;21(2):209-17). Women had an increase in B-cell activity, part of the immune response, six and 20 weeks later. In men, there was an increase in cell-mediated activity, another part of the immune system, which includes T-cell activity, natural killer cells and phagocytes, with levels measured eight weeks after vaccination. Participants were given the vaccine six hours after exercising.

The exercises included several sets of weighted bicep curls and lateral arm raises for the shoulders. Eccentric exercises involve lowering weights, rather than lifting them. For example, if you are doing shoulder exercises, you slowly lower the weight from your shoulder to your side. This helps to elongate the muscles.

This was a randomized controlled trial, the gold standard of studies, in 60 young, healthy adult participants. The authors surmise that the inflammation due to exercises may have been the mechanism that helped boost the effect of the vaccine.

Green tea

The great thing about green tea is that it may have benefits for many diseases and their prevention. But, did you know that green tea may actually help prevent the influenza virus? In an observational study involving over 2,000 Japanese elementary schoolchildren, those who drank green tea at least six days a week were 40 percent less likely to get the flu than those who drank green tea three or fewer days per week (J. Nutr. 2011;141(10):1862-1870). Results were confirmed using an antigen test to detect the virus.

In a separate study, health care workers who took daily green tea supplements in an RCT saw a significant reduction in the incidence of the influenza virus than the placebo group (BMC Complement Altern Med. 2011 Feb 21;11:15). The supplements contained two compounds in green tea: 378 mg of catechins and 210 mg of theanine. There were 197 participants in the study.

Hand sanitizers

Many of us use hand sanitizers regularly. Are they beneficial or dangerous? It turns out that hand sanitizers may help reduce the transmission of the flu vaccine by breaking down the lipid envelope of the virus.

In a small study, healthy participants were subjected to the flu H1N1 strain on their fingertips. They were then randomly given wipes, foam or gels that contained at least 60 percent alcohol (Am J Infect Control. 2012 Nov;40(9):806-9). It did not matter which vehicle was used to deliver the sanitizer, they all worked equally well to reduce the viral load significantly.

Be careful not to overutilize sanitizers as they may dry out the skin and cause cracking, allowing pathogens to invade the body. Sanitizers should not replace washing your hands with soap and water, but rather be an additional defense.

Although this year’s flu season seems like it is one of the more dramatic, there are ways to reduce the risk. Exercise is a great way to improve your immunity, particularly in combination with the vaccine. It may also help those who are obese, and thus may have decreased immune functioning. And drinking green tea should be easy, since flu season is during the cold weather.

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.

This week, I thought it would appropriate to talk about the significance of low iron, since I wrote about iron overload last week. The major causes of low iron are anemia of chronic disease, iron deficiency anemia, sideroblastic anemia and thalassemia. Of these, iron deficiency anemia is the most common.

However, there is a much less known, but not uncommon, form of low iron. This is called iron deficiency without anemia. Unlike iron deficiency anemia, the straightforward CBC (complete blood count) that is usually drawn cannot detect this occurrence since the typical indicators, hemoglobin and hematocrit, are not yet affected.

So how do we detect iron deficiency without anemia? Not to despair, since there is a blood test done by major labs called ferritin. What is ferritin? I mentioned in my pervious article that ferritin is a protein that is involved in iron storage. When ferritin is less than 10 to 15 ng/ml, the diagnosis of iron deficiency is most likely indicated. Even healthy people with ferritin slightly higher than this level may also have iron deficiency (Br J Haematol. 1993;85(4):787-798). The normal range of ferritin is 40-200 ng/ml.

You should be asking at this point, who does low ferritin affect and what are the symptoms? Women and athletes are affected primarily, and low ferritin levels may cause symptoms of fatigue. It is also seen with some chronic diseases such as restless leg syndrome (RLS) and attention deficit hyperactivity disorder (ADHD) in children.

Effect on women

In a prospective (forward-looking) study done in 1993 looking at primary care practices, it was determined that 75 percent of patients complaining of fatigue were women (BMJ 1993;307:103). Interestingly, less than 10 percent of these women had abnormal lab results when routine labs were drawn, most probably without a ferritin level. Many of them had experienced these symptoms for at least three months.

There was a recent randomized controlled trial (RCT), the gold standard of studies, that showed women who were suffering from fatigue and low or low normal ferritin levels (less than 50 ng/ml), but who did not have anemia, benefited from iron supplementation (CMAJ. 2012;184(11):1247-1254). When comparing women with these ferritin levels, many of those that were given 80 mg of oral prolonged release ferrous (iron) sulfate supplements daily saw a significant improvement in their fatigue symptoms when compared to those women who were not given iron.

Almost half the women taking iron supplements had a significant improvement in fatigue symptoms. The results were seen in a very short 12-week period. This is nothing to sneeze at, since fatigue is one of main reasons people go the doctor. Also, although this was a small study, there were 198 women involved, ranging from 18 to 53 years old.

There are caveats to these study results. There was no improvement in depression or anxiety symptoms, nor in overall quality of life. Even though it was blinded, stool changes occur when a patient takes iron. Therefore, the women taking supplements may have known. Nonetheless, the study results imply that physicians should check ferritin level, not only a CBC, when a premenopausal woman complains of fatigue. Note that all of the women in the study were premenopausal. This is important to delineate, since postmenopausal women are at much higher risk of iron overload, rather than deficiency. They are no longer menstruating and therefore do not rid themselves of significant amounts of iron.

Athletes

According to a recent article, athletes’ endurance may be affected by iron deficiency without anemia (Am J Lifestyle Med. 2012;6(4):319-327). Low ferritin levels are implicated, as in the previous study. Iron is important for exercise motivation and may play a role in peak mental functioning, as reported in “Iron: Nutritional and Physiological Significance.” In animal studies, iron deficiency without anemia is associated with reduction in endurance, because of a decrease in oxygen-based enzymatic activity within the cells. However, this has not been shown definitively in human athletes and remains an interesting, but yet to be proven hypothesis.

Interestingly, female endurance athletes are more likely to be affected by iron deficiency without anemia, which occurs in about 25 percent of this population, according to studies (J Am Diet Assoc. 2005;105:975–978). Low ferritin is not seen as much in male athletes. This difference in gender may be due to the fact that women not only menstruate, losing iron on a regular basis, but also their intake of dietary iron seems to be lower (J Pediatr. 1989;114:657–663).

However, male athletes are not immune. At the end of the season for high school runners, 17 percent had iron deficiency without anemia (J Adolesc Health Care. 1987;8:322–326).

Do not take iron supplements without knowing your levels of hemoglobin and ferritin and without consulting a doctor. Studies are mixed on the benefits of iron supplementation without anemia for athletes.

Impact on restless leg syndrome

Iron deficiency with a ferritin level lower than 50 ng/ml affects approximately 20 percent of patients who suffer from restless leg syndrome (Am Fam Physician. 2000;62(4):736). Restless leg syndrome (RLS), classified as a neurologic movement disorder, causes patients to feel like they need to move their legs, most commonly about a half hour after going to bed. In a very small study, patients with restless leg syndrome who had ferritin levels lower than 45 ng/ml saw significant improvement in symptoms within eight days with iron supplementation (Sleep Med. 2012;13(6):732-735). Before you get too excited, the caveat is that 75 percent of restless leg patients have high ferritin levels.

Ferritin levels — both high and low — may play a role in a number of diseases and symptoms. If you are suffering from fatigue, a CBC blood test may not be enough to detect iron deficiency. You may want to suggest checking your ferritin level. Though iron supplementation may help those with symptomatic iron deficiency without anemia, it is very important not to take iron supplements without the direct supervision of your physician.

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.

Iron is contained in most of the foods that we eat. It is needed for proper functioning of the body and plays an integral role in such processes as DNA synthesis and adenosine triphosphate (ATP) production, which provides energy for cells (Proc Natl Acad Sci USA. 1997;94:10919–10924). It is very important to maintain iron homeostasis, or balance.

When we think of iron, we associate it with reducing fatigue and garnering energy. In fact, many of us think of the ironman triathlons — endurance and strength come to mind. If it’s good for us, then the more we get the better right? It depends on the circumstances. But for many of us, this presumption is not grounded in reality.

Iron in excess amounts is dangerous. It may contribute to a host of diseases, including diabetes, diabetic retinopathy, age-related macular degeneration (AMD), glaucoma, Parkinson’s disease and even heart disease. These diseases are perpetuated because when we have excess iron it may cause reactive oxygen species, or free radicals, which cause breakdown of DNA and tissues, ironically, the very things that iron homeostasis tends to preserve (Clin Haematol. 1985;14(1):129).

So what helps us differentiate between getting enough iron and iron overload? It is a good question and depends on the type of iron we ingest. There are two main types: heme iron and nonheme iron. Dietary heme, or blood, iron primarily comes from red meat and is easily absorbed into the gut. Dietary nonheme iron comes from other sources, such as plants and fortified foods, which are much more difficult sources to absorb. By focusing on the latter source of dietary iron, you may maintain homeostasis, since the gut tends to absorb 1-2 mg of iron, but also excretes 1-2 mg of iron through urine, feces and perspiration.

Not only does it matter what type of iron we consume, but also the population that ingests the iron. Age and gender are critical factors. Let me explain. Women of reproductive age, patients who are anemic and children may require more iron. However, iron overload is more likely to occur in men and postmenopausal women because they cannot easily rid the body of excess iron.

Let’s investigate some of the research that shows the effects of iron overload on different chronic diseases.

Impact on diabetes

In a recent meta-analysis (a group of 16 studies), results showed that both dietary heme iron and elevated iron storage (ferritin) may increase the risk of type 2 diabetes (PLoS One. 2012;7(7):e41641). When these ferritin levels were high, the risk of diabetes increased 66 percent to 129 percent. With heme iron, the group with the highest levels had a 39 percent increased risk of developing diabetes. There were over 45,000 patients in this analysis. You can easily measure ferritin with a simple blood test. Also these levels are modifiable through blood donation and avoidance of heme iron. Thus, reducing the risk of iron overload.

Diabetic retinopathy

Diabetic retinopathy is a complication of diabetes that occurs when glucose, or sugar, levels are not tightly controlled. It affects the retina, or the back of the eye. Iron excess and its free radicals can have detrimental effects on the retina (Methods Enzymol. 1990;186:1-85). This is potentially caused by oxidative stress resulting in retinal tissue damage (Rev Endocr Metab Disord. 2008;9(4):315-327).

So how is iron related to uncontrolled glucose levels? In vitro studies (preliminary lab studies) suggest that high glucose levels may perpetuate the breakdown of heme particles and subsequently raise the level of iron in the eye (Biophysical Chemistry. 2003;105:743-755). In fact, those with diabetic retinopathy tend to have iron levels that are 150 percent greater than those without the disease (Indian J Ophthalmol. 2004;52:145-148). Diets that are plant-based and, therefore, nutrient-dense are some of the most effective ways to control glucose levels and avoid diabetic retinopathy.

Age-related macular degeneration (AMD)

Continuing with the theme of retinal damage, excessive dietary iron intake may increase risk of AMD according to the Melbourne Collaborative Cohort Study (Am J Epidemiol. 2009;169(7):867-876). AMD is the number one cause of blindness for people 65 and older. People who consumed the most iron from red meat increased their risk of early AMD by 47 percent, however, due to the low incidence of advanced AMD among study participants, the results for this stage were indeterminate.

I have been frequently asked if unprocessed red meat is better than processed meat. Well, this study showed that both types of red meat were associated with an increased risk. This was a large study with over 5,000 participants ranging in age from 58 to 69.

Cardiovascular disease

Though we have made considerable headway in reducing the risk of cardiovascular disease and even deaths from these diseases, there are a number of modifiable risks that need to be addressed. One of these is iron overload. In the Japan Collaborative Cohort, results showed that men who had the highest amount of dietary iron were at a 43 percent increased risk of stroke death, compared to those who ate the least amounts. And overall increased risk of cardiovascular disease death, which includes both heart disease and stroke, was increased by 27 percent in men who consumed the most dietary iron. There were over 23,000 Japanese men who were between the ages of 40 to 79 that were involved in this study.

In conclusion, we should focus on avoiding heme iron, especially for men and postmenopausal women. Too much iron creates a plethora of free radicals that damage the body. Therefore, the best way to circumvent the increased risk of chronic diseases with iron overload is prevention. Significantly decreasing red meat consumption and donating blood on a quarterly basis, assuming that one is not anemic, may be the most effective strategies for not falling into the trap of iron overload.

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.

Milind Diwan

Continued from page B15

“If you measure their properties in this far-away detector, there will be differences,” Diwan predicts. “I suspect those differences will be quite large and … can be directly linked to the way the universe evolved in its first few microseconds” when antimatter was annihilated.

“We have been struggling to understand this miraculous event,” Diwan explained. “This is one of the key problems in all of science.”

While scientists plan to send the neutrinos on a long journey through the Earth, the researchers themselves are expecting their own long trek.

Based on the current plan, the LBNE will start producing data in 2022. By then, would-be scientists who are planning to graduate from high school this year may contribute to the research.

While that might seem like a slow build for a long range project, there are competitive time pressures.

“Japanese physicists want to perform a similar experiment with a shorter distance and Europeans want to perform a bigger experiment with almost the same experimental features,” Diwan explained. “At this point, there is agreement that in terms of planning, we are ahead of them.”

A resident of Port Jefferson Station, Diwan and his wife Sucheta, an engineer at Hauppauge-based Parker Hannifin, have a 14-year old daughter, Renuka, and a 10-year old son, Yashodhan.

His wife’s job is “much more important than mine,” he offers. Her company makes fuel gauges for jumbo jets.

As for his work, Diwan has been in the physics department at BNL since 1994. He is eager to see the LBNE project through.

“I feel very fortunate that I am working on a question that is important,” he offered. “It is extraordinary that we have the tools to actually perform this experiment.”