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Yearly Archives: 2013

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Oxidative stress may play a role in heart failure

Heart attacks and heart disease get a lot of attention, but chronic heart failure is something that tends to be overlooked by the press. Heart failure occurs in about 20 percent of the population over the age of 40 (Circulation. 2002;106(24):3068). There are about 5.8 million Americans with HF (Circulation. 2010;121(7):e46). Not surprisingly, incidence of heart failure increases with age (J Am Coll Cardiol. 2003;41(2):21).

Heart failure occurs when the heart’s pumping is not able to keep up with the body’s demands and may decompensate. It is a complicated topic, for there are two types, systolic heart failure and diastolic heart failure. The basic difference is that the ejection fraction (output of blood with each contraction of the left ventricle of the heart) is more or less preserved in diastolic HF, while it can be significantly reduced in systolic HF.

We have more evidence-based medicine, or medical research, on systolic heart failure. Fortunately, both types can be diagnosed with the help of an echocardiogram, an ultrasound of the heart. The signs and symptoms may be similar, as well, and include shortness of breath on exertion or when lying down; edema or swelling; reduced exercise tolerance; weakness and fatigue. The risk factors for heart failure include diabetes, coronary artery disease, high blood pressure, obesity, smoking, heart attacks and valvular disease.

Typically, heart failure is treated with blood pressure medications, such as beta blockers, ACE inhibitors and angiotensin receptor blockers.

We are going to look at how diet, iron and the supplement CoQ10 impact heart failure.

Effect of diet

If we look beyond the usual risk factors mentioned above, oxidative stress may play an important role as a contributor to HF. Oxidative stress is thought to potentially result in damage to the inner lining of the blood vessels, or endothelium, oxidation of cholesterol molecules, and a decrease in nitric oxide, which helps vasodilate blood vessels.

In a newly published population-based, prospective (forward-looking) study, called the Swedish Mammography Cohort, results show that a diet rich in antioxidants reduces the risk of developing HF (Am J Med. 2013 Jun:126(6):494-500) In the group that consumed the most nutrient-dense foods, there was a significant 42 percent (p<0.001) reduction in the development of HF, compared to the group that consumed the least. According to the authors, the antioxidants were derived mainly from fruits, vegetables, whole grains, coffee and chocolate. Fruits and vegetables were responsible for the majority of the effect.

This nutrient-dense approach to diet increased oxygen radical absorption capacity. Oxygen radicals have been implicated in cellular damage and DNA damage, potentially as a result of increasing chronic inflammation. What makes this study so impressive is that it is the first of its kind to investigate antioxidants from the diet and their impacts on heart failure prevention. This was a large study, involving 33,713 women, with good duration — follow-up was 11.3 years. There are limitations to this study, since it is an observational study, and the population involved only women. Still, the results are very exciting, and it is unlikely there is a downside to applying this approach to the population at large.

CoQ10 supplementation

Coenzyme Q 10 is a substance produced by the body that helps the mitochondria (the powerhouse of the cell) produce energy. It is thought of as an antioxidant. In a meta-analysis (group of 13 studies), the results showed that supplementation with CoQ10 may help improve functioning in patients with heart failure (Am J Clin Nutr. 2013 Feb;97(2):268-75). This may occur because of a modest rise in ejection fraction functioning. It seems to be important in systolic heart failure. Supplementation with CoQ10 may help to reduce its severity.

The doses used in the meta-analysis ranged from 60 mg to 300 mg. Interestingly, those that were less than or equal to 100 mg showed statistical significance, while higher doses did not reach statistical significance. This CoQ10 meta-analysis was small. It covered 13 studies and fewer than 300 patients.

Like some other supplements, CoQ10 has potential benefits, but more study is needed. Because there are no studies showing significant deleterious effects, which doesn’t mean there won’t be, it is worth starting HF patients with comprised ejection fractions on 100 mg CoQ10 and titrating up, as long as patients can tolerate it.

Preliminary results of the new Q-SYMBIO study showed an almost 50 percent reduction in the risk of all-cause mortality and 50 percent fewer cardiac events with CoQ10 supplementation. This one randomized controlled trial followed 420 patients for two years who had severe heart failure.

The lead author goes as far as to suggest that CoQ10 should be part of the paradigm of treatment. He may be a bit enthusiastic, but this is the first new “drug” in over a decade to show survival benefits. The caveat is that these results were only recently presented at the prestigious Heart Failure 2013 Congress May 25 to 28, and they still need to be published in a peer-reviewed journal.

Iron Deficiency

Anemia and iron deficiency are not synonymous, since iron deficiency can occur without anemia. A recent observational study that followed 753 heart failure patients for almost two years showed that iron deficiency without anemia increased the risk of mortality in heart failure patients by 42 percent (Am Heart J. 2013;165(4):575-582).

In this study, iron deficiency was defined as a ferritin level less than 100 ug/L (the storage of iron) or, alternately, transferrin saturation less than 20 percent (the transport of iron) with a ferritin level in the range 100-299 ug/L.

The authors conclude that iron deficiency is potentially more predictive of clinical outcomes than anemia, contributes to the severity of HF, and is common in these patients.

Thus, it behooves us to try to prevent heart failure through dietary changes, including high levels of antioxidants, because it is not easy to reverse the disease. Those with HF should have their ferritin levels checked, for these are correctable. I am not typically a supplement advocate; however, based on the latest results, CoQ10 seems like a compelling therapy to reduce risk of further complications and potentially death. Consult with your doctor before taking CoQ10 or any other supplements, especially if you have heart failure.

 

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 or consult your personal physician.

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Where has all the soy yogurt gone? 

WholeSoy yogurt is nowhere to be found on supermarket shelves.

Okay, so I am not crazy. Well, I am, but not when it comes to my conspiracy theories about the sudden and suspicious disappearance of all-soy yogurt from the supermarket shelves. 

For the past few weeks, I’ve been trekking from store to store in search of strawberry-flavored soy yogurt. The shelves at my usual haunts —Stop & Shop, Wild by Nature, Whole Foods and Trader Joe’s — were all filled in with coconut milk yogurts, as if to deny that the soy yogurt had ever existed. The stock people couldn’t give me any information and would give me that “crazy lady” look when I told them that the only soy yogurt to be found anywhere has dairy in it — what is the point of that? I was convinced that something was up. And they were convinced that I was a little nutty. 

But you could sort of see why one might jump to the conclusion that there had been some kind of organic soy bean blight or something. Had my instincts directed me to the WholeSoy and Co. website sooner, I could have saved myself some consternation and possibly even commiserated with the people who “stuffed” the company’s inboxes and comments page with messages. 

As it happens, according to WholeSoy’s May 31 blog, the facility where they made and packaged their yogurt “just abruptly closed its doors” with only three days notice! Fortunately, for them, they were already in the process of completing paperwork and testing equipment for a move to a new facility. A process that can usually take several months, took them only eight weeks, they say, but it still caused a yogurt shortage.

Yesterday’s blog post shared the good news that the California-based company’s new facility has not only received its “organic certification,” it also started to produce strawberry and vanilla yogurt over the weekend! Progress for those going through strawberry soy yogurt withdrawal. And yet, the wait won’t be over just yet. 

WholeSoy, and yes, the company is cutesy in the way it spells its name, will begin shipping what it’s made so far this week. But, says the company’s website, “With demand so high, and a distribution channel that has been completely empty of WholeSoy for a few weeks, it will take time to completely refill the entire yogurt pipeline from warehouses to store shelves with every flavor.” 

Nevertheless, they are on it, running production literally 24-7 for the next several weeks. What commitment! They estimate that we’ll start to see yogurt on our shelves here on the East Coast by late next week. Phew! It’s still a wait, but I feel so much better just knowing, don’t you?

As to the disappearance of the Trader Joe’s brand soy yogurt, all I’ve been told from a store in California is that it has been out of stock since May. I can only presume that, perhaps, they used the same facility that suddenly shut its doors. 

Either way, the great soy yogurt shortage is about to come to an end, and all will be right with the world again. And won’t the stock clerks at the stores where I shop be glad about that!

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Dad with his three daughters on a trip to the Bronx Zoo. Photo from the Glowatz family collection

A dad is a funny thing.

But not as funny as he thinks he is.

Especially, it seems, when he is in a house full of females, as my father was when I was growing up and usually still is. Perhaps he is just misunderstood, because between his wife and three daughters — four, if you count the dog — Dad can get lost in the shuffle.

He has to contend with a gaggle of cackling women, a sometimes-boisterous group that frequently discusses matters or cracks jokes that aren’t for male ears or are just plain lost on him. Usually he smiles and watches patiently through it all — or stays away entirely. There is great satisfaction on his face when we talk about a subject he can easily contribute to, like business, politics or baseball. Or AC/DC. On those topics, he is the expert and everybody knows it.

But this isn’t to say that he feels uncomfortable without any other guys around — my dad is all about his ladies. He has worked from a home office my entire life, so he was there just about every day, fixing boo-boos, making home videos about the trials and tribulations of a doll’s life and breaking up some pretty bad sisterly fights, too.

Dad gets friendly with a cardboard President Ronald Reagan on the streets of New York City. Photo from the Glowatz family collection
Dad gets friendly with a cardboard President Ronald Reagan on the streets of New York City. Photo from the Glowatz family collection

While many women would say they don’t want to marry someone like their father, my dad is a model for whom I should be with. He can be rough around the edges but when it counts, he is a true gentleman. He can be a real tough guy, but he’ll cry if he feels like it (in recent history, he got choked up at my older sister’s wedding). He often reminds us, whether we roll our eyes at the repetition or not, the importance of holding on to our traditions and values. His family is his top priority and always has been, and he would defend any one of us to the death — he once threw himself between me and a snarling dog that had escaped its yard and lunged toward us while we went for a walk (in case you’re wondering how we got out of that, my dad ferociously barked at it and it cowered away).

And as much as we hate to admit, although we women sometimes tease him, my dad is beyond cool, partly because he is himself, no matter what other people say.

My mother told me many times when I was growing up that apart from her own father, my dad is the finest man she has ever known. While I understood what she was saying, I never fully grasped it until I had grown.

I once asked my dad whether he was disappointed that he never had any sons. He reminded me that he loves his three girls, tutus and all, and that he still did all the great stuff with us he would have done with boys, like teaching us how to ride bikes, taking us to baseball games and hugging us when we cried.

I guess the only real disappointment in my dad not having any sons is that he can’t teach any young men to be just like him.

Happy Father’s Day to my dad and all the great ones like him.

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Works with a team of scientists to help in research from cancer to radiation detection

Growing up in Catania, Sicily, Gianluigi De Geronimo caught the bug from his engineer grandfather Giuseppe Nicotra, who was a structural engineer, and his uncle, Luigi Nicotra, who is a doctor with a passion for mechanics and electronics.

Determined to study engineering, De Geronimo took the first of what would become several steps away from the home he knew to pursue his growing passion, traveling to Milan Polytechnic to earn a master’s degree and then a Ph.D. He worked in radiation detection with Emilio Gatti, who came to Brookhaven National Laboratory for one month each year. Gatti recommended De Geronimo to BNL and, after an interview in 1997, the Sicilian engineer moved with his wife Marcella to Long Island, where they have lived ever since.

The moves have proven productive for De Geronimo, who, in April, was named the “Inventor of the Year” at BNL by Battelle, the Ohio-based company that manages BNL in partnership with Stony Brook University.

“I strongly believe that my achievements have been possible not only for my hard work but also for the environment I was blessed with, which includes my BNL colleagues and my family,” he said.

At BNL, De Geronimo designs application-specific integrated circuits for scientific research and tools for national security and medical imaging. He leads the ASIC development team. Some of the ASICs that De Geronimo and his group of five electrical engineers have designed have enabled products like the ProxiScan camera, which can identify prostate cancer in its early stages, as well as the high-resolution, x-ray Maia detector, which can be used to map specific elements in materials and artwork and was used last year to validate the authenticity of Rembrandt’s painting, “Old Man with a Beard.”

The team’s ASIC designs also enabled equipment upgrades for the Atlas detector at the Large Hadron Collider in Europe.

Other researchers often approach De Geronimo, who is in the instrumentation group at BNL, to develop technology that will further their scientific efforts.

“Usually, scientists come to the instrumentation division and discuss the problem,” he said. “Together, we develop the detector, the sensor, the electronics and all the rest that they might need to do their science. We make our scientists competitive by developing instruments they need.”

In a description of De Geronimo’s work as part of the award ceremony, Battelle wrote that he has helped deploy “over a million transistors on an ASIC consisting of just a few square millimeters of silicon, to bring about transformational changes in radiation detector performance.”

“The challenge we have is to integrate all these functionalities into a small area with a very low power dissipation,” he explained. Each channel generates heat, which creates problems for the sensing process.

He needs to “integrate a large number of channels in a small area with low power,” he said.

De Geronimo said radiation sensors convert radiation into electric charge, which moves toward electrodes generating small currents. The detectors read those currents.

The detectors can operate at room temperature or in environments of minus 200 degrees Celsius. His team helped develop ASICs for the Long Baseline Neutrino Experiment, which operates submerged in liquid argon at minus 190 degrees Celsius.

The instrumentation group is also developing instruments for security that can detect sources of dangerous radiation.

He called the BNL radiation detector effort “state of the art,” because of the combination of specialized scientists who have backgrounds in core technologies, including microelectronic engineering and detector science, necessary to create the detector.

De Geronimo teaches a graduate class in the Department of Electrical and Computer Engineering at Stony Brook called Advanced Design of Low-Noise and Low-Power Analog Circuits.

The BNL scientist said he hopes this course “gives SBU students a [competitive] edge” because “there are very few places in the world” that offer similar courses.

He and his wife, Marcella, an assistant vice president at Krasnoff Quality Management Institute at North Shore-LIJ Health System, live in Syosset with their children Frederico, 13, Francesca, 12, and Giovanni, who will be nine soon.

De Geronimo said he has been especially impressed by the way people react in difficult situations.

“We couldn’t even give blood after 9/11 because the lines were so long,” he said. “People in the United States have a good heart.”

As for his work, De Geronimo said he feels “extremely happy at BNL. That fact that I am succeeding is due to the wonderful collaborations. It’s a very positive environment.”

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Two prestigious organizations disagree on sodium reduction amounts

Sodium is once again mired in controversy. The Institute of Medicine recently released a report that questioned the levels to which Americans should reduce their sodium levels in order to reduce chronic ailments, such as cardiovascular disease. Interestingly, the IOM and the American Heart Association disagree. The AHA believes stricter levels are critically important.

The generally accepted guidelines suggest that healthy people reduce their daily sodium intake to less than 2,300 milligrams, or about a teaspoon, and that those in high-risk categories reduce this further to less than 1,500 mg, or just over a half teaspoon. About 70 percent of Americans are at high risk, which includes those over 50, African Americans and patients with chronic kidney disease, heart failure, diabetes, hypertension (high blood pressure) or prehypertension (MMWR Morb Mortal Wkly Rep 2009; 58:281-283).

The IOM was asked to determine whether there was enough information to suggest everyone follow the less-than-1,500-mg sodium levels, regardless of their risk level. However, the IOM did not find enough data to substantiate that level and even questioned whether 2,300 mg may be too low. If the IOM is right and the research does not support less than 1,500 mg of sodium for anyone, should we be more liberal with sodium? The short answer is “No.”

We will discuss an article written by The New York Times, the Center for Science in the Public Interest’s response and the beneficial effects of sodium reduction on dementia.

 

The New York Times

On May 14, NYT published an article on the IOM’s findings. NYT did say that IOM showed inconclusive results as to whether levels less than 1,500 mg daily are beneficial or not. However, NYT went further, suggesting sodium levels less than 1,500 mg may be dangerous to your health.

The author of the article referenced two studies. The first is a small, randomized controlled Italian study of patients with moderate to severe congestive heart failure. It showed those who consumed 1,840 mg of sodium per day were about three times as likely to be readmitted to the hospital and about twice as likely to suffer mortality, compared to those who consumed more sodium, 2,760 mg per day (Clin Sci (Lond). 2008 Feb;114(3):221-30).

In the second study, an observational one, patients with high blood pressure who consumed more than 7,000 mg of sodium or who consumed less than 3,000 mg per day were more likely to have cardiovascular events, such as congestive heart failure, heart attacks and stroke, as well as higher risk of death (JAMA. 2011 Nov 23;306(20):2229-38). The results are what researchers call a J curve, where the patients at the extremes suffer, while those in the middle do better.

 

Center for Science in the Public Interest

What are we to make of the studies? Even though The New York Times is one of the most prominent newspapers in the country, it is not a peer-reviewed medical journal and, in this case, the journalist is not a scientist.

However, there was an intriguing response from Michael F. Jacobson, who has a doctorate in microbiology from MIT and is the executive director of the CSPI, a highly regarded nonprofit organization focused on health and science. In his analysis of the NYT article and the IOM findings, he found several problems. The New York Times did not bring to light the fact that the IOM report found the evidence of a detrimental effect from very low sodium levels in the diet was “insufficient and inconsistent.” In other words, no conclusion could be drawn.

The studies that showed dangerous effects with very low sodium, including those mentioned above, were flawed in their methodology. It also included a strange treatment regimen for the congestive heart failure patients in the Italian study because they were restricted not only with sodium levels but also significantly limiting the amount of water intake, which is not something we typically do in the U.S. In addition, according to “National Health and Nutrition Examination Survey” data from 2003 to 2006, less than 5 percent of Americans actually consume strict sodium levels of less than 1,500 mg (ars.usda.gov). Jacobson points out that the IOM also did not take into account that consuming less sodium results in lower blood pressure.

As we know, high blood pressure leads to cardiovascular disease and potentially increased mortality. This is why the AHA believes that a sodium intake of less than 1.500 mg is so important, not just for high-risk patients, but also for the general population (www.heart.org/sodium). In the Trials of Hypertension Prevention follow-up, the results showed that a 25 percent reduction of sodium from 3,556 mg to 2,286 mg daily results in a 25 to 30 percent reduction in cardiovascular events, including heart attacks and strokes (BMJ 2007;334:885). This was one of the few studies the IOM said was not flawed.

So how are Americans doing? Not very well. We are currently consuming an average of 3,463 mg per day as of 2010 (www.heart.org/sodium). Evidence shows that the restaurant industry is contributing to Americans’ consumption of higher sodium (JAMA Intern Med online 2013;May 13). From 2005 to 2011, the amount of sodium used by the industry increased. Many processed foods are also part of the problem.

 

Preventing cognitive decline in older adults

With sedentary older adults (67 to 84 years old), a relatively recent population study showed that those who consumed less sodium had a lower risk of cognitive decline in a linear relationship (Neurobiol Aging 2012;33(4):829.e21-829.e28). Those who consumed the lowest levels (about 1,800 mg) of sodium saw less decline than those consuming higher levels (approximately 2,600 mg and 3,900 mg). It was an intake-dependent response. Interestingly, those who exercised regularly were not affected by sodium levels.

Sodium reduction may be important for additional diseases, such as osteoporosis and kidney stones. I wrote about the beneficial effects of reduced sodium on May 25, 2011.

The IOM and the CSPI make a strong case that there does not seem to be any downside to lowering sodium especially since we get far too much in our diet. Sodium reduction is a simple way of lowering the risk of cardiovascular disease and events, as well as potentially other chronic diseases. And the good news is that our taste buds usually adapt to lower sodium levels within six weeks, making food taste more vibrant.

 

 

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 or consult your personal physician.

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Gift cards are a much appreciated end-of-year gift.

Color-coordinated shirts for field day? Check. Watermelon, bubbles and chalk for class party? Check. Graduation party invites? Check. Teacher gifts? Teacher gifts….

Still trying to devise a fresh way to show your appreciation to the people who meet your children at the other side of the bus or car line, whose supply of patience seems to outpace yours by miles and who, most importantly, educate and nurture our children throughout the day? No pressure or anything. I’m just saying.

The good news is that, in many cases, classes pool their resources, taking donations from all the parents, to purchase a class gift for the teacher.  If this is the case, then you’re golden. But not all classes do a group gift and some families still like to do something for the teacher in addition to a class gift. Of course, if you have more than one child and each has more than one teacher, personalized gifting can get a bit daunting and even a little pricey.

So I reached out to my network of mom and teacher friends to get some more ideas of gifts that say “thank you,” are useful and don’t contribute to clutter.

  1. Gift Cards. Everyone — teachers and parents alike — universally agree that you can’t go wrong with a gift card.  Barnes & Noble, Starbucks, Target, Visa, restaurant gift cards and movie passes. It’s all good!
  1. Photo gifts. If you’ve got a camera-happy class parent or students on sports teams and in clubs who like to document everything with their cell phone camera, you can put together photo gifts like travel mugs or photo books. And FYI, the end of the year coincides with fantastic Father’s Day sales on photo sites, so photo gifts can be sentimental and economical.
  1. A gift that is personalized and says something about your child’s relationship with the teacher. A friend mentioned personalized cereal bowls. She has a word each of her children uses to describe their teachers, along with the teachers’ names, inscribed on a cereal bowl.  As far as I can tell, you can never have enough cereal bowls! Another friend who taught high school mentioned a student who made awards — à la the Emmys — for his teachers. She still remembers the student and his thoughtfulness years later.
  1. A new take on homemade treats. Or maybe this is an old take, but it’s yummy and relatively healthy. If you have the time and energy and like to cook, like one of my Martha Stewart-esque friends, homemade preserves may be the way to go. And I think it’s pretty safe to say that most teachers don’t have an overabundance of preserves landing on their desks.
  1. Potted Plants.  I’m sure it’s been done before, but it’s such a lovely idea, especially at this time of year. Another mother — and former Camp Fire Girl, always the nature lover — mentioned that you can get really nice plants on clearance at the end of the season. That will make both your teacher and wallet happy.
  1. Thank you notes from the kids. This, by far, seemed to have the greatest resonance among teachers, who said they remembered those notes for years after students had left their classrooms. Whether your child is young and draws a picture or writes a few words, or is older and can tell the teacher what he learned from her that year, this is always a treasured gift.

At the end of the day — or school year, really — what really matters is that your gift is a token of appreciation and acknowledgment of the role a teacher has played in your child’s development. And while teachers don’t expect anything and will appreciate just about any gesture, it is the simple one — the one that expresses what your child experienced with that teacher — that has the most meaning.

 

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BNL’s team works with Fermilab to unite large electromagnet with powerful accelerator

Before they can look for undiscovered particles that may only exist for an incredibly small amount of time, they have to haul something 3,200 miles that is so sensitive that a slight movement can cause damage.

Starting in the middle of this month, scientists at Brookhaven National Laboratory are shipping an electromagnet that is 50 feet in diameter from its home in Upton to the Fermi National Accelerator Laboratory in Batavia, Ill. The weight of that electromagnet is about 35,000 pounds — or the equivalent of almost three adult African bull elephants.

The first step, which will occur on June 10 or 11, involves removing the side of a building and securing the ring on a red, octagonal pinwheel with spokes. The structure, which Emmert International built as it manages the major move, looks like an octagonal wagon wheel with long spokes.

Traveling at night, a truck carrying the electromagnet will receive a police escort as it travels at close to five miles per hour from Upton to a barge 10 miles due south of BNL at Smith Point Marina on Bellport Bay. That trip is expected to take one night.

“The trailer has eight pairs of axles, which are all hydraulically self-leveling, so that even if it hits a pothole with one, there are many other tires” to keep the ring balanced, said Chris Polly, a project manager for Fermilab.

The ring is expected to board the barge on June 16, when it will travel around the southern tip of Florida, up the Mississippi River to Illinois. The journey, including a two-night trek from the river to Fermilab, should take about six weeks.

The reason scientists are sending such a sensitive piece of equipment over such a great distance is to explore an area of nature that might expand the world of particle physics. Back in 2001, scientists at BNL found something incredibly small but potentially revolutionary, that they couldn’t explain.

High energy interactions, such as those at the Fermilab accelerator, produce muons, which, like an electron, have negative charge but are 200 times more massive. These muons exist for only 2.2 millionths of a second. However, more than a decade ago, scientists at BNL noticed that these muons gyrated as expected — up to a point.

“We look at how these muons revolve,” said William Morse, resident spokesman for muon g-2 at BNL.

The frequency of the spin axis around a magnetic field differed, albeit in a miniscule way, from what the theory predicted.

The so-called Lande g-factor should have been 2.0023318358. In the BNL experiment, however, that factor was 2.0023318416.

If the experiments found new particles, “It would be a revolution” in physics, said David Hertzog, who was a part of the original experiment in 2001 at BNL and is now a professor at the University of Washington and a spokesman for the muon g-2 effort. “The whole motivation is to figure out what is beyond the standard model.”

The findings could cause a “rewriting of our textbooks and understanding,” Hertzog added.

Scientists suspected they were on to something, but they didn’t have a precise enough measure to know for sure. By moving the electromagnet to Illinois, they are uniting one of the world’s largest superconducting magnets to the powerful accelerators that can provide a customized beam of neutrons.

Once the electromagnet arrives in Illinois, it will start generating data in 2016 and may start producing results as early as 2017 or 2018.

Morse, who was also involved with the landmark study in 2001, said those results have generated over 2,000 references in the scientific literature.

“In my previous experiments, I would have said that 20 or 30 was a lot. We do think this is kind of a unique measurement.”

Morse, who has worked at BNL since 1976, lives in East Patchogue with his wife Sara, a teacher at Bellport Methodist preschool. They have four children: Andrew, a banker; Kathleen, who works in sustainable living; David, a physics grad student; and Rachel, a respiratory therapist. Morse is a fan of the ocean, where he enjoys swimming, fishing and crabbing.

As for the benefit of the muon experiment, Morse said it will gather basic information about the world and can train a future generation of scholars, industry leaders, and researchers.

“After the last experiment at BNL [in 2001], there were quite a number of graduate students. Many of them are off doing interesting things,” Morse said. “One of them is working on developing chambers to scan cargo ships, others are at universities and some are at national labs.”

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There is an increased risk for cardiovascular disease and high blood pressure with white coat hypertension

“White-coat hypertension” (high blood pressure) is defined as blood pressure that is elevated to at least 140/90 mm Hg at a physician’s office, but “normal” when measured at home. The blood pressure considered normal at home is less than 135/85 mm Hg. This is a real phenomenon caused by the anxiety or stress of being in a doctor’s office. It is also known as “isolated office hypertension.”

About 20 to 30 percent of patients experience white-coat hypertension (www.uptodate.com). However, when the diastolic (bottom number) blood pressure is greater than 105 mm Hg, it is unlikely to be simply caused by doctor’s office-related stress (J Hypertens. 2001;19(6):1015).

 

Consequences

What are the consequences of white-coat hypertension? We sometimes discount it, because it seems benign or harmless. However, some studies show that it may increase the risk of sustained hypertension, which is a major contributor to developing cardiovascular disease — heart disease and stroke.

It is very important to take white-coat hypertension seriously, because recent data shows that hypertension rose by 10 percent in the United States in the four years from 2005 to 2009 (CDC.gov).

 

What can be done?

What can be done about white-coat hypertension? Well, it does not need to be treated with medication, except potentially in elderly patients (over 80 years of age), but should involve lifestyle modifications, including dietary changes, stress reduction and exercise. In terms of diet, increased beet juice, green leafy vegetables and potassium, as well as decreased sodium intake may be important. You should monitor the blood pressure at home, taking multiple readings during the day, or by 24-hour ambulatory blood pressure readings, which require wearing a monitor. The latter provides the additional advantage of blood pressure readings during your sleep.

If you do monitor your blood pressure at home, the American Heart Association has suggestions on how to get the most accurate readings, such as measurements early in the morning before exercising and eating, as well as in the evening (Am Fam Physician. 2005 Oct 1;72(7):1391-1398). You should also be comfortably seated, don’t cross your legs and sit for a few minutes before taking a reading. For more details, see the article referenced, which was published in the American Family Physician journal. Let’s look at the evidence.

 

Risk of sustained high blood pressure

There were no substantial studies demonstrating any consequences from white-coat hypertension until 2005. Most previous studies on white-coat hypertension were not of long enough duration.

In the 2005 population-based Ohasama study, results showed that the participants who had white-coat hypertension were 2.9 times more likely to develop sustained hypertension, compared to those who had normal blood pressure in the doctor’s office (Arch Intern Med. 2005 Jul 11;165(13):1541-6). There were almost 800 participants involved in this study, with a mean age at the start of 56. What was really impressive about the study was its duration, with an eight-year follow-up. This gives a better sense of whether white-coat hypertension may develop into sustained hypertension. The researchers concluded that it may lead to a less than stellar outlook for cardiovascular prognosis.

Another study, published in 2009, reinforced these results. The PAMELA study showed that those with white-coat hypertension had about a 2.5-times increased risk of developing sustained high blood pressure, compared to those who had normal readings in all environments (Hypertension. 2009; 54: 226-232). There were 1,412 participants involved in the study, ranging in age from 25 to 74. Just like the previous study, an impressive aspect was the fact that there was a long follow-up period of 10 years. Thus, this was a substantial study, applicable to the general population over a significant duration.

 

Prevention of sustained hypertension

In a recent small, randomized controlled trial, beet juice was shown to reduce blood pressure significantly (Hypertension. Online 2013; April 15). Patients either were given 250 ml (about 8 ounces) of beet juice or comparable amounts of water. The patients who drank the beet juice saw an 11.2 mm Hg decrease in blood pressure, while those who drank water saw a 0.7 mm Hg reduction. This effect with the beet juice continued to remain significant. Even after 24 hours, there was a sustainable 7.2 mm Hg drop in blood pressure, compared to readings taken prior to drinking the juice.

Though these results are encouraging, we need to study whether these effects can be sustained over the long term with daily beet juice consumption. Also, this study was done in patients with high blood pressure. I don’t know of any prevention studies done in patients with white-coat hypertension.

The researchers believe the effect is caused by high nitrate levels in beet juice that are converted to nitrite when it comes in contact with human saliva. Nitrite helps to vasodilate, or enlarge blood vessels, and thus helps to decrease blood pressure in a similar way as some antihypertensive (blood pressure) medications.

The authors go on to surmise that green leafy vegetables offer protection from cardiovascular disease in part due to increased nitrite levels, similar to those in beet juice. If you have diabetes, prediabetes, a family history or a high risk for diabetes, I recommend eating beets instead, since drinking beet juice will raise your sugar levels.

Increasing potassium levels significantly through food sources, not supplements, has a profound effect in reducing blood pressure. In a study where 3,500 to 4,700 mg of potassium were consumed through foods, the systolic (top number) blood pressure was reduced by 7.1 mm Hg (BMJ. 2013 Apr 3;346:f1378). We should be getting 4,700 mg of potassium daily, which equates to about 10 bananas daily. Almonds, raisins and green leafy vegetables, such as Swiss chard, also have significant amounts of potassium. To learn more about potassium’s effect on blood pressure, please read my April 11, 2013 article.

White-coat hypertension should not be neglected. It is important to monitor blood pressure at home for at least three days with multiple readings, and then send them to your physician for review. Though patients don’t need to be on blood pressure medications at this stage, it does not mean you should be passive about the process. Make lifestyle modifications to reduce your risk of developing sustained hypertension.

Dr. Dunaief is a speaker, author and local lifestyle medicine physician focusing on the integration of medicine, nutrition, fitness and stress management. For further information, go to the website www.medicalcompassmd.com and/or consult your personal physician.

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Using the enzyme mix in Xiaflex to treat Dupuytren’s contracture, frozen shoulders and now cellulite

It’s a nuisance during the summer months, when the weather heats up and bathing suits and shorts come out. Never a distinguishing or welcome sign, it’s the dimpled skin condition known as cellulite.

Researchers at Stony Brook University, however, believe they have come up with a possible injection-based cure. Using the same enzymes they’ve applied with frozen shoulder and Dupuytren’s contracture, a deforming hand condition that limits finger mobility, Marie Badalamente and Alexander Dagum have had some success in treating 10 patients in a first-round study of their injections.

Later this year, they expect to enter the Food and Drug Administration’s so-called Phase 2A trials, where they will continue to test their drug, called Xiaflex. They plan to advertise for study subjects and will likely test their remedy against a placebo (using something harmless as an injection that isn’t known to have any effect on cellulite).

In their first trial, their results showed promise. On average, patients saw a 77 percent reduction in cellulite one day after the injection. After six months, those patients still saw a 76 percent reduction. Side effects included soreness, black-and-blue areas and mild edema.

“This is the first properly controlled clinical trial of an injectable treatment that has a good chance to be FDA-approved,” said Badalamente in an interview.

Cellulite affects about 90 percent of women and 10 percent of men. Women have “more of these thin-strand fibers” in their thighs and buttocks, so the fat “kind of pushes up and through, although like a honeycomb of fibers,” said Badalamente, who is a professor of orthopedics. The result is this classic dimpling appearance in those areas.

“Patients flock to cosmetic plastic surgeons’ offices in search of treatments that may help them,” she said. “It’s very troubling to a women’s sense of herself.”

In a press release, Dr. Dagum, who is the interim chairman of surgery at Stony Brook School of Medicine, added that the “methods to remove cellulite are many, but none yet have been supported in medical literature to be effective or potentially usable as a standard practice.”

Through her work with other problems, like Dupuytren’s contracture and frozen shoulder, Badalamente had used the enzyme mixture in Xiaflex. Badalamente and Edward Wang, an associate professor of Orthopedics, are collaborating on the frozen shoulder treatments.

“The common thread is the presence of a substance called collagen,” Badalamente said. “In Dupuytren’s contracture, there’s an abnormal deposition [of collagen] from the palm to the fingers. There’s a normal collagen capsule around the shoulder. In frozen shoulder, there’s an adhesion of collagen that builds up.”

The enzyme mixture lyses, or dissolves, the collagen in frozen shoulder, freeing the shoulder to return to its normal range of motion. For frozen shoulder, these Phase 2A trials have just been completed. The treatment reduces the need for extended physical therapy or arthroscopy (surgery). Phase 2B trials will begin this summer or fall.

“It was readily apparent to me that this injectable drug, which is a combination of two collagenase enzymes, clearly had other uses in a class of disorders,” she explained. “The light bulb on the top of the head moment was that I knew about the microanatomy of cellulite.”

Although the studies with Xiaflex on cellulite are still in the early stages, the use of the enzyme mixture to treat Dupuytren’s contracture has been effective over a longer period of time. If, for example, it recurs years later, patients can get another injection.

“That might be the same for cellulite,” Badalamente said.

The researchers cautioned that safety always comes first in any new treatment, even with a procedure that has won FDA approval for other uses.

For the Dupuytren’s contracture, the process took about 15 years.

“That one probably took too long,” Badalamente said. “Each indication, as it comes forward, should take much less time.”

Badalamente said she sees firsthand the problems that affect patients.

“In the case of the hand, if you can image this disease affecting both of your hands, [there’s] misery,” she said. “It’s not cancer and it’s not going to kill you, but it’s gong to interfere with your function. If you see that misery and you’re able to potentially think about a therapy that’s less invasive than surgery, there’s nothing better in the world than getting a ‘Thank you’ from the patients.”

The male ensemble of Wood, Evan Teich, Josh Rothberg, Ben Rosenbach, Matthew Michael Urinak, Dennis Setteducati and Paul Velutis along with the females Jamila Sabares-Klemm, Diana Rose Becker, Audra Rizzo, Erin Raquel Garcia and Kate Cherichello all meshed together like the breech of a 16-inch battleship’s gun — another tribute to DiPietropolo.

This season-topper was yet again another exhibition of what the Engeman can mount in its unquestionable adherence to the highest norms of professionalism.

“South Pacific” will run at the Engeman Theater, 250 Main St., Northport through July 14. Call 261-2900 or go to www.engemantheater.com for tickets.

 

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Finding an inexpensive catalyst to break water down to its components is the key

It often looks like an outline of Mickey Mouse’s head, with a large circle and two overlapping or attached smaller circles. Drawn in a chemistry class, the larger circle is oxygen, while the two smaller ears are hydrogen.

In plants that produce their own food through photosynthesis, taking apart the three circles helps them make food, such as sugars. Scientists like Wei-Fu Chen at Brookhaven National Laboratory are imitating nature by breaking apart, or electrolyzing, water, releasing hydrogen that could serve as an alternative to fossil fuels.

“This process mimics how plants convert sunlight and nutrients into sugars,” said Chen.

As the lightest element, hydrogen has the highest gravimetric energy density of any known fuel, which means it produces the highest energy of all the elements.

Scientists can reduce the effort it takes to split water by using a catalyst. While platinum and palladium have fulfilled that role, they are expensive, which makes them less viable long-term options.

Chen suggested twin high school students Shilpa and Shweta Iyer from Comsewogue High School, who were working in his lab, go home and search their kitchen for ingredients that, using much more cost-efficient substances like metal carbide and metal nitride, might become a catalyst alternative. In the presence of molybdenum, soybeans, which are rich in proteins, worked. The 17-year-old Iyer twins recently placed fourth in the chemistry category of the Intel International Science and Engineering Fair for their efforts (see related story in the Port Times Record and online).

So far, in tests with soybeans, the catalyst has continued to be effective for over 500 hours. The production process, Chen said, is mature for industrial applications, with a projected cost that is “fairly economical” compared to other options. For commercial use, however, tests may need to take at least a year. Chen is searching for collaborators and would like to transfer the technology to an interested commercial partner.

Now that his lab has developed a process that works, Chen said that the next steps involve understanding the chemical mechanism that enables soybeans to act as a catalyst in the electrolysis of water.

“We don’t know why it’s so active,” he explained. “My job is to figure out the mechanism in the solution.”

Chen is able to tap into the considerable resources at BNL, including the National Synchrotron Light Source. By shooting beams of light through the reaction, Chen has found information about the catalytic active center and how the applied voltage changes its electronic state. He plans to study how changes in some of the conditions, such as the temperature or the pH (whether the solution is more of an acid or a base) affect the process.

The NSLS beams can allow scientists to monitor changes that occur in an incredibly short time scale, which makes it possible to track small changes in the reaction.

“By knowing the reaction mechanisms, scientists will be able to predict new effective structures for the water electrolysis and may find new principles in the reaction,” Chen suggested.

Chen explained that developing a hydrogen fuel-based economy remains a challenging task. While he is working hard to develop ways to make hydrogen fuel more available through water electrolysis, other scientists are researching the problem of storing and transporting hydrogen.

“The coming hydrogen age will be based on the completion of production, delivery, storage and utilization,” Chen said.

Chen said some hydrogen-driven cars are already available for purchase.

“There are already some prototype products out there, but the problem is that the cost is too high,” he said. There are fuel cell cars that use hydrogen in California.

Chen lives in Ridge with his wife Chiu-Hui Wang (who uses the American name Chloe). Wang works as an electron microscope specialist in the chemistry department at BNL and at Graphene Laboratories in Calverton.

A native of Kaohsiung City, the second largest city in Taiwan, Chen said he enjoys the natural life and the fresh air on Long Island. He also loves skiing, hiking and photography. He has a blogspot site where he has posted pictures of a fawn foraging in the snow and a negative photo of rainwater on a window. Photography inspired him in 2006, when he viewed a series of photographs of Taipei City in 1957 taken by a member of the U.S. Army, Tom Jones.

As for his work, Chen hopes hydrogen fuel becomes a viable, and affordable, alternative to fossil fuels.

“Considerable work needs to be done before a hydrogen-fueled vehicle becomes an option for us,” he said.

 

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