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Yearly Archives: 2013

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The ‘normal’ pulse range may help impact longevity

Everyone has a heart rate, so everyone needs to pay attention. But what does that heart rate, or pulse, tell us beyond the obvious fact that we are alive?

Our “normal” resting heart rate is between 60 to 100 beats per minute. We know that a RHR above 100 bpm is abnormal; it is referred to as tachycardia, or a racing heartbeat, and has potentially serious consequences. However, even “normal” RHRs can be stratified to identify risks for diseases. What I mean is that, even in the “normal” range, as your resting heart rate increases, so do your potential risks. Actually, RHR below approximately 70 bpm may be ideal.

The importance of the resting heart rate should not be underestimated. In fact, it may play a role in longevity, heart disease — including heart failure, arrhythmias, heart attacks and sudden cardiac death, and even chronic kidney disease.

The good news is that the RHR is modifiable. Methods that may reduce your rate include medications for high blood pressure, such as beta blockers and lifestyle modifications, including meditation, dietary changes and exercise.

 

Impact on lifespan

We all want to live longer and healthier lives. Reducing the RHR may be an important component in achieving this goal.

In the Copenhagen Male Study, a prospective (forward-looking) study that followed 2,798 participants for 16 years, results showed that those with higher resting heart rates had greater risk of death (Heart Journal 2013 Jun;99(12):882-7). There was a linear relationship between risk of death and increasing RHR. Those who had a resting heart rate above 90 bpm were at a threefold greater risk of death, compared to those who had a RHR at or below 50 bpm. RHR was inversely related to the amount of physical activity.

Thus, the authors concluded that a “healthy” person with higher RHR may still have a shorter lifespan, with all other factors being equal, such as physical activity and blood pressure.

In contrast with the previous study, the following one took a “glass is half-full approach” to longevity. The Jerusalem longitudinal cohort study showed that elderly women and men who had a lower RHR lived the longest (J Am Geriatr Soc. 2013;61(1):40-45). There were more than 2,000 participants, ranging from 70 to 90 years old.

 

Heart disease mortality

In the Nord-Trondelag health study, a prospective observational study, those with a higher RHR at the end of the study than they did 10 years prior, at the beginning of the study, were more likely to die from heart disease (JAMA 2011; 306:2579-2587). In other words as the RHR increased from less than 70 bpm to over 85 bpm, there was a 90 percent greater risk of heart disease, compared to those who maintained a RHR of less than 70 throughout the two measurements. This study involved 30,000 participants, but unlike some other studies, many of us can relate to the population: They were at least 20 years old and were healthy volunteers.

Heart attacks

It is more common for women to have heart attacks with atypical symptoms than men. Therefore, it is very important for women to reduce their risks. In the Women’s Health Initiative, results showed a 26 percent decrease in the risk of cardiovascular events in those postmenopausal who had a RHR below 62 bpm, compared to those who had a RHR above 76 bpm (BMJ. 2009 Feb 3;338:b219). Interestingly, these results were even more substantial in the subgroup of women who were newly postmenopausal, ranging in age from 50 to 64.

 

Effect on kidney function

Since I wrote about chronic kidney disease on May 9, I thought an interesting follow-up might be resting heart rate and its impact on kidney function. In the Atherosclerosis Risk in Communities Study, results showed that the most severe form of chronic kidney disease, end-stage renal disease, was 98 percent more likely to occur in those with the highest RHR, compared to those with the lowest (J Am Soc Nephrol. 2010 Sep;21(9):1560-70). There were approximately 13,000 participants in the study, with a 16-year follow-up.

The authors hypothesized that this negative affect on the kidney may be due to a loss of homeostasis in the autonomic (involuntary) nervous system, resulting blood vessel dysfunction, such as increased inflammation and vasoconstriction (narrowing).

 

Eating fish

What can be done to reduce the resting heart rate with minimal side effects? Fish consumption has recently been shown to have a positive effect. In a study, European men who ate greater amounts of fish — more than one serving per week — had lower resting heart rates than those who ate fish rarely (Circulation. 2003;108:820-825). There was also a direct relationship between the amount of fish consumed and the RHR: The more fish consumed per week, the greater the reduction in RHR. This was a prospective observational study involving about 5,000 men. Some beneficial side effects of eating fish included decreased triglycerides and diastolic (lower number) blood pressure, as well as increased HDL (“good cholesterol”). Even after controlling for these beneficial side effects, there still was a significant improvement in RHR with fish consumption.

Is there a resting heart rate that is too low? Well, it depends on the context. If you are a marathoner or an athlete, then a RHR in the 40s may not be abnormal. For a healthy, physically active individual, it is not uncommon to have a resting heart rate in the 50s. However, if you are on medications that reduce your RHR and/or have a chronic disease, such as heart failure, it is probably not advisable to go much below 60 bpm. Always ask your doctor about the appropriate resting heart rate for your particular situation.

Thus, resting heart rate is an easy and inexpensive biomarker to potentially determine risk stratification for disease manifestation and to increase longevity, even for those in the “normal” range. We can utilize RHR as tool for primary prevention of disease. The fact that it is modifiable means it is something that we need to monitor, so that we can achieve the ideal RHR, rather than just the “normal.”

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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New dog park will be off Boyle Road

Irene Rabinowitz with her dog, Sydney, at the site of the future dog park in Selden. Photo by Erika Karp

Soon Middle Country dogs and their owners won’t have to travel far for puppy play dates or a walk in the park, as plans for a local dog park are moving forward.

The park, which will be located on a property off Boyle Road, just north of Independence Plaza in Selden and across from Washington Heights Street, could be completed by the end of this year, according to Councilwoman Kathy Walsh (I-Centereach).

Irene Rabinowitz, a Selden resident and the former owner of Barks-n-Bubbles Boutique on Middle Country Road in Centereach, has been a driving force behind the project. In 2011, Rabinowitz created Central Suffolk Paws, a local affiliate of Long Island Dog Owners Group, a nonprofit organization dedicated to increasing access to parkland for dogs and their owners.

“You go into this wooded property right off of Boyle Road [and] it’s just so relaxing and peaceful,” Rabinowitz said in a phone interview about the planned site for the dog park.

Walsh said in a phone interview there is money available in this year’s town budget to create a small gravel parking lot and to install fencing for the park, but she was unsure of the project’s total cost. The park will take up about four acres on the northern side of the 10-acre wooded property. Paths that already exist throughout that section will remain for dogs and their owners to roam freely.

Rabinowitz, who owns four dogs including an 11-year-old Australian shepherd named Sydney who needs to stay active, said she has always wondered why there were no dog parks in the central Suffolk area. Last October, Rabinowitz and Sydney completed a 70-mile walk from Centereach to Montauk to raise money and awareness for Central Suffolk Paws and the Arthritis Foundation, Long Island Chapter.

“It is a matter of socialization,” Rabinowitz said about the need for dog parks. “[Sydney] wants to be out there with other dogs and people.”

Brookhaven Town has a few parks for dogs already, including the town’s Middle Island Dog Park, one in Mud Creek County Park in Patchogue and another at the county’s Robinson Duck Farm in Brookhaven hamlet. There are also other dog parks throughout Suffolk County, including the Blydenburgh Dog Park in Hauppauge and East Northport Dog Park in East Northport.

All of these are 20 to 30 minutes away from this community so that’s why we need one here,” said Kevin McCormack, the former executive director of the Middle Country Coalition for Smart Growth, a nonprofit organization working to develop and revitalize the Middle Country community.

McCormack said the idea to create a dog park in Middle Country goes back to when the group was putting together the Middle Country Sustainable Community Plan. In the 2008 community plan, which listed the community’s assets and needs, a dog park was listed as an item the community expressed “significant interest” in.

For the last three months, McCormack said residents involved with the initiative have really tried to move forward with it. A car-wash fundraiser was held recently, and Rabinowitz said she wants to continue to raise funds and hold monthly car washes over the summer. Another fundraiser will be held at the Middle Country Beer Garden in July. Rabinowitz said Central Suffolk Paws is also looking for sponsors for the dog park, with the hope of purchasing things like benches for the park and developing it further.

McCormack said residents could also volunteer to help out, especially on Saturday, May 18, when the Town of Brookhaven will hold its sixth annual Great Brookhaven Clean Up at various locations throughout the town, including the soon-to-be dog park’s location. The property sometimes attracts unwanted visitors, who leave behind alcohol bottles and other trash.

“Volunteers are more than welcome,” McCormack said. “The more we can get [the property] clean, the less we have to rely on the town.”

For updates on the park’s progress or to find out more information, residents can visit the Central Suffolk Paws Facebook group or email [email protected].

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Comparing bacteria’s genes and computer code brought about some scientific surprises

A computational systems biologist, Sergei Maslov recently showed what makes some pieces of computer code critically important to computer systems, the same way certain genes are common and important among bacteria.

“I was working with Linux, which has real similarities with bacteria,” said Maslov, who is a computational biology group leader at the Department of Biosciences at Brookhaven National Laboratory and an external faculty member at Stony Brook. Engineers can “reuse packages created by other engineers, who could be on another continent. It’s a complex interdependency.”

The most frequently used parts are also among the most functionally important ones. Scientists can measure their importance by looking at how many other components depend on them for their operation.

“I was rather shocked by how much is similar” when comparing bacterial genes and computer codes, he said. His results were recently published in the Proceedings of the National Academy of Sciences.

As a systems biologist, Maslov typically works with large amounts of data to make sense of patterns.

“The models I create explain the real world around us. I am very interested in complex networks,” he said. “The first challenge is to get data describing those networks.”

Fortunately, he said, the amount of publicly available data has grown enormously over the last two decades. Indeed, in his study, Maslov looked at over 2 million Linux computers and 500 bacterial species.

Maslov is one of four principal investigators in a large Department of Energy-sponsored project called KBase.

The project, which started a year and a half ago, includes researchers from a wide range of institutions. Maslov leads the group of scientists based at BNL, Cold Spring Harbor Laboratory and Yale.

One of the goals of KBase is to provide a “solid platform that supports predictive biology in a framework that does not require users to learn separate systems to formulate and answer questions spanning a variety of topics in systems biology research,” according to the KBase website.

The application of that predictive research includes handling biological problems in energy and the environment.

In addition to his work with KBase, Maslov has looked at stock price fluctuations, Internet connectivity data, World Wide Web pages, hyperlinks and many others.

He is currently analyzing food webs by using data in KBase that describes microbial communities and uses network analysis tools to make sense of microbe-microbe and plant-microbe interactions.

“I view food webs as a network of interacting objects,” he said. “You can study all the individual microbes in a food web very well, but still not understand how they interact.”

He looks at the pattern of connections among species, to determine which species might be more important. Long-term, he said he wants to understand how certain perturbations — or changes — will cascade down food webs.

“We want to understand which perturbations lead to minor changes and which will lead to large-scale systemwide changes,” he said.

Maslov said the biggest lesson he’s learned from studying the patterns in evolution is that “if you want to design software or any other complex system, make it evolvable. Make sure it doesn’t become too rigid.”

Maslov has lived in many towns since he came to Long Island two decades ago, including in Stony Brook, Sound Beach, and Dix Hills. Indeed, when he resided in Dix Hills, he lived in saxophone great John Coltrane’s house, which is now being turned into a museum.

Maslov’s wife Olga Maslova, a costume designer, is working on sets and costumes for an opera in Boston. Maslova left for the first meeting with producers on the day of the marathon, but was on the Long Island ferry during the attack.

The couple lives in Shoreham with their 10-year-old son Leo and their 6-year-old Alexander.

Maslov grew up in Moscow and appreciates the proximity of Long Island to the City.

As for his research, “We allow the people who do experiments on organisms to recommend particular genes they should pay attention to, maybe provide some guidance on how best to optimize a plant to survive in drought or good soil conditions. We organize the data and allow researchers to work with it.

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Testing a bar-coding approach as a cost-effective way to study how neurons interact

Using the three pounds of matter between his ears, Tony Zador came up with an idea. Instead of looking closely at all the individual neurons to understand the connections in the brain, he would take advantage of a cost-effective way to monitor those links.

A professor of biology and program chair of neuroscience at Cold Spring Harbor, Zador has created a bar-coding system in which he hopes to label each neuron. He also plans to monitor the connections among those neurons.

Scientists “know a lot about individual neurons, but far less about how they’re wired up,” Zador said. “Much of the scientific community believes that disorders like autism and schizophrenia arise from problems with wiring. My core interest is in understanding how we go from a wired-up brain to behavior.”

The way our brains work has become a new frontier in science, as President Obama announced a new brain initiative. The effort is designed to enhance our understanding of the mind, help combat diseases and disorders, and lead to new companies and jobs.

Zador’s bar-coding approach differs from that of many other researchers.

“Very smart people at great places — MIT, Harvard, Stanford — are all trying to develop the technology to put together a wiring diagram using electron microscope images. The problem is, even if they succeed, it’s incredibly expensive,” Zador said.

The cost of sequencing genes has gone down precipitously over the last decade. About 10 years ago, the cost for determining the order of base pairs for a person was about $1 billion. Today, that is now about $1,000 to $3,000, Zador estimated.

“If we could somehow convert the problem of figuring out the connectivity of the brain to a problem of sequencing DNA, then this problem, in principal, would be quick and cheap,” he said.

The way this works is by studying mice in which each neuron has a unique DNA label (created by his lab). He believes those labels will not affect the circuitry of the brain, although he plans to test that hypothesis. By looking at these circuits, he will be able to get an idea of how they connect.

The science is a “work in progress,” he said. He’s about to submit a proof of principle that shows how the process works.

If and when this system works and the researchers can determine the typical connections in the brain, they might start looking at the brains in a mouse model of autism.

“It’s quite plausible to believe we’ll get a much better understanding of what’s going on in the brain of someone with autism or schizophrenia if we can understand what happens in a mouse that has those genes disrupted in the way they are in humans,” he said.

Knowing what the normal circuit looks like is a starting point that opens up a wide range of questions.

At this point, one of the theories about autism is that some of the longer-range neuronal connections are impaired, while the local connections are more active.

If that turns out to be the case, scientists might be able to use different drugs to enhance one type of connection while quieting the effect of another.

While Zador came up with an idea he believes will work, his background in physiology and computational and theoretical science didn’t prepare him to develop the molecular biology techniques he’d need for his research. An avid runner who covers five or six miles each day — either outside the lab or on a treadmill — Zador used to run alone.

For the last five or six years, he’s run a few times a week with Josh Dubnau. A colleague at CSHL, Dubnau provides a “one hour tutorial” on molecular biology with each run — while discussing other scientific challenges and, on occasion, politics.

A resident of Laurel Hollow, which is within walking distance of the lab, Zador and his wife Kathy Shamoun, who practices Chinese medicine at Cold Spring Harbor and is also a childbirth educator, have two sons, 7-year-old Ronin and 3-year-old Bowie.

Zador recognizes his research is going in a different direction from other scientists.

“What are the chances it’s going to work?” he wonders. “I’m betting my career on it. I’m enthusiastic and optimistic.”

 

Correction:

In the article “BNL’s James Dickerson: facilitating nanotechnology” that ran last week, we incorrectly reported how long the Center for Functional Nanomaterials has been open. The building has been open for 5 years. We regret the error.

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Significant improvements were seen in one month with lifestyle modifications

Chronic kidney disease is on the rise in this country. In a study that looked at data from the National Health and Nutrition Examination Survey, prevalence of chronic kidney disease (CKD) increased more than 30 percent from 1988 to 2004 (JAMA. 2007;298:2038-2047). Early-stage (mild) CKD is no exception and may not be getting enough attention. In this article, we will look beyond the more obvious causes of mild chronic kidney disease, such as diabetes, smoking, aging, obesity and high blood pressure (JAMA. 2004;291:844-850).

Why is early-stage CKD so important? It is associated with a 40 percent increased risk of developing cardiovascular events, such as heart attacks (N Engl J Med. 2004;351:1296-1305). It also significantly increases the risk of peripheral artery disease (PAD). Those with decreased kidney function have a 24 percent prevalence of PAD, compared to 3.7 percent in those with normal kidney function (Circulation. 2004;109:320–323). Of course, it can lead ultimately to end-stage renal (kidney) disease, requiring dialysis and potentially a kidney transplant.

One of the problems with early-stage CKD is that it tends to be asymptomatic. However, there are simple tests, such as a basic metabolic panel and a urinalysis, that will indicate whether a patient may have mild chronic kidney disease. These indices for kidney function include an estimated glomerular filtration rate (eGFR), creatinine level and protein in the urine. While the other two indices have varying ranges depending on the laboratory used, a patient with an eGFR of 30 to 59 mL/minute/1.73 m2 is considered to have mild disease. The eGFR and the kidney function are inversely related, meaning as eGFR declines, the more severe the chronic kidney disease.

What can be done to stem early-stage CKD, before complications occur? There are several studies that have looked at medications and lifestyle modifications and their impacts on its prevention, treatment and reversal.

Let’s look at the evidence.

 

Medications

Allopurinol is usually thought of as a medication for the prevention of gout. However, in a randomized controlled trial, the gold standard of studies, the results show that allopurinol may help to slow the progression of CKD, defined in this study as an eGFR less than 60 mL/min/1.73 m2 (Clin J Am Soc Nephrol. 2010 Aug;5:1388-1393). The group using 100 mg of allopurinol showed significant improvement in eGFR levels (a 1.3 mL/minute per 1.73 m2 increase) compared to the control group (a 3.3 mL/minute per 1.73 m2 decrease) over a two-year period. There were 113 patients involved in this study. The researchers concluded that there was a slow progression of CKD with allopurinol. Allopurinol also decreased cardiovascular risk by 71 percent.

Fibrates are a class of drug usually used to boost HDL (“good”) cholesterol levels and reduce triglyceride levels, another cholesterol marker. Fibrates have gotten negative press recently for not showing improvement in cardiovascular outcomes. However, in patients with mild to moderate CKD, a meta-analysis (a group of 10 studies) recently showed a 30 percent reduction in major cardiovascular events and a 40 percent reduction in the risk of cardiovascular mortality with the use of fibrates (J Am Coll Cardiol. 2012 Nov. 13;60:2061-2071). This is important, since patients with CKD are mostly likely to die of cardiovascular disease.

The authors concluded that fibrates seem to have a much more powerful beneficial effect in CKD patients, as opposed to the general population. So, there may be a role for fibrates after all.

 

Lifestyle modifications

Fruits and vegetables may play a role in helping patients with CKD. In a recent study, the results showed that fruits and vegetables work as well as sodium bicarbonate in improving kidney function by reducing metabolic acidosis levels (Clin J Am Soc Nephrol. 2013;8:371-381).

What is the significance of metabolic acidosis? It means that body fluids become acidic and it is associated with chronic kidney disease. The authors concluded that both sodium bicarbonate and a diet including fruits and vegetables were renoprotective, helping to protect the kidneys from further damage in patients with CKD. Alkali diets are primarily plant-based, although not necessarily vegetarian or vegan-based diets. Animal products tend to cause an acidic environment. The study was one year in duration, however, though the results were impressive, the study was small, with 77 patients.

Sodium rears its ugly head yet again. Red meat is not thought of positively, and animal fat is not far behind. In the Nurses’ Health Study, the results show that animal fat, red meat and salt all negatively impact kidney function (Clin J Am Soc Nephrol. 2010; 5:836-843). The risk of protein in the urine, a potential indicator of CKD, increased by 72 percent in those participants who consumed the highest amounts of animal fat compared to the lowest, and by 51 percent in those who ate red meat at least twice a week. With higher amounts of sodium, there was a 52 percent increased risk of having lower levels of eGFR.

The most interesting part with sodium was that the difference between higher mean consumption and the lower mean consumption was not that large, 2.4 grams compared to 1.7 grams. In other words, the difference between approximately a teaspoon of sodium and three quarters of a teaspoon was responsible for the decrease in kidney function.

In my practice, when CKD patients follow a vegetable-rich, nutrient-dense diet, there are substantial improvements in kidney functioning. For instance, for a recent patient, his baseline eGFR was 54 mL/min/1.73 m2. After one month of lifestyle modifications, his eGFR improved by 9 points to 63 mL/min/1.73 m2, which is a return to “normal” functioning of the kidney. However, this is an anecdotal story and not a study.

Therefore, it is important to have your kidney function checked with mainstream tests. If the levels are low, we should address the issue through medications and/or lifestyle modifications to manage and reverse early-stage CKD. However, lifestyle modifications don’t have the negative side effects of medications. Don’t wait until symptoms and complications occur. In my experience, it is much easier to treat and reverse a disease in its earlier stages, and CKD is no exception.

 

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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Researcher examines the relationships between the structure, size and optics of rare earth oxides

James “Jay” Dickerson isn’t sitting back and waiting for people to come to him. The assistant director at the Center for Functional Nanomaterials at Brookhaven National Laboratory, Dickerson is actively looking to find ways for the technological powerhouse to collaborate with everyone from small-business owners with innovative ideas to scientists to multinational companies.

“We at CFN need to reach out to the industrial community in Long Island, New York state and the mid-Atlantic area,” he said. “We sometimes are guilty of saying ‘Hey, we’re here. Come and find us.’”

This problem is most evident, he said, with small businesses that may have brilliant ideas, but may not have the resources to use expensive equipment, the background, or the contacts to use nanotechnology characterization or equipment.

At CFN, he suggests they have waited for people from industry to come to them. He suggests a more efficient approach involves actively pursuing and engaging local companies through workshops to show them what is available.

A facility that’s about 10 years old, the CFN is housed in a two-story glass building on the BNL campus. The research ranges from electronic nanomaterials, including structures for photovoltaics and electrochemical energy storage systems, to soft and biological nanomaterials, theory and computation, electron microscopy and nanoscale catalysis and interface science.

“We are a Department of Energy facility,” Dickerson said. “That means our taxpayer dollars are paying for our facilities. My personal interest is not just helping out the scientific community, be it universities or national labs, but also helping out the commercial or industrial community.”

That could include facilitating companies to conduct research in areas that will help their bottom line, either through nonproprietary research, in which the results of the experiments are expected to be published, or through proprietary research, in which the results of the studies can remain privately held. In the latter case, the companies provide full cost recovery for use of the facilities, capabilities and expertise that the center would incur.

“If you’re a company that is a manufacturer of a type of material that might have a nanostructure, feel free to contact me,” he offered.

Since he arrived, Dickerson said he has worked with companies interested in proprietary and nonproprietary research, including electronic and biomedical materials device companies.

The physical, chemical and mechanical properties of nanomaterials tend to be different from the same properties for larger materials, even when the atoms of both are identical. Scientists explore ways to exploit those properties for new devices, processes, and materials.

Dickerson said he expects some of the products companies are developing with the CFN may become commercially available (either individually or as a part of something else) within the next 10 years.

In his own research, Dickerson has examined the relationships between the structure, size and optical properties of rare earth oxides, such as europium sesquioxide. Many cathode ray tube TV screens used europium-based compounds to produce red color. His work looks toward applications, such as in highly efficient display devices and X-ray intensifying screens.

“I’m really interested in understanding fundamentally how the structure, composition, and the physical properties of nanomaterials correlate with each other. Particularly, I’m interested in trying to understand how the structure of a material, down to very small nanoscale, relates to how magnetism evolves as you shrink materials further and further down, approaching a single molecule of europium and sulfur.”

A past chairman of the Committee on Minorities in Physics of the American Physical Society, Dickerson was a recipient of an APS scholarship in 1989 and 1990.

His participation on the committee was a chance to “help those students in kindergarten through 12th grade, as well as students in undergraduate programs, at junior colleges and graduate students in their progression to the next stage in their academic lives and careers,” he said.

The number of minorities in physics has grown over the last 25 years, he said, but it’s still not “exactly reflective of the demographics of minorities in greater society. That’s something we’re endeavoring to improve.”

He said the imbalance needs to be addressed not just for the sake of having a balance in the numbers, but to solve the nation’s need for more technology and science development.

A resident of Brooklyn, Dickerson is married to Courtney Martin, an art historian and professor at Vanderbilt University in Nashville, Tenn.

Dickerson encourages anyone with an interest in BNL’s facilities, to meet their commercial or research goals, to reach out to him.

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Associating calories with exercise expenditures results in better choices

When we think of losing weight, calories are usually the first thing that comes to mind. We know that the more calories we consume, the greater our risk of becoming overweight or obese and developing many chronic diseases, including top killers such as heart disease, diabetes and cancer. Despite this awareness, obesity and chronic diseases are on the rise according to the Centers for Disease Control.

How can this be the case? I am usually focused on the quality of foods, rather than calories, and I will delve into this area as well, but we suffer from misconceptions and lack of awareness when it comes to calories. The minefield of calories needs to be placed in context. In this article, we will put calories into context, as they relate to exercise, and help to elucidate the effects of mindful and distracted eating.

Let’s look at the studies.

 

Impact of energy expenditure

One of the most common misconceptions is that if we exercise, we can be more lax with what we are eating. But researchers in a recent study found that this was not the case (J Exp Biol. 2013; Abstract 367.2). The results showed that when menu items were associated with exercise expenditures, consumers tended to make better choices and ultimately eat fewer calories. In other words, including the amount of exercise needed to burn calories was paired on the menu with food options, resulting in a significant reduction in overall consumption. The example that the authors gave was that of a four-ounce cheeseburger, which required that women walk with alacrity for two hours in order to burn off the calories.

Those study participants who had menus and exercise expenditure data provided simultaneously, compared to those who did not have the exercise data, chose items that resulted in a reduction of approximately 140 calories, 763 versus 902 kcals.

Even more interestingly, study participants not only picked lower calorie items, but they ate less of those items. Although this was a small preliminary study, the results were quite impactful. The effect is that calories become a conscious decision rooted in context, rather than an abstract choice.

 

The importance of mindful eating

Most of like to think we are multitaskers. However, when eating, multitasking may be a hazard. In a meta-analysis (a group of 24 studies), researchers found that when participants were distracted while eating, they consumed significantly more calories immediately during this time period, regardless of dietary constraints (Am J Clin Nutr. 2013 April;97:728-742).

This distracted eating also had an impact on subsequent meals, increasing the amount of food eaten at a later time period, while attentive eating reduced calories eaten in subsequent meals by approximately 10 percent. Distracted eating resulted in greater than 25 percent more calories consumed for the day. When participants were cognizant of the amount of food they were consuming, and when they later summoned memories of their previous eating, there was a vast improvement in this process.

The authors concluded that reducing distracted eating may be a method to help in both weight loss and weight management, providing an approach that does not necessitate calorie counting. These results are encouraging, since calorie counting frustrates many who are watching their weight over the long term.

 

The perils of eating out

Most of us eat out at least once in a while. In many cultures, it is a way to socialize. However, as much as we would like to control what goes into our food, we lose that control when eating out. In a study that focused on children, the results showed that when they ate out, they consumed more calories, especially from fats and sugars (JAMA Pediatr. 2013;167:14-20). Of the 9,000 teenagers involved in the study, between 24 percent and 42 percent had gone to a fast food establishment and 7 to 18 percent had eaten in sit-down restaurants when asked about 24-hour recall of their diets on two separate occasions.

Researchers calculated that this resulted in increases of 310 calories and 267 calories from fast food and sit-down restaurants, respectively. This is not to say we shouldn’t eat out or that children should not eat out, but that we should have more awareness of the impact of our food choices. For example, the Bloomberg administration has required calories be displayed in many New York City chain restaurants.

 

Quality of calories

It is important to be aware of the calories we are consuming, not only from the quantitative perspective, but also from a perspective that includes the quality of those calories. In another study involving children, the results showed that those offered vegetables for snacks during the time that they were watching television needed significantly fewer calories to become satiated than when given potato chips (Pediatrics. 2013;131:22-29). The authors commented that this was true for overweight and obese children as well, however, they were more likely to be offered unhealthy snacks, like potato chips.

In a paper published in JAMA in June 2012, the authors state that we should not restrict one type of nutrient over another, but rather focus on quality of nutrients consumed (JAMA 2012; 307:2627-2634).

In my practice, I find that when my patients follow a vegetable-rich, nutrient-dense diet, one of the wonderful “side effects” they experience is a reduction or complete suppression of food cravings. As far as mindless eating goes, I suggest if you are going to snack while working, watching TV or doing some other activity, then snack on a nutrient-dense, low-calorie food, such as carrots or blackberries. If you don’t remember how many vegetables or berries that you ate, you can take heart in knowing it’s beneficial. It can also be helpful to keep a log of what you’ve eaten for the day, to increase your cognizance of distracted eating.

Therefore, rather than counting calories and becoming frustrated by the process, be aware of the impact of your food choices. Why not get the most benefit out of lifestyle modifications with the least amount of effort? Rather than having to exercise more to try to compensate, if you actively choose nutrient-dense, low-calorie foods, the goal of maintaining or losing weight, as well as preventing or potentially reversing chronic diseases, becomes attainable through a much less painful and laborious process.

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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International scientific team seeks causes of the decline of ancient reptiles

Enormous and powerful though they were, dinosaurs didn’t appear on the Earth and muscle out other animals — mostly reptiles. Somehow, many of those reptiles, who were eating, sleeping and reproducing for about 50 million years during the Triassic period, died during a major extinction event, making it possible for dinosaurs to dominate during the Jurassic period.

What, scientists have wondered, caused such a major shift from one set of creatures to another?

In a new paper in the prestigious journal Science, researchers from Stony Brook University, Columbia, MIT, Rutgers and Université Mohammet Premier in Oujda, Morocco believe they may have the answer.

These scientists, including Associate Professor Troy Rasbury from SBU, looked at rocks in Newark, N.J., and Hartford, Conn., that were a part of an area called the Central Atlantic Magmatic Province, which is likely the largest of the Large Igneous Provinces. These rocks suggest that a large outpouring of gases and aerosols may have been responsible for the extinction.

The lava and gases were released in four pulses over 600,000 years, which is a relatively short time frame for such violent environmental changes.

Scientists had known about the extinction and the lava flows, but they hadn’t been able to pinpoint the time frame over which the Earth may have been less habitable. During the Triassic period, the Earth was just starting to break apart from a period when it was the supercontinent called Pangaea.

The researchers used a process called uranium-lead dating using zircon. Zircon crystals that are millions of years old are extremely resistant to lead. They do, however, include uranium. The only way lead, however, can become embedded in the crystals is if it starts out as an isotope of uranium and decays slowly into lead.

This dating technique, coupled with others that examine the periodic effect of other celestial bodies like the planets in our milky way, has greatly enhanced the ability to narrow down the time span during which these major events occurred.

“There’s definitely rocks contemporaneous with extinction,” said Rasbury. “We can imagine that there’s a lot of gases that come with that, as they’re being erupted. There’s an out-gassing and an environmental deterioration. That’s the link.”

Rasbury praised the work of her colleagues, who have done “a tremendous job” by analyzing samples that were collected from the surface.

“That’s what makes this such a special study. The ages are demonstrating that it’s plausible,” she said. The coincident timing of the presence of these gases and the animal turnover suggests there may be a causal link between the mass extinction and the relatively sudden environmental change.

Rasbury’s main role in this study is to bring the team together. She put together the National Science Foundation proposal that provided some of the funding for this research.

Rasbury and her colleagues at Stony Brook will soon be able to do some of the same research on other rock samples. The university received funding for a mass spectrometer. The lab had a grand reopening on April 19.

“The equipment is here and there’s a lot of hard work in front of us to make sure we can do the high-precision analysis,” she said. “It requires an enormous amount of attention to details.”

Born in North Carolina but raised in Texas, Rasbury speaks at a rapid pace.

“I had a professor at the University of New Orleans who said he didn’t know it was possible to have a Texas accent and talk that fast,” she laughed.

Her identical twin Sidney Rasbury Hemming, who was born 27 minutes before Troy, is also a geologist and attends some of the same professional gatherings.

“I was at a meeting and everybody was calling me Sidney because we talk and laugh the same,” she said.

Rasbury is married to Department of Geosciences Professor William Holt. The couple, who live in East Setauket, have two daughters. Rebecca, 12, is in sixth grade at Setauket School while Virginia, who will be 9 next month, is in third grade.

The house is filled with rocks, although Rasbury said her daughters bring many of them in from the beaches. Her daughters also love to go to gem and mineral shows.

She and her husband talk about geology at home “as long as our kids will let us.”

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Two studies provide seemingly conflicting information on heart disease

L-carnitine, or carnitine, has been around for a while. The people most familiar with it may be athletes, because for years it has been touted as possibly providing more energy, though the research has not borne out on this topic.

What is L-carnitine and why is it of interest? It is derived from amino acids and most healthy individuals can get sufficient amounts regardless of their type of diet. Carnitine helps in the production of energy in the cell. It is involved in bringing long-chain fatty acids to the mitochondria — “the powerhouse” of the cell — which are then utilized for energy through oxidation. It also keeps potential waste from accumulating in the mitochondria so it performs more efficiently. Thus, it may have antioxidant properties (ods.od.nih.gov/factsheets).

So why is all of this important? L-carnitine may play a role in several chronic diseases, such as heart disease, type 2 diabetes, high blood pressure and even fatty liver disease.

Let’s look at the evidence.

 

Heart disease

There are two studies with conflicting results on heart disease. In one study, the results are negative, while the other study shows beneficial results. How could that be the case?

In the first study, L-carnitine appears to increase the risk of heart disease through the development of atherosclerosis, or plaque deposits, in the arteries (Nat Med Online. 2013 April 7). L-carnitine is found in foods such as red meat. In this study, mice and healthy human volunteers who regularly ate red meat were observed. Interestingly, the bacteria in the gastrointestinal tract, or gut, in those who consumed red meat were such that L-carnitine was broken down into a metabolite called trimethylamine-N-oxide (TMAO).

This metabolite was then found to increase cholesterol deposits in the arterial walls of mice. In other words, TMAO may promote the development of atherosclerosis. In humans, there was a predicted elevated risk of developing cardiovascular disease and cardiac events, such as heart attacks, strokes and death after three years, but like the mice, only in those that had elevated TMAO levels.

Also of interest, the researchers demonstrated that vegetarians and vegans, when given carnitine supplements, did not produce TMAO. Thus, TMAO production may have to do with microbes that populate the gut of those who consume red meat. This is a preliminary study, mind you, but it makes you wonder if it is the carnitine or the red meat that may be promoting the development of TMAO and the potential for increased atherosclerosis. Carnitine by itself did not cause increased risk of heart disease, but rather the metabolite TMAO did.

In the second study, a meta-analysis (a group of studies) showed those patients given L-carnitine supplements after a heart attack had a statistically significant reduced risk of death from all-causes by 22 percent in 11 trials, ventricular arrhythmias by 65 percent in five trials and chest pain (angina) by 40 percent in two trials (Mayo Clin Proc Online. 2013 April 15).

These were randomized controlled trials (RCTs), the gold standard of studies. The benefits may have been derived from containing the amount of infarct, or dead tissue, in the heart, as well as by increasing the amount of energy in cardiomyocytes (the muscle cells of the heart). In some of the studies, L-carnitine supplements were given for as long as six to 12 months.

Thus, the authors concluded that L-carnitine may be important for those suffering a heart attack, but also in the secondary prevention of a recurrent heart attack. The authors postulated that the mechanism by which L-carnitine derived its beneficial effects was through the improvement in glucose (sugar) utilization in the mitochondria. However, even though it was a meta-analysis, the population size was not large. According to the authors, the patients who might be candidates for carnitine supplementation are those who have had a heart attack and can’t take beta blockers or ACE inhibitors.

 

Type 2 diabetes

In a meta-analysis (a group of four studies), those given L-carnitine saw an improvement in parameters associated with type 2 diabetes (Exp Clin Endocrinol Diabetes Online. 2013 Feb. 2). There was a significant decrease in fasting glucose (sugar) levels of 14.3 mg/dL and in LDL “bad” cholesterol levels of 8.8 mg/dL. The patients who received L-carnitine were those who were deficient. These studies were RCTs, though they were not large in size.

 

Role in high blood pressure

In a study involving rats, the results ultimately showed that L-carnitine reduced oxidative stress on the kidneys and helped reverse hypertension-induced kidney damage (Eur J Nutr Online. 2012 Dec. 6). The impact is most likely from the downregulation, or decrease, in inflammatory factors, such as NF-kB, and the upregulation of anti-inflammatory factors, such as NRF2 and PPAR alpha. Thus, L-carnitine may have antioxidant properties that help protect the kidney against damage produced by high blood pressure. These results are exciting, but they are preclinical, or animal-based, and need studies in humans to confirm the results.

 

Fatty liver disease

As I discussed in last week’s article, fatty liver is a pervasive disease that is benign most of the time, but not always. In a RCT, L-carnitine reduced the liver enzymes significantly (Am J Gastroenterol. 2010;105:1338-1345). These patients had the complication of hepatitis, which was induced by non-alcoholic fatty liver disease. So these were patients on a potentially dangerous road to cirrhosis and, ultimately, to hepatocellular carcinoma (cancer of the liver). In 24 weeks, L-carnitine supplementation not only decreased the liver enzymes, but also cholesterol, glucose and insulin levels. Thus, as the authors concluded, L-carnitine supplementation seemed to improve the overall liver functioning in patients with complications of fatty liver disease.

Though these studies are early or small and more study is warranted, this may be a valuable substance. Thus, it may be worth having your L-carnitine blood levels checked if you have a chronic disease where there might be a deficiency, such as in type 2 diabetes. Check with your physician first, but patients could take L-carnitine supplements if their levels were low or for a protective effect. In cases of heart attacks, high blood pressure and fatty liver disease, carnitine supplementation may decrease organ damage, regardless of your levels.

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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Future results and discoveries may help stave off the symptoms of Alzheimer’s

Like other parts of the body, the brain produces waste that needs to be cleared away. Through the so-called glymphatic system, the brain uses a type of water channel to remove tau proteins and other products.

When the glymphatic system isn’t functioning properly, these proteins do not clear correctly from the brain. From this research, scientists believe a breakdown may lead to or exacerbate problems related to the development of Alzheimer’s or chronic traumatic encephalopathy, a progressive degenerative disease that is often caused by multiple concussions.

“Normally, we produce proteins and peptides that are getting excreted,” explained Helene Benveniste, a professor in the Department of Anesthesiology and Radiology at Stony Brook University’s School of Medicine. It’s not under a lot of pressure, so it’s a slower process, but it’s like taking a water hose to a dirty street, she said. “If this system doesn’t work, compounds may build up and could lead to diseases.”

While scientists and medical researchers knew a defect in the clearing system could lead to neurological problems, they weren’t sure how to track the clearing process in real time.

That’s where Benveniste — who works one day a week in the operating room as a clinical anesthesiologist and the rest of the time in research — entered the picture. Using magnetic resonance imaging, she was able to use two different contrast agents to map this pathway, where she also found important clearance pathways for brain waste. The studies were done on an animal model.

The contrast approach is “a common way of detecting leaks,” she explained.

By using this same technique, she and her team were able to follow the glymphatic process, which often operated in parallel to major arteries.

Using these imaging techniques, doctors may be able to monitor the human brain to determine disease susceptibility. Through several MRI views over time, doctors might be able to detect signs of problems with the glymphatic system before a patient shows any symptoms of Alzheimer’s.

She hopes one day that doctors will track individuals who “may be susceptible” to Alzheimer’s.

“Anything we can do now to understand how a pathological process is building or is imminently developing in a human with the end result of Alzheimer’s is incredibly valuable,” said Benveniste.

While there is no cure for Alzheimer’s, tracking it before an intellectual slide into a potentially irreversible course of the disease may provide some effective preclinical intervention.

If doctors could slow down Alzheimer’s by 20 to 30 percent, they might not prevent people from getting the disease, but they might extend the time period during which individuals can live independent lives, she suggested.

“The impact on health costs and society is tremendous,” Benveniste said. “Do I think this is just a diagnostic tool or could it teach us something about how we might treat Alzheimer’s? The answer is yes, this might be important for that purpose.”

The challenge, and it’s significant, is to understand how the glympathic system works in the human brain, so that doctors can manipulate it.

There are also studies that show that some people have tau and amyloid in their brains who don’t show signs of Alzheimer’s. However, she said, there are pathological diagnostic criteria which can quantify the impact of the proteins present and often, the severity of the pathology correlates with the cognitive decline.

If, as Benveniste believes, these channels become critically important early signs of a susceptibility to disease or a preclinical state for the disease, researchers would also need to develop more therapies.

She doesn’t have any direct family experience with Alzheimer’s. She feels blessed that her 93-year-old mother is still sharp mentally.

A native of Copenhagen, Benveniste came to the United States in 1989, where she worked at Duke for 11 years. She came to Stony Brook in 2000.

She travels regularly back to Denmark. Those trips may prove especially valuable because Stony Brook is obtaining a PET/MRI machine, which is expected to be installed in the summer. In Copenhagen, they have had this same system up and running for over a year and she plans to travel in the next few months to Copenhagen to see how they are running their machine.

She and her husband, Peter Huttemeier, a retired anesthesiologist, met in Copenhagen. They live in Northport, where being so close to the water reminds them of Denmark.

As for her work, Benveniste hopes that the ability to track the glymphatic system leads to considerably more research from her colleagues in and out of Stony Brook.

 

 

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