Yearly Archives: 2013

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The disease is much more common than you might expect; lifestyle modifications help

When we think of the most prevalent chronic diseases, heart disease, stroke, cancer, diabetes and others come to mind. However, there is also a chronic liver disease — nonalcoholic fatty liver disease — a conglomeration of fats, including triglycerides.

The problem with this disease is that it could lead to nonalcoholic steatohepatitis (fatty liver hepatitis), fibrosis (too much connective tissue due to repair) and eventually cirrhosis, which might ultimately result in cancer (hepatocellular carcinoma).

Fortunately, the risk of going down this dangerous path is relatively small. Most of the time, it remains a mild fatty liver disease.

Although it is rare, a study presentation in 2012 at the American Association for the Study of Liver Diseases suggested that NAFLD was the third most common risk for hepatocellular carcinoma behind infection and alcohol abuse (AASLD. 2012 Nov. 11; Abstract 97). Some study patients with hepatocellular carcinoma progressed to this level without first having cirrhosis. Those patients who developed liver cancer but did not have cirrhosis were more likely to have diabetes, obesity, high blood pressure and/or a high cholesterol profile. NAFLD occurs more frequently in males than females, and it needs to be taken very seriously.

The prevalence of NAFLD, which is benign in most cases, is relatively high, with estimates ranging from 10 to 46 percent (Gastroenterology. 2011; 140:124-131). In fact, a recent study shows that adolescents between the ages of 12 and 18 have seen a threefold increase in NAFLD, from 3.3 percent to almost 10 percent, in the last 20 years, according to data from the National Health and Nutrition Examination Survey (DDW. 2012 May 18; Abstract 705). This correlated primarily with obesity, but the rise outstrips the rate of increase in obesity in this adolescent population.

 

How is it diagnosed?

When liver enzymes are elevated, usually two to five times normal, then it tends to be more commonly diagnosed (Hepatology. 2003; 37:1286-1292). These liver enzymes include aspartate aminotransferase and alanine aminotransferase. What makes this disease diagnosis more difficult is that patients without elevated liver enzymes may have the disease and, in most cases, they have no symptoms.

The gold standard of diagnosis is through a liver biopsy, though this is invasive and thus has its dangers. Another method is through ultrasound, a first-line diagnosis method. Ultrasound is 60 to 94 percent sensitive and 66 to 95 percent specific (J Hepatol. 2009; 51:433–445). Though it is not the most accurate, it has the fewest side effects. Ultrasound is also technician-dependent in terms of grading the amount of fatty infiltrates in the liver — mild, moderate and severe. Unfortunately, the milder the amount of fatty infiltrates, the less accurate the reading. Other methods for diagnosis include transient elastography, computed tomography and magnetic resonance.

 

What might be the cause?

What is the potential cause? One theory is that intraperitoneal fat (visceral fat or central obesity) infiltrates the liver through the portal vein, resulting in insulin resistance and fatty liver (Arterioscler Thromb Vasc Biol. 1990; 10:493-496). Therefore, it is not surprising that, along with insulin resistance, there is glucose intolerance. High triglycerides and low HDL (“good”) cholesterol are also commonly associated with the disease (Gastroenterology. 1999; 116:1413–1419).

 

How can we alter this disease?

The good news is that NAFLD is potentially reversible through lifestyle modifications, including changes in diet and an increase in exercise.

With exercise, the premise is that the more activity a patient gets, the higher the probability of metabolizing the liver fat.

In an epidemiologic study of over 3,000 patients using data from NHANES, results showed that those with NAFLD are significantly less active than those without the disease. It did not matter the type of activity, NAFLD patients did less of it. In fact, patients who had both diabetes and NAFLD were found to do the least amount of physical activity (Aliment Pharmacol Ther. 2012; 36:772-781). The scary aspect is that patients with NAFLD have a significant eight times increased risk of cardiovascular death between the ages of 45 and 54 (Am J Gastroenterol. 2008; 103:2263–2271). And we know activity improves cardiovascular results.

In a meta-analysis (a group of 23 studies ranging from one to six months in duration) that used the Cochrane database, the results showed a significant reduction in fat content in the liver and a decrease in liver enzymes when lifestyle modifications were employed (J Hepatol. 2012 Jan.; 56:255-266). Reduction in weight had the most substantial correlation with the results. Of the 23 studies, five that looked at liver cells on a microscopic level showed a reduction in inflammation that occurred with lifestyle changes. In addition, there were also improved glucose levels and sensitivity to insulin after the modifications.

Benefits of coffee

In yet another study, coffee was shown to reduce the risk of NAFLD developing into fibrosis, a more advanced stage liver disease, by a substantial 36 percent (AASLD. 2012 Nov. 11; Abstract 99). However, weaknesses in this trial were that it was unclear how many cups of coffee were needed to have this effect and whether the coffee needed to include caffeine. The researchers theorize that there are hundreds of compounds in coffee, such as vitamins, minerals, phenolic compounds, lignans and quinides that may have this effect, not just caffeine.

In my practice, I have seen several patients with liver enzymes elevated to at least twice normal levels. After following a nutrient-dense, plant-rich diet, they saw their liver enzymes significantly reduced or returned to normal levels within a few months. One patient’s liver enzymes had been raised for 20 years without a known cause, and a first-line relative had recently been diagnosed with liver cancer.

If you have risk factors for nonalcoholic fatty liver disease, such as obesity, diabetes, high blood pressure and high cholesterol, I recommend having your liver enzymes checked on a regular basis. Those with family histories of elevated liver enzymes and hepatocellular carcinoma (liver cancer) may also want to get a scan, at least with ultrasound.

The best way to treat NAFLD is with lifestyle modifications, and while it is never too late to treat NAFLD, it is better to discover the disease earlier to reduce your risk of complications. If you are obese, NAFLD is one more important reason to transform your body composition by reducing fat mass.

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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A protected species in the Bahamas, whitetips are hunted elsewhere for their fins

Demian Chapman has one of those jobs that turns heads at social gatherings: he’s a shark biologist. The New Zealand native, who is also an assistant professor in the School of Marine and Atmospheric Sciences at Stony Brook University, is in the middle of studying the oceanic whitetip sharks.

Known for living far from land, the whitetips, which eat tuna, mahi mahi, marlin and squid, have declined precipitously in numbers in the last few decades, in part because some people consider their fins a delicacy.

Chapman, his wife Debra Abercrombie — also a shark biologist — and several other researchers recently published results of a study on the whitetips. Starting in 2011, Abercrombie and other field biologists went to the Bahamas, where the waters are aggressively patrolled and the sharks are actively protected, to fit some sharks with pop-up satellite tags that could track their location.

As Chapman explained it, the researchers put bait in the water near the Bahamas at a time when the sharks are closer to land. If it’s alone, the first shark won’t typically approach a piece of bait. Once other sharks arrive for a meal, however, the shark’s competitive instincts take over and it becomes easier — albeit still a struggle — to reel them in.

The researchers slip a rope around the tail of the shark and then drive the boat slowly while they outfit the cartilaginous fish with a tag. Chapman said the tags, which weigh only a few grams, are probably barely noticeable to the sharks, which can be as long as eight feet and can weigh about 150 pounds.

What the tags showed was that one of the sharks traveled about 2,000 kilometers, or over 1,200 miles, in under a year. Five of the sharks traveled outside the exclusive economic zone (or EEZ) for the Bahamas, where they are better protected. This suggests that more countries might need to safeguard these sharks.

This March, the Convention on International Trade in Endangered Species of Wild Fauna and Flora is meeting in Bangkok, where representatives from several countries will consider whether to list this species. Such a listing would mean that permits would be required to trade the species across international boundaries. People caught trading the species without those permits would face penalties.

The sharks “do spend a lot of time in the Bahamas, where they are well protected,” Chapman said. “The fact that they do leave raises concerns. If you don’t have some parallel measures outside the Bahamas, that may undermine what the Bahamas has done.”

Chapman hopes that this paper, along with further research, helps to raise awareness of the delicate state of the shark population.

Countries vote to determine which species make it to different protected lists. A species has to get two-thirds of the vote.

“It’s difficult to get,” Chapman said. “Some countries that are pro-shark trade — if they consume fins — will never vote for a shark to be” on the list.

There’s definitely politicking at these meetings, he said, where some countries vote to list species in exchange for the votes of other countries on other organisms.

Chapman went to Asia in late February to help train customs agents to recognize the fins of different sharks.

Unusual for his combined expertise in DNA analysis and field work, Chapman made a remarkable find in 2005. A female hammerhead shark had been in an aquarium without any access to males for about three years. After all that time in isolation, it gave birth. The aquarium sent a copy of the mother and pup’s DNA to Chapman. He concluded that the shark had given a so-called virgin birth.

While impossible in mammals, animals like sharks, snakes and turkeys can somehow combine an unfertilized egg with the genetic code of a polar body, which essentially acts like a sperm.

The polar bodies are “cells that could have been an egg” but were produced during the production of eggs, he said.

Residents of Miller Place, where they recently purchased a house, Chapman and Abercrombie, who is originally from South Carolina and is a consultant for the New York Department of Environmental Conservation, met when they were at a field station in the Bahamas.

Chapman tries to avoid the “Shark Week” series on the Discovery Channel because of the frequent recreations of shark attacks.

“They try to add a conservation message,” Chapman said, “but it’s difficult to reconcile how the sharks need to be protected” after people have watched them attack swimmers.

As for working with sharks, he said he’s never had a “bad experience with them.”

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Salt is also necessary, but most people consume far too much sodium

One of the most popular spices is also one of the most dangerous: salt. We need salt, but not in excess. On the other hand, potassium is beneficial in our diet. However, we have the opposite problem with potassium: It is underconsumed.

More than 90 percent of people consume far too much sodium, with salt being the primary culprit (Am J Clin Nutr. 2012 Sep;96(3):647-57). Sodium is found in foods that don’t even taste salty.

Bread and rolls are the No. 1 offenders, since we eat so much of them. Other foods with substantial amounts of sodium are cold cuts and cured meats, cheeses, pizza (which has both bread and cheese), fresh and processed poultry, soups, meat dishes, pastas and snack foods. Foods that are processed and those prepared by restaurants are where most of our consumption occurs (www.cdc.gov).

By contrast, only about 2 percent of people get enough potassium from their diets (Am J Clin Nutr. 2012 Sep;96(3):647-57). According to the authors of the study, we would need to consume about eight sweet potatoes or 10 bananas each day to reach appropriate levels.

Why is it important to reduce sodium and increase potassium? A high sodium-to-potassium ratio increases the risk of cardiovascular disease by 46 percent, according to a study looking at over 12,000 Americans over almost 15 years (Arch Intern Med. 2011;171(13):1183-1191). In addition, both may have significant impacts on blood pressure and cardiovascular disease, while sodium may also impact multiple sclerosis and potentially other autoimmune diseases.

To improve our overall health, we need to tip the sodium-to-potassium scales, consuming less sodium and more potassium. Let’s look at the evidence.

 

Reduced sodium

There are two recent studies that illustrate the benefits of reducing sodium in high blood pressure and normotensive (normal blood pressure) patients, ultimately preventing cardiovascular disease: heart disease and stroke.

The first study used the prestigious Cochrane review to demonstrate that blood pressure is reduced by a significant mean of -4.18 mm Hg systolic (top number) and -2.06 mm Hg diastolic (bottom number) involving both normotensive and hypertensive participants (BMJ. 2013 Apr 3;346:f1325). When looking solely at hypertensive patients, the reduction was even greater with a systolic blood pressure reduction of -5.39 mm Hg and a diastolic blood pressure reduction of -2.82 mm Hg.

This study was a meta-analysis (a group of studies) that evaluated data from randomized clinical trials, the gold standard of studies. There were 34 trials reviewed with more than 3,200 participants. Salt was reduced from 9-12 grams per day to 5-6 grams per day. These levels were determined using 24-hour urine tests. The researchers believe there is a direct linear effect with salt reduction. In other words, the more we reduce the salt intake, the greater the effect of reducing blood pressure. The authors concluded that these effects on blood pressure will most likely result in a decrease in cardiovascular disease.

In the second study, a meta-analysis of 42 clinical trials, there was a similarly significant reduction in both systolic and diastolic blood pressures (BMJ. 2013 Apr 3;346:f1326). This meta-analysis included adults and children. Both demographics saw a reduction in blood pressure, though the effect, not surprisingly was greater in adults. Interestingly, an increase in sodium caused a 24 percent increased risk of stroke incidence, but more importantly, a 63 percent increased risk of stroke mortality. The risk of mortality from heart disease was increased as well, by 32 percent.

In an epidemiology modeling study, the researchers projected that either a gradual or instantaneous reduction in sodium would save lives (Hypertension. 2013; 61: 564-570). For instance, a modest 40 percent reduction over 10 years in sodium consumed could prevent 280,000 premature deaths. These are only projections, but in combination with the above studies may be telling.

 

Potassium’s positive effects

When we think of blood pressure, sodium comes to mind, but not enough attention is given to potassium. The typical American diet is lacking in enough of this mineral.

In a recent meta-analysis involving 32 studies, results showed that, as the amount of potassium was increased, systolic blood pressure decreased significantly. When foods containing 3.5 grams to 4.7 grams of potassium were consumed, there was an impressive -7.16 mm Hg reduction in systolic blood pressure with high blood pressure patients. Anything more than this amount of potassium did not have any additional benefit. Increased potassium intake also reduced the risk of stroke by 24 percent. If this does not sound like a large reduction, consider that, by comparison, aspirin has been shown to reduce the risk of stroke by 20 percent.

This effect was important: The reduction in blood pressure was greater with increased potassium consumption than with sodium restriction, although there was no head-to-head comparison done. The good news is that potassium is easily attainable in the diet. Foods that are potassium rich include bananas, sweet potatoes, almonds, raisins and green leafy vegetables such as Swiss chard.

Multiple sclerosis

There are several recent, very preliminary studies that suggest higher levels of salt may increase the risk of multiple sclerosis.

One study showed that salt seems to increase the levels of interleukin-17-producing CD4 helper T cells(Th17) that are potentially implicated in autoimmune diseases, such as multiple sclerosis (Nature. 2013 Mar 6). The researchers used mice to show feeding them high levels of salt resulted high levels of Th17 cells and, as a result, a severe form of multiple sclerosis.

Lowering sodium intake may have far-reaching benefits, and it is certainly achievable.

Dr. Kirsten Bibbins-Domingo, associate professor of Medicine at UCSF, who is published extensively on heart disease, commented in Jane Brody’s New York Times article dated April 1 that once we lower sodium intake, our taste buds tend to adapt to the change in about six weeks by expecting less salty foods.

We need to reduce our intake and give ourselves a brief period to adapt. We can also improve our odds by increasing our potassium intake, which also has a substantial beneficial effect, striking a better sodium-to-potassium balance.

 

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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Keeping a lab humming when working with nanomaterials

Aaron Stein was hired to work at a place that existed only on paper. About a decade ago, the physicist agreed to work at Brookhaven National Lab’s Center for Functional Nanomaterials, even though BNL hadn’t started construction on the cutting edge facility.

“I see something that went from an idea to a hole in the ground to a place where lots of science is being done,” Stein said.

Indeed, Stein, who earned a Ph.D. in physics from Stony Brook University, was the first official hire at the CFN, which is one of only five nanoscale science research centers funded by the Department of Energy’s Office of Science.

The study of nanomaterials involves examining how to exploit or understand physical and chemical changes that occur at an incredibly small scale. While construction of a skyscraper follows certain laws of physics — such as how much weight a load-bearing wall can support — the manufacture of objects, such as fuel cells or computer parts, is guided by other forces and interactions.

“There are certain things you’d never see otherwise if not for shrinking them down to that size scale, either due to quantum effects, size effects — you have more surface area — or other things,” Stein explained. “Everything changes and gets weird and interesting on the nano scale.”

Stein has worked in nanomagnetism, X-ray optics and photovoltaics, among many others.

Working with nanomagnets isn’t all that different, he explained, from using the bar magnets children use in middle school, except that the scale, functionality and experiments are considerably altered.

“The side I’m on is in making these magnets,” he said. “We make millions of these magnets at a time and play with the physics. We’re building our own little playground to test theories and observe” the results.

Stein has worked with Kenneth Evans-Lutterrodt, a staff scientist at BNL, since his days as a Ph.D. candidate at Stony Brook. The two have worked for years developing and honing miniature lenses that could have applications ranging from creating higher resolution and better contrast diagnostic X-ray images all the way to looking at the stress, on an atomic level, of a helicopter bearing.

“We have spent many years developing the ideas behind this,” Evans-Lutterodt said. “We look at what new design to try. He does the e-beam lithography.”

In e-beam lithography, a tiny piece of silicon is coated with a material called a resist. The material scientists like Stein uses varies, depending on what they are trying to manufacture. The researcher shoots an electron beam at the resist. The resist is sensitive to electrons in the same way that film is sensitive to light: after exposure, it is developed and the contrast can be used to create structures or finely crafted objects that are of almost any shape and size, Stein said.

Evans-Lutterodt uses the lenses Stein makes in collaborations with other scientists. The lenses themselves, he said, are not like the ones that sit in prescription glasses: they have considerably more curvature.

“The shape is quite asymmetric,” Evans-Lutterodt said. “It’s very difficult to bend X-rays. The lenses are also made out of silicon, which is opaque to visible light, but somewhat transmissive to X-ray.”

As far as a commercial application, Evans-Luterrodt said he would expect it to take about three years, optimistically, before he and Stein had developed a commercial application from their research.

Stein’s goal is to “enable science.”

As for his own work, much of it is in understanding the limits of the tools and the materials he is employing.

“A big part of the job,” he said, “is to keep the lab humming.” That includes making sure the equipment is maintained, the supplies are available, and the tools are in the same condition for everyone.

Stein also spends considerable time focusing on the environmental components of nanofabrication, ensuring that everyone who comes into the lab goes home safely.

A resident of Huntington, Stein is married to Sasha Abraham, who is a member of an advocacy group that works on prostate awareness and screening. They have an 11-year-old daughter, Lily, and a 9-year-old son, Henry.

Stein grew up in Syracuse and said he never imagined coming to Long Island to build his life and career.

“There are a narrow set of places I could work,” he explained. “Probably, where I am now, is really an ideal situation for me.”

 

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The Mediterranean diet reduces cardiovascular disease significantly

We have made great strides in the fight against heart disease, yet it remains the No. 1 cause of death in the United States. Approximately one-third of Americans over the age of 35 will die of heart disease (Circulation. 2008;117(4):e25). I hope this statistic has captured your attention, because it should.

What is causing or contributing to such high numbers of heart disease deaths: genetics, environment or both? Many of us have the propensity toward heart disease. Can we alter this course or is it our destiny?

A recent study, involving the Paleo-type diet and other ancient diets, suggests that there is a significant genetic component to cardiovascular disease, while another study looking at the Mediterranean-type diet implies that we may be able to reduce risk factors greatly. Most of the risk factors for heart disease, such as high blood pressure, high cholesterol, sedentary lifestyle, diabetes, smoking and obesity are modifiable (see www.uptodate.com). Let’s look at the evidence.

 

Genetic components

In a study published online in The Lancet, researchers used computed tomography scans to look at 137 mummies from ancient times across the world, including Egypt, Peru, the Aleutian Islands and Southwestern America (The Lancet. 2013;Mar 11). The cultures were diverse, including hunter-gatherers (consumers of a Paleo-type diet), farmer-gatherers and solely farmers. Their diets were not vegetarian, but rather involved significant amounts of animal protein: fish and/or cattle.

Researchers found that one-third of these mummies had atherosclerosis (plaques in the arteries), which is a precursor to heart disease. The ratio should sound familiar. It seems to coordinate with modern times.

Interestingly, but not surprisingly, the average age of death was 43. The authors concluded that atherosclerosis could be part of the aging process in mankind. In other words, it may be a result of our genes. Being human, we all have a genetic propensity toward atherosclerosis and heart disease — some more than others — but many of us can reduce our risk factors significantly.

I am not saying that the Paleo-type diet specifically is not beneficial compared to the standard American diet. Rather, that we do not know it based on this study, which was not meant to provide the validity of the Paleo-type diet but whether atherosclerosis is part of the normal aging process. However, other studies demonstrate that we can reduce our chances of getting heart disease with lifestyle changes, potentially by following a Mediterranean-type diet with an emphasis on a plant-rich approach (see my article, “Seven highly effective habits for preventing heart disease,” March 15, 2012).

 

Mediterranean-type diet

A study about the Mediterranean-type diet and its potential positive impact on cardiovascular disease risk was recently published in the New England Journal of Medicine (N Engl J Med. Online 2013;Feb 25). Here, two variations on the Mediterranean-type diet were compared to a low-fat diet. People were randomly assigned to three different groups. The two Mediterranean-type diet groups both showed about a 30 percent reduction in the risk of cardiovascular disease, with end points including heart attacks, strokes and mortality, compared to the low-fat diet. This improvement in risk profile occurred even though there was no significant weight loss.

The Mediterranean-type diets both consisted of significant amounts of fruits, vegetables, nuts, beans, fish, olive oil and potentially wine. I call them “the Mediterranean diet with opulence,” because both groups consuming this diet had either significant amount of nuts or olive oil and/or wine. If the participants in the Mediterranean diet groups drank wine, they were encouraged to drink at least one glass a day.

The study included three groups: a Mediterranean diet supplemented with mixed nuts (almonds, hazelnuts or walnuts); a Mediterranean diet supplemented with extra virgin olive oil (at least four tablespoons a day); and a low-fat control diet. The patient population included over 7,000 participants in Spain at high risk for cardiovascular disease. The high-risk population included those with high blood pressure (80 percent of the population), diabetes and those who were overweight and/or were smokers.

The strength of this study, beyond its high-risk population and its large size, was that it was a randomized clinical trial, the gold standard of trials. However, there was a significant flaw, and the results need to be tempered. The group assigned to the low-fat diet was not, in fact, able to maintain this diet throughout the study. Therefore, it really became a comparison between variations on the Mediterranean diet and the standard American diet.

What do the leaders in the field of cardiovascular disease and integrative medicine think of the Mediterranean diet study? Interestingly there are two diametrically opposed opinions, split by field. You may be surprised by which group liked it and which did not. Cardiologists hailed the study as a great achievement. They included Henry Black, M.D., who specializes in high blood pressure, and Eric Topol, M.D. They emphasized that now there is a large RCT measuring clinical outcomes, such as heart attacks, stroke and death.

On the other hand, the integrative medicine physicians, Caldwell Esselstyn, M.D., and Dean Ornish, M.D., both of whom stress a plant-rich diet that may be significantly more nutrient dense than the Mediterranean diet in the study, expressed disappointment with the results. They feel that heart disease and its risk factors can be reversed, not just reduced. Both clinicians have published small, well-designed studies showing significant benefits from plant-based diets (J Fam Pract. 1995;41(6):560-8; Am J Cardiol. 2011;108:498-507). Dr. Ornish actually showed a reversal of atherosclerosis in one of his studies (JAMA. 1998 Dec 16;280(23):2001-7).

So which group of physicians is correct about the Mediterranean diet? Each opinion has its merits. The cardiologists’ enthusiasm is warranted, because a Mediterranean diet, even one of “opulence,” will appeal to more participants, who will then realize the benefits. However, those who follow a more strict diet, with greater amounts of nutrient-dense foods, will potentially see a reversal in heart disease, minimizing risk — and not just reducing it.

Thus, even with a genetic proclivity toward cardiovascular disease, we can very much alter our destinies. The degree depends on the willingness of the participants. Potentially, we can have an impact that ranges from reduction to reversal.

 

 

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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This is the second part of a two-part series on four Stony Brook University researchers who recently received an NSF Career Award. Designed to give researchers in the early part of their careers a financial boost before they compete against established scientists for the same dollars, the award funds projects, allows the scientists to expand their educational goals and offers recognition.

Last week, the Times Beacon Record Newspapers featured questions and answers with Radu Laza and Jonathan Rudick. This week, the paper will have insights from Alex Orlov and Emre Salman.

 

Alex Orlov

TBR: Are you excited to win this award?

Orlov: This was absolutely delightful news. Receiving this award, especially just before significant budget cuts to science, is even more amazing.

TBR: What will these funds enable you to do? Will you hire anyone new? Will you do more teaching?

Orlov: These funds will have a huge impact on my research focused on sustainable energy. It will also allow us to start new collaborations with Brookhaven National Lab and with other groups outside Stony Brook (University). I expect to hire several undergraduate and graduate students, who will be working on this project. There will be also a very significant impact on undergraduate and graduate teaching here.

Almost 80 graduate and undergraduate students are taking my courses and this project will allow me to introduce several innovative case studies based on this funded project into the classroom. We are also planning to develop new teaching techniques for engineering courses to help students (high school and university ones) to educate them on designing better consumer products while protecting the environment.

TBR: Is there anything new in your lab since we spoke? [The Times Beacon Record profiled Orlov on Dec. 18.]

Orlov: [He was named a fellow of the Royal Society of Chemistry in Britain in February.] The fellowship is something very exciting. There are also several interesting projects I am doing in collaboration with my colleagues (I am the principal investigator, but a significant player), such as developing a new computer game to educate students on environmental topics. There is a paper which was just accepted where we found a better way to get hydrogen fuel from water.

 

Emre Salman

TBR: How would you characterize the scope of your research?

Salman: Our research activities focus on high performance and energy efficient integrated circuits. We develop design techniques for next generation microprocessors, mobile computing devices as well as communication chips. We also investigate emerging integrated circuit technologies to overcome the fundamental limitations of current electronic systems such as high power consumption. At the NanoCAS Lab, our workstations are equipped with the latest electronic design automation software that allow us to verify our algorithms, models and design techniques.

Our ultimate objective is to develop future integrated circuits that are more portable, can interact with the environment, consume low power, yet still offer significant computing capability.

TBR: How will you use the funds from the award?

Salman: The NSF Career funds will support between one and two Ph.D. students in my research group (NanoCAS Lab) for five years. Part of the funds will be used to fabricate and test a three-dimensional integrated circuit to demonstrate and validate our methodologies. Furthermore, a scholarship will be available to an undergraduate student each year. Our objective is to provide undergraduate students with real research experience in our lab. These research activities will be integrated with multiple educational initiatives such as developing new course modules and outreach events for high school students within Long Island.

TBR: What would you tell those who are considering a career in research?

Salman: I would encourage them. It is fascinating to spend time on something that is not yet known by anybody. The hard part is to ask the right questions. If the questions are right, I believe the answers are likely to come, even though it may take some time. It is also very rewarding to share these experiences through teaching.

TBR: Where do you live?

Salman: I have been on Long Island since September 2010 and currently live in Sound Beach. I grew up in a small town on the Mediterranean coast in Turkey, so I enjoy being close to water. I like the nature of Long Island, hiking trails and its close proximity to New York City.

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Although rare, between 3 percent and 5 percent of the MS population had symptoms before age 18

Children were falling through the cracks. A decade ago, when a child developed signs of a problem that primarily affects adults, their pediatricians generally had little or no experience, while the medical care workers who did hadn’t worked with children.

It was a problem Lauren Krupp decided needed action. A professor in clinical neurology and a practicing physician at Stony Brook University, Krupp founded the National Pediatric Multiple Sclerosis Center, which was recently renamed the Lourie Center for Pediatric MS.

“We saw parents who were frightened and who were told that multiple sclerosis can’t occur in children, which is obviously not true, or they were told, ‘Yes, it is multiple sclerosis, but I’m an adult neurologist,’” Krupp recalled. “It makes a real difference to parents if they can take their child somewhere where there’s experience with something that’s rare.”

About 3 percent to 5 percent of the MS population has a disease that begins before age 18. Among children, MS occurs once for about every 100,000 people, Krupp estimated.

Krupp has been working with some of the other facilities designated as Regional Centers of Excellence by the National Multiple Sclerosis Society to develop a better understanding of the way MS progresses in children. Recently, she joined with several other researchers to publish research about the potential cognitive effects of the disease.

“This was the first time a uniform approach to looking at kids and their cognitive functioning was taken across the country,” she said. “We also included children at a very early stage of the disease.”

Children who had only one attack had an 18 percent frequency of cognitive problems. In children with more than one attack, the cognitive problems rise to about 33 percent.

As an example, she cited the case of a teenager who loved playing in her school band. All of a sudden, she was getting failing grades in music. The problem had nothing to do with music — she couldn’t remember her locker combination.

Some children with MS don’t need additional services (and may need a locker with a key instead of a combination lock), while others could need anything from having someone take notes in class, to getting extra time for tests, Krupp suggested.

“Cognition needs to be considered,” she explained. “We’re very eager to come up with interventions” to improve treatment.

She’s exploring the possibility of developing strategies that don’t necessarily involve medication.

“There’s a lot of promise in innovative computer-based training programs,” she said. She hopes to study some of these models in the next several months.

Krupp has also organized a camp called Teen Adventure, where children from 13 to 18 with multiple sclerosis can “go out there and do stuff and be like other kids.”

The camp enables networking among the children. Krupp says she doesn’t attend because she doesn’t want to “medicalize” the experience, although there is a team of experts, including nurse practitioners and recreational therapists, on site.

Krupp believes her efforts, as well as those of others in her field, including the National Multiple Sclerosis Society, have helped the medical community become aware of pediatric multiple sclerosis.

In people who have MS, the immune system attacks the myelin, or protective sheath around the axons of the brain and spinal cord, potentially leading to neurological, physical and cognitive problems.

The cause of MS, a disease in which the symptoms can include weakness, visual problems, numbness and trouble speaking, involves an interaction between a genetic predisposition and environmental factors.

Some studies have shown that the farther away people live from the equator, the higher the incidence of MS. Indeed, children born near the equator who move before the age of 15 develop MS at the same rate as those who have lived all their lives farther from the equator.

“We think the reason for this has to do with higher prevalence of sunlight exposure,” offered Krupp.

Sunlight is among the biggest sources of vitamin D. Doctors have different approaches to vitamin D. Many think the best strategy is to maintain a normal to high vitamin D level in the blood and use vitamin D doses as needed, she said.

Krupp and her partner live in Setauket. They have twin daughters, Gina and Alexa, who are on their respective sailing teams in college.

People who are interested in finding out more about the camp, Krupp’s research efforts, or ways to help can visit www.pediatricmscenter.org.

Krupp’s professional goal is simple: “To be put out of business. I would like to see the disease ended.”

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Sugar consumption may increase diabetes prevalence

What causes type 2 diabetes? It would seem like an obvious answer: obesity, right?

Well, obesity is a contributing factor, but not necessarily the only factor. This is important, because diabetes prevalence is at epidemic levels in the United States, and it continues to grow. The latest statistics show that about 8 percent of the U.S. population has type 2 diabetes. For those 65 and older, the prevalence is considerably higher, at 26.9 percent (https://diabetes.niddk.nih.gov).

Not only may obesity play a role, but sugar by itself, sedentary lifestyle and visceral (abdominal) fat may also contribute to the pandemic. These factors may not be mutually exclusive, of course.

We need to differentiate among sugars, because form is important. Sugar and fruit are not the same with respect to their effect on diabetes, as the research will help clarify. Sugar, processed foods and sugary drinks, such as fruit juices and soda, have a similar effect, but fresh fruit does not.

 

Sugar’s impact

Sugar may be sweet, but it also may be a bitter pill to swallow when comes to its effect on diabetes’ prevalence. In an epidemiological (population-based) study published in the journal PLoS One in February, the results show that sugar may increase the prevalence of type 2 diabetes by 1.1 percent worldwide (PLoS One. 2013;8(2):e57873). This seems like a small percentage, however, we are talking about the overall prevalence, which is around 8 percent in the U.S., as noted in the introduction.

Also, the amount of sugar needed to create this result is surprisingly low. It takes about 150 calories, or one 12 ounce can of soda per day, to potentially cause this rise in diabetes. This is looking at sugar on its own merit, irrespective of obesity, lack of physical activity or overconsumption of calories. The longer people were consuming sugary foods, the higher the incidence of diabetes. So the relationship was a dose-dependent curve. Interestingly, the opposite was true as well: As sugar was less available in some countries, the risk of diabetes diminished to almost the same extent that it increased in countries where it was overconsumed.

In fact, the study highlights that certain countries, such as France, Romania and the Philippines, are struggling with the diabetes pandemic, even though they don’t have significant obesity issues. The study evaluated demographics from 175 countries, looking at 10 years’ worth of data. This may give more bite to New York City Mayor Michael Bloomberg’s drive to limit the availability of sugary drinks. Even steps like these may not be enough, though. Before we can draw definitive conclusion from the study, however, there need to be prospective (forward-looking) studies.

 

The effect of fruit

The prevailing thought has been that fruit should only be consumed in very modest amounts in patients with — or at risk for — type 2 diabetes. A new study challenges this theory. In a randomized controlled trial, newly diagnosed diabetes patients who were given either more than two pieces of fresh fruit or fewer than two pieces had the same improvement in glucose (sugar) levels (Nutr J. published online March 5, 2013). Yes, you read this correctly: There was a benefit, regardless of whether the participants ate more fruit or less fruit.

This was a small trial with 63 patients over a 12-week period. The average patient was 58 and obese, with a BMI of 32 (less than 25 is normal). The researchers monitored hemoglobin A1C (HbA1C), which provides a three-month mean percentage of sugar levels.

It is very important to emphasize that fruit juice and dried fruit were avoided. Both groups also lost a significant amount of weight while eating fruit. The authors, therefore, recommended that fresh fruit not be restricted in diabetes patients.

 

What about cinnamon?

It turns out that cinnamon, a spice many people love, may help to prevent, improve and reduce sugars in diabetes. In a review article, the authors discuss the importance of cinnamon as an insulin sensitizer (making the body more responsive to insulin) in animal models that have type 2 diabetes (Am J Lifestyle Med. 2013;7(1):23-26).

Cinnamon may work much the same way as some medications used to treat type 2 diabetes, such as GLP-1 agonists. In a study with healthy volunteers, cinnamon raised the level of GLP-1 (Am J Clin Nutr. 2007;85:1552–1556). Also, in a RCT with 100 participants, 1 gram of cassia cinnamon reduced sugars significantly more than medication alone (J Am Board Fam Med. 2009;22:507–512). The data is far too preliminary to make any comparison with FDA-approved medications. However it would not hurt, and may even be beneficial, to consume cinnamon on a regular basis.

 

Sedentary lifestyle

What impact does lying down or sitting have on diabetes? Here, the risks of a sedentary lifestyle may outweigh the benefits of even vigorous exercise. In fact, in a recent study, the authors emphasize that the two are not mutually exclusive in that people, especially those at high risk for the disease, should be active throughout the day as well as exercise (Diabetologia online March 1, 2013).

So in other words, the couch is “the worst deep-fried food,” as I once heard it said, but sitting at your desk all day and lying down also have negative effects. This coincides with my Jan. 31 article on exercise and weight loss, where I noted that people who moderately exercise and also move around much of the day are likely to lose the greatest amount of weight.

Thus, diabetes is mostly likely a disease caused by a multitude of factors, including obesity, sedentary lifestyle and visceral fat. The good news is that many of these factors are modifiable. Cinnamon and fruit seem to be two factors that help decrease this risk, as does exercise, of course.

As a medical community, it is imperative that we reduce the trend of increasing prevalence by educating the population, but the onus is also on the community at large to make at least some lifestyle modifications. So America, take an active role and get off your butt.

 

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 www.medicalcompassmd.com and/or consult your personal physician.

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Finding out why cancer cells become drug resistant should help patients recover

Back when she was in Boston, Raffaella Sordella was a part of an incredible discovery. Some patients with non-small cell lung cancer had mutations that made their tumors sensitive to drugs such as Tarceva and Iressa.

When the patients took the medicine twice a day, “the tumor was shrinking,” recalled Sordella. “Within a couple of weeks, the patient could resume a normal life, more or less.”

To top it off, the drug didn’t have all the side effects of conventional chemotherapy.

“This was a turning point in my career,” explained Sordella, who is originally from Turin, Italy, and was conducting her research at Massachusetts General Hospital.

The promising therapy for these patients, however, wasn’t as effective as researchers, clinicians and patients had hoped. Within a year, the tumors in even these patients had developed a resistance to the drugs.

Undeterred, Sordella decided she would search for reasons for the change. Now an associate professor at Cold Spring Harbor, Sordella is pursuing several possible explanations which she hopes one day will extend the effectiveness of drugs.

Lung cancer is the leading cause of cancer deaths in the world. It was responsible for 160,340 deaths in the United States in 2012, according to the American Cancer Society. More than 226,000 cases were diagnosed last year.

Tarceva and Iressa were sometimes effective initially on the tumors that harbor specific mutations because they blocked the epidermal growth factor receptors (or EGFR). Without signals from the EGFR sites, the tumors either stopped growing or began shrinking.

As Sordella and others have observed, however, these drugs became less effective over time. One possible explanation was that the cancers were changing, developing a secondary mutation that altered the way the tumor grew or developed. That likely accounted for about half of the cases. In the rest, scientists now know that resistance can develop through other mechanisms, such as the expression of other genes.

“If we understand the mechanism, we can slow down the process,” she explained. Scientists may not find a cure in the short term, but they may be able to extend the period when the tumors are sensitive to the drug out from one year.

Sordella discovered that the interleukin-6 protein, which was produced during inflammation, was responsible for decreasing the sensitivity of the tumor to the drugs.

Resistance was increased “by factors secreted during inflammation,” Sordella observed.

By turning off or blocking interleukin-6, researchers may be able to create a combination of drugs that blocks the growth and spread of tumors.

This, Sordella offered, would be considerably easier than trying to anticipate and stop the next cancerous mutation.

When she first started exploring the ways tumors might develop drug resistance, the most obvious, and medically most challenging possibility was that the tumor was heterogeneous, which means that it had a mix of cells with different genetic codes that kept it several steps ahead of the available drugs.

Sordella feels a scientific urgency to continue with her research, in the hopes of helping those suffering with cancer.

“What we are doing is not just for us,” she said. “It can make a difference to patients.”

Sordella and her husband Manuel Barriola, a theoretical physicist who works as a consultant, live on campus at Cold Spring Harbor. They have two daughters, Victoria, who is in second grade and Alicia, who is in kindergarten.

Sordella and her husband, who is from Spain, miss their connection to Europe. She explained that the Italian culture she grew up with is considerably different from that for third-generation Italian Americans.

“When I was in Boston, there was this old guy that learned I was Italian,” she recalled. “He spoke to me in what he thought was Italian.” Sordella suspected that he was speaking a dialect from Sicily and wasn’t able to understand a single word.

Sordella enjoys going to Manhattan to people watch. She said she doesn’t think about her research when she’s in the city, even though she knows cancer is so prevalent that any medical breakthrough could make a difference for everyone.

 

African violets

Continued from page B16

Any number of small insect pests, including aphids and spider mites as well as mealybugs, can attack African violets. I find that the yellow sticky traps are very helpful in dealing with insect pests in the house in general. If that doesn’t work, you may have to resort to using a pesticide. Make sure that the one you select can be used on houseplants and that you follow directions carefully.

Prevention is the best route to take. Check any new acquisitions carefully before bringing them into the house. You may also want to quarantine them for a few weeks so that if there is a problem it won’t affect your entire houseplant collection.

For more information, the African Violet Society of America can be reached at www.avsa.org.

 

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

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Using remote sensing, Rogers and other scientists look for evidence of water on Mars

By Daniel Dunaief

After searching in 40 other places — albeit from millions of miles away — Deanne Rogers and her scientific colleagues from the U.S. and U.K. found what they were seeking. Using images beamed back to Earth, they found minerals on rocks that typically form in the presence of water.

The discovery, in the McLaughlin Crater on Mars, where deposits are probably 3.8 billion years old or older, is consistent with an expanding body of knowledge about the Red Planet.

“I almost expected we should see something like this,” explained Rogers, an assistant professor of geoscience at Stony Brook. “A lot of recent observations point to groundwater in the subsurface. There was a hint of water deep in the subsurface.”

Without channels going into or out of the basin, scientists suggested that the water likely came from under the ground.

Much of the water on Mars is likely a result of volcanic activity, although comet impacts may have also carried some. The water likely percolated through soil that is much more porous on Mars than it is on Earth. It likely collected several kilometers below the surface. The water may have come back up in deep basins, such as the McLaughlin Crater.

Indeed, there could still be water in the Martian crust.

If manned missions went to Mars, experts have suggested that the astronauts might need to find water on the planet to drink while they’re there and to restock their supplies for the long journey back to Earth.

Rogers suggested that astronauts probably wouldn’t be able to drill deep enough to get any groundwater. Some scientists, however, have been working on how to free the water trapped in the minerals on the rocks. By heating the rocks, astronauts might be able to release water. They could also go to high latitudes, where there is water ice within centimeters of the surface.

So far, the McLaughlin crater “is the only place where we find evidence of these minerals” together in a basin setting, Rogers offered. Some are covered in dust, which obstructs the scientists’ view, while others may never have had water upwell in that region.

The presence of water, even long ago, might suggest that conditions on Mars could have supported life. Those extraterrestrial organisms could have lived in the subsurface, where they might be sheltered from the harsh environment on the surface.

Despite the pervasive dust, Mars presents a clearer picture in some areas of geological processes than the Earth. Plate tectonics — the slow movement of the enormous landmasses on which the continents rest — on our planet muddy the waters of interpreting how the planet may have changed over its history.

Mars, however, does not have any such movement of tectonic plates. Additionally, the meteorites that slammed into its surface have helped reveal what is and was beneath the surface.

“It’s a lot easier to study craters on Mars because they are well preserved,” explained Rogers. “On Earth, they are buried under vegetation or erased from Earth’s surface” by the movement of the plates and by erosion or weathering.

Rogers explained that she has divided her research into analyzing data sent from orbiters and studying the properties of similar rocks and minerals that other researchers at Stony Brook have created.

“We can look at the spectra of altered samples to compare it to Martian data,” she explained. “We can confirm it in the lab.”

She also does some remote sensing of the moon and asteroids.

Rogers lives in Selden with Tim Glotch, who is also an associate professor in the same department (see July 17, 2012 issue), and their two preschool-age children.

Glotch, Rogers and a few other Stony Brook faculty are working on a multidisciplinary proposal, which is due in April, that considers the possibility of human exploration of the moon and asteroids. Glotch is the lead investigator, while Rogers and others have responsibilities specific to their expertise.

Their research is benefiting from a resurgence of interest in Mars, in part because of the newest rover, Curiosity.

Rogers said she hopes to continue to participate in research on Mars because “there are so many things left unexplored at this point.”