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Yearly Archives: 2014

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Sgt. Bradford comes home to cheers and a hug from his family. Photo by Elana Glowatz

Sgt. Robert Bradford came home to a sea of red, white and blue last Friday afternoon, as local members of motorcycle charity Patriot Guard Riders lined Brookhaven Boulevard in Port Jefferson Station outside his home to welcome him and thank him for his service to the United States.

Sgt. Bradford comes home to cheers. Photo by Elana Glowatz
Sgt. Bradford comes home to cheers. Photo by Elana Glowatz

Bradford, 24, was returning after seven months in Afghanistan on his first deployment with the U.S. Army.

Terryville Fire Department trucks draped an American flag over Route 112 and set off sirens as the minivan Bradford rode in made its way down the street and turned onto his block. The roughly 15 members of the Patriot Guard Riders raised their own flags and stood at attention as the van entered the driveway of the Bradford family’s home.

When the soldier stepped out of the car, the guard erupted in cheers and claps and shouted, “Thank you for your service.”

Bradford showed his appreciation for the gesture, going up to each member to shake hands and share a hug.

“I appreciate all you guys,” he told the guard, before sharing a group hug with his family in the middle of the road.

His mother, Pat, said the Port Authority police escorted the family to the gate at LaGuardia Airport to meet the sergeant, and there was an announcement on the loudspeaker for everyone who wanted to greet him. The people “came in droves from everywhere,” she said.

When she saw her son again, “My heart was beating.” Asked to describe what it was like, the mother said, “Every good word in the book.”

Sgt. Bradford comes home to cheers. Photo by Elana Glowatz
Sgt. Bradford comes home to cheers. Photo by Elana Glowatz

She turned to Pete Jepson, an East Moriches resident leading the guard, and said, “I have my son home.”

According to Jepson, the welcoming group was made up of volunteers, some of whom are veterans. Local members of the national nonprofit Patriot Guard Riders attend similar homecoming events as well as funerals for fallen military members, first responders and veterans.

“We love doing it. It’s an honor for us to do it,” Jepson said.

Bradford, who is with the 338th Military Intelligence Battalion based in Shoreham, said everyone from his squad came back, which is good because “I wasn’t going to leave without all of them.”

He said, “It’s very exciting, overwhelming and weird” to be home. “It’s a whole different lifestyle.”

There’s not as much to worry about at home, he explained, adding with a laugh that the air is fresher on Long Island.

One thing that’s already different is that while he was overseas, he carried his rifle with him everywhere, including to the bathroom, to “chow” and to sleep. When he was on the plane to LaGuardia, he said, he fell asleep and when he woke up, someone’s phone rang and it sounded like “the alarm for incoming,” and he jumped and didn’t have his gun.

Bradford, who first enlisted in 2008 and re-enlisted on Veterans Day, said he is proud to serve his country.

“It’s nothing special that I did.”

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Many of his colleagues are focused on the instructions the factory has to follow. Chang-Jun Liu, however, is more concerned with the on and off switch. The factory, in this case, is a plant cell’s genes, and the on and off switch are the signals that indicate when to start and stop production of a class of chemicals called phenols that are used in everything from flavoring foods to promoting cardiovascular health.

Liu, a scientist in the Department of Biosciences at Brookhaven National Laboratory and an adjunct professor in biochemistry and cell biology at Stony Brook, looked at a process in which a key enzyme, called phenylalanine ammonia lyase, gets removed or broken down, slowing or even stopping the process of producing phenols. He and his research group are exploring ways to fine-tune the concentration and activity of PAL. With less PAL, plants, in this case an Arabidopsis plant that is widely found in backyards around Long Island, produces less phenol.

“You can enhance the final production or reduce the final production” depending on “the application” scientists or industry are seeking, Liu said. “We know how this process works. We can turn down those kinds of proteins, and prevent the degradation of a key enzyme or we can increase the activity.”

How much phenol scientists or businesses desire in plants depends on the application. Phenols are a part of a large class of compounds that are made of both small molecule chemicals and larger polymers. The smaller phenolics are used in foods, beverages and cosmetics, providing fragrances and flavors. The typical example of this is vanillin.

Most phenolics have antioxidant properties and can potentially prevent cardiovascular disease, treat cancer or prevent obesity, Liu said.

Other scientists praised Liu’s ability to apply his basic research into a range of other arenas. “What’s really remarkable about his work is he does a lot of things that have fundamental basic importance in science and takes them to translational situations,” said Brenda Winkel, professor and head of biological sciences at Virginia Tech. “He’s able to take [his research] and find the practical uses of these new insights. That is really unusual.”

Liu, who worked with postdoctoral research associates Xuebin Zhang and Mingyue Gou, said other researchers have exerted considerably more energy in developing a gene regulation approach. Liu, however, worked at the protein level, exploring how to use the cell’s own recycling system, either to keep a protein that encourages the production of phenols in place, or encouraging its removal, and decreasing the manufacture of phenols.

Plants use these phenols for a variety of purposes, most notably to react to changes in its environment, either from variation in its habitat or an attack by a fungus or bacteria. “If you manipulate those phenolic compounds” Liu said, “it will increase the resistance of a plant to environmental stress and therefore increase the ability of plants to live” in harsh conditions.

Liu’s next steps are to apply this understanding of how to alter phenol synthesis to other plants, including in horticulture. Increasing phenols can increase coloration intensity among different flowering plants, he said, which might be a desirable trait for people looking for a particular hue.

He also wants to expand his study to other crops like poplar trees. Taking lignin out of poplar trees to generate paper currently requires “harsh chemicals that are bad for the environment,” said Winkel.
Winkel said Liu’s work with biofuels is a crowded field and “big deal folks have been in it forever” but Liu is “right in there with the giants of the field, making unique contributions.”

A resident of Rocky Point, Liu lives with his wife, Yang Chen, a teacher’s aid at Rocky Point Middle School, and their two children, 14-year-old Allen and 12-year-old Bryant. Liu, who grew up in China, said he has gradually started to learn to ski.

He’s been to Blue Mountain and Shawnee in the last few years and calls himself “still a learner” on skis. “It is extremely exciting when you challenge yourself and do something a bit beyond your ability,” he said.
As for his work, Liu said he feels a satisfaction about his findings. “I’m pretty excited,” he said. “We continually want to look for more potential applications.”

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Potential increased risk of cardiovascular disease

Testosterone is a hot topic in the news lately. Men are going through andropause or have unusually low testosterone (hypogonadism), or as it is most recently referred by the pharmaceutical industry: “Low T.” We are bombarded continually with ads suggesting that men should talk to their doctors about Low T. The formal name for treatment is androgen replacement therapy.

Is this all hype, or is this a serious malady that needs medical attention? The short answer is it depends on the candidate. The best candidates have deficient testosterone levels and are symptomatic.

The greatest risk factor for lower testosterone is age. As men age, the level of testosterone decreases. Respectively, 20, 30 and 50 percent of those who are in their 60s, 70s and 80s have total testosterone levels of less than 320 ng/dL. 1 However, some of the pharmaceutical ads would have you think that most men over 40 should seek treatment. Treatments include gels, transdermal patches and injections.

While real estate is all about “location, location, location,” with testosterone “caution, caution, caution” should be used.

Who are the most appropriate candidates for therapy? Those who have symptoms including lack of sexual desire, fatigue and lack of energy. However, what is scary is that around 25 percent of patients are getting scripts for testosterone without first testing their blood levels to determine if they have a deficiency.2 A simple blood test can measure total testosterone, as well as free and weakly bound levels at mainstream labs.

The number of testosterone scripts has increased threefold from 2001-11 for men more than 40 years old.3 Either we have discovered vast numbers of men with low levels or, more likely, marketing has caused the number of scripts to outstrip the need.

What are the risks and benefits of treating testosterone levels?

Is testosterone treatment really the fountain of youth?

There are benefits reported for those who actually have significantly deficient levels. Benefits may include improvements in muscle mass, strength, mood and sexual desire.4

However, several studies have recently suggested that testosterone therapy may increase the risk of cardiovascular disease, including stroke, heart disease and even death. These are obviously serious side effects. It also may cause acquired hypogonadism by shrinking the testes, resulting in a dependency on exogenous, or outside, testosterone therapy.

When testosterone is given, it may be important to also test PSA levels.5 If they increase by more than 1.4 ng/ml over a three-month period, then it may be wise to have a discussion with your physician about considering discontinuing the medication. You should not stop the medication without first talking to your doctor, and then a consult with an urologist may be appropriate. If the PSA is greater than 4.0 ng/ml initially, treatment should probably not be started without a urology consult.

How can you raise testosterone levels and improve symptoms without hormone therapy? Lifestyle changes, including losing weight, exercising and altering dietary habits, have shown promising results.

Let’s look at the evidence:

Cardiovascular risk

In the newest study, results showed that men were at significantly increased risk of experiencing a heart attack within the first three months of testosterone use.6 There was an overall 36 percent increased risk. When stratified by age, this was especially true of men who were 65 and older. This population had a greater than twofold risk of having a heart attack. The risk may have to do with an increased number of red blood cells with testosterone therapy. Those who were younger showed a trend toward increased risk, but did not meet statistical significance.

However, if the patient was younger than 65 and had heart disease, there was a significant twofold greater risk, but those without did not show risk. This does not mean there is no risk for those who are “healthy” and younger, it just means the study did not show it. This observational study compared over 50,000 men who received new testosterone scripts with over 150,000 men who received scripts for erectile dysfunction drugs: phosphodiesterase type 5 (PDE5) inhibitors, including tadalafil (Cialis) and sildenafil (Viagra). PDE5 inhibitors have not demonstrated this cardiovascular risk.

Unfortunately, this is not the only study that showed potential cardiovascular risks. Another recent study reinforces these results. In 2013, results showed that there was an increased risk of stroke, heart attack and death after three years of testosterone use.7 Ultimately, it found a 30 percent greater chance of cardiovascular events.

What is worse is that risk was significant in both those with a history of heart disease and those without. This was a retrospective study involving 1,200 men with a mean age of 60.

We need randomized controlled trials to make a more definitive association. Still, these are two large studies that suggest increased risk.

If you already have heart disease, be especially careful when considering testosterone therapy.

FDA response

As of Jan. 31, the FDA, which approved testosterone therapy originally, will now investigate the possible cardiovascular risk profile based on the above two studies.8 The FDA doesn’t suggest stopping medication if you are taking it presently, but it should be monitored closely. The agency, in the meantime, has issued an alert to doctors about the potential dangerous side effects of androgen replacement therapy. The FDA says that the use of testosterone therapy is for those with low levels and other medical issues, such as hypogonadism from either primary or secondary causes.

Obesity and weight loss

Not surprisingly, obesity is an important factor in testosterone levels. In a study that involved 900 men with metabolic syndrome — borderline or increased cholesterol levels, sugar levels and a waist circumference greater than 40 inches — those who lost weight were 50 percent less likely to develop testosterone deficiencies. Those who participated in lifestyle modification had a highly statistically significant 15 percent increase in testosterone.9 Also, when men increased their physical activity and made dietary changes, there was an almost 50 percent risk reduction one year out, compared to their baseline at the start of the trial.

Interestingly, metformin had no effect in preventing lower testosterone levels in patients with abnormal sugar levels, but lifestyle modifications did. These patients were relatively similar to the average American biometrics with prediabetes: HbA1c of 6 percent and glucose of 108 mg/dL; a mean of 42-inch waists; and a BMI that was obese at 32 kg/m2. The mean age was between 53 and 54.

If there is one thing that you get from this article, I hope it’s that testosterone is not something to be taken lightly. You can improve testosterone levels if you’re overweight by losing fat pounds. If you think you have symptoms and you might need testosterone, talk to your doctor about getting a blood test before you do anything. It may be preferable to try alternate medications that improve erections such as sildenafil and tadalafil.

References:

1 J Clin Endocrinol Metab. 2001 Feb;86(2):724. 2 J Clin Endocrinol Metab. Online 2014; Jan 1. 3 JAMA Intern Med. 2013 Aug 12;173(15):1465-6. 4 J Clin Endocrinol Metab. 2000 Aug;85(8):2839. 5 UpToDate.com. 6 PLoS One. 2014 Jan 29; 9(1):e85805. 7 JAMA. 2013;310:1829-1836. 8 FDA.gov. 9 ENDO 2012; Abstract OR28-3.

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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Michael Villaran has been able to maintain his own energy levels while he’s running long distances. The 64-year-old electric power engineer and principal engineer at Brookhaven National Laboratory has completed 10 marathons.

Villaran, who has been at BNL for 27 years, knows a thing or two about other forms of energy as well: the kind that heats houses and provides electricity.

He is a staff engineer in the Sustainable Energy Technology Department, a group that started in 2010. BNL created the group when the campus became a host site for the Long Island Solar Farm, which delivers about 32 megawatts of peak alternating-current power to the Long Island Power Authority substation.

Some of the research at the station has included looking at how changes in weather affect the plant. Additionally, researchers are exploring the long-term effects the area climate has on the plant parts and system.

As a part of the solar farm agreements, BNL is building the Northeast Solar Energy Research Center. Construction of the first portion of the NSERC is expected to be completed by the middle of this month. The NSERC will support research on grid integration, energy storage and distributed energy, among other areas.
For the Long Island Solar Farm, Villaran “came up with the concept of the electric power instrument monitoring system,” he said. He has also contributed to a design with the new research facility that uses a similar electric power instrument monitoring system.

Villaran’s colleagues appreciate his contribution. He is “absolutely essential in this capacity because he can manage from a business and engineering perspective simultaneously,” said Paul Giannotti, a senior electrical engineer at BNL.

Giannotti said he has been assisting Villaran in working on the NSERC, which is “a very exciting project because it will answer many questions on the future viability of solar power stations, especially in the more cloudy regions of the northeast.”

Electrical engineers often work closely with meteorologists, hoping to get a better read on when a significant change in the weather might knock out parts of the system. An upstate partner of BNL has successfully used historical data to predict the outcome of an approaching storm on their power grid.

When he worked for Lilco, Villaran said everyone needed to provide an emergency response, because “it’s not a question of are we going to have ice storms and hurricanes,” it’s a matter of when.

Indeed, recently, BNL organized a series of utility workshops, one of which focused on applying risk techniques to utility planning, which included weather effects. That was postponed twice, once for Hurricane Sandy and again for Winter Storm Nemo.

“By looking at historical data and where and when and how severely it affects the system, they can get resources in place that could minimize the number of outages,” he said.

Villaran said BNL is working with a partner to create a high-speed monitoring system for the grids that would come at a low price, which would greatly improve the operation of the system by telling utilities when the system is in trouble and by reducing inefficiencies.

Villaran and his wife, Denise, who works in the administrative office at the Rocky Point School District, live in Rocky Point. Villaran has three sons from a previous marriage: Michael, 35, Tim, 34, and Kevin, who will be 30 this year.

After his divorce from his first wife, Villaran had sole custody of his children for several years, which meant he “had to be a wiz at scheduling. There were some days when three people were playing in three different sports in three different locations.” One Saturday, he said, he was in and out of the car 30 times. He appreciates the support of his parents, who pitched in regularly.

Villaran has been an active participant since around 1999 in a mentoring program for the Longwood School District for children with various difficulties and hardships. “Now that I have no children around, it’s fun to work with these kids,” he said.

Villaran said his team, and utilities experts, are excited about the creation of the new NSERC. “Electric utilities are interested in trying out ideas for the operation of their distribution systems,” he said. “They’ll try some ideas in a setting like we’ll make available here, before deploying [them] in the field.”

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Age-related cognitive decline may not be as prevalent

The brain has to be the most important and complex organ, yet what we know about the brain is inverse to its prominence. In other words, our knowledge only scratches the surface. While other organs can be transplanted readily, it is the one organ that can’t, at least not yet.

The brain also has something called the blood-brain barrier. This is an added layer of small, densely packed cells, or capillaries, that filter what substances from the blood they allow to pass through from the rest of the body (1). This is good, since it protects the brain from foreign substances; however, on the downside, it also makes it harder to treat, because many drugs and procedures have difficulty penetrating the blood-brain barrier.

Unfortunately, there are many things that negatively impact the brain, including certain drugs, head injuries and lifestyle choices. There are also numerous disorders and diseases that affect the brain, including neurological (dementia, Parkinson’s, stroke); infection (meningitis); rheumatologic (lupus and rheumatoid arthritis); cancer (primary and secondary tumors); psychiatric mood disorders (depression, anxiety, schizophrenia); diabetes; and heart disease.

These varied diseases tend to have three signs and symptoms in common: they either cause an alteration in mental status; cognitive decline, weakness or change in mood; or a combination of these.

Probably our greatest fear regarding the brain is cognitive decline. We have to ask ourselves if we are predestined to this decline, either because of the aging process alone or because of a family history, or if there is a third option, a way to alter this course. Dementia, whether mild or full-blown Alzheimer’s, is cruel; it robs us of functioning. We should be concerned about Alzheimer’s because 5.2 million Americans have the disease, and it is on the rise, especially since the population is aging (2).

Fortunately, there are several studies that show we may be able to choose the third option and prevent cognitive decline by altering modifiable risk factors. They involve rather simple lifestyle changes: sleep and exercise and possibly omega-3s. Let’s look at the evidence.

The impact of clutter

The lack of control over our mental capabilities as we age is what frightens us the most since we see friends, colleagues and relatives negatively affected by it. Those who are in their 20s seem to be much sharper and quicker. But are they really?

In a recent study, German researchers found that educated older people tend to have a larger mental database of words and phrases to pull from since they have been around longer and have more experience (3).  When this is factored into the equation, the difference in terms of age-related cognitive decline becomes negligible.

This study involved data mining and creating simulations. It showed that mental slowing may be at least partially related to the amount of clutter or data that we accumulate over the years. The more you know, the harder it becomes to come up with a simple answer to something.

We may need a reboot just like a computer. This may be possible through sleep and exercise and omega-3s.

Sleep

I have heard people argue that sleep gets in the way of life. Why should we have to dedicate 33% of our lives to sleep? There are several good reasons. One involves clearing the mind, and other involves improving our economic outlook.

For the former, a recent study shows that sleep may help the brain remove waste, such as those all-too-dangerous beta-amyloid plaques (4). When we have excessive plaque buildup in brain, it may be a sign of Alzheimer’s. This study was done in mice. When mice were sleeping, the interstitial space (the space between brain gyri, or structures) would increase by as much as 60 percent.

This allowed the lymphatic system, with its cerebrospinal fluid, to clear out plaques, toxins and other waste that had developed during waking hours. With the enlargement of the interstitial space during sleep, waste removal was quicker and more thorough because cerebrospinal fluid could reach much further into the spaces. When the mice were anesthetized, a similar effect was seen as with sleeping. Interestingly, the follow-up study may be done in collaboration with Helene Benveniste, M.D., an anesthesiologist at Stony Brook University Hospital.

In the second study, done in Australia, results showed that sleep deprivation may have been responsible for an almost 1 percent decline in gross domestic product for the country (5). The reason is obvious: people are not as productive at work when they don’t get enough sleep. Their attitude tends to be more irritable, and concentration may be affected. We may be able to turn on and off sleepiness on an acute, or short-term, basis, depending on the environment, but it’s not as if we can do this continually.

According to the Centers for Disease Control, 4 percent of Americans have fallen asleep in the past month behind the wheel of a car (6). I hope this hammers home the importance of sleep.

Exercise

How can I exercise, when I can’t even get enough sleep? Well there is a study that just may inspire you to exercise.

In the study, which involved rats, those that were not allowed to exercise were found to have rewired neurons in the area of their medulla, the part of the brain involved in breathing and other involuntary activities. There was more sympathetic (excitatory) stimulus that could lead to increased risk of heart disease (7). In those rats that were allowed to exercise regularly, there was no unusual wiring, and sympathetic stimuli remained constant. This may imply that being sedentary has negative effects on both the brain and the heart.

This is intriguing, since we used to think that our brain’s plasticity, or ability to grow and connect neurons, was finite and stopped after adolescence. This study’s implication is that a lack of exercise causes unwanted new connections. Of course, these results were done in rats and need to be studied in humans before we can make any definitive suggestions.

Omega-3 fatty acids

In the Women’s Health Initiative Memory Study Magnetic Resonance Imaging Study, results showed that those postmenopausal women who were in the highest quartile of omega-3 fatty acids had significantly greater brain volume and hippocampal volume than those in the lowest quartile (8). The hippocampus is involved in memory and cognitive function.

Specifically, the researchers looked at the level of omega-3 fatty acids, called eicosapentaenoic acid and docosahexaenoic acid, in red blood cell membranes. The source of the omega-3 fatty acids could either have been from fish or supplementation. This was not delineated. The researchers suggest eating fish high in these substances, such as salmon and sardines, since it may not even be the omega-3s that are playing a role, but some other substances in the fish.

It’s never too late to improve brain function. You can still be sharp at a ripe old age. Although we have a lot to learn about the functioning of the brain, we know that there are relatively simple ways we can positively influence it.

References: (1) medicinenet.com. (2) alz.org. (3) Top Cogn Sci. 2014 Jan.;6:5-42. (4) Science. 2013 Oct. 18;342:373-377. (5) Sleep. 2006 Mar.;29:299-305. (6) cdc.gov. (7)J Comp Neurol. 2014 Feb. 15;522:499-513. (8) Neurology. 2014;82:435-442.

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 medicalcompassmd.com and/or consult your personal physician.

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They often refuse to stop, go away, or even shut down for long. That’s what makes them such powerful killers. Cancer has an ability to work around temporary solutions doctors and scientists discover, going with backup plans to take over cells and damage organs, systems and endanger lives.

Looking specifically to alter a group of receptors, which are like docking stations for cellular signals, Sabine Brouxhon, clinical associate professor of emergency medicine at Stony Brook, has found an antibody that doesn’t just knock out one route for the development and spread of cancer, but may disable several such options. At the same time, her approach causes cancer cells to die.

The antibody she’s working with targets a specific protein, called a shed protein, in the area around a tumor. The antibody causes growth factor receptors to become internalized in a cell, where they get degraded. “We have an antibody-based therapy that downregulates” these receptors, said Brouxhon.

The receptors she’s targeting are the ones that have become the site of several treatments approved by the Food and Drug Administration and are involved in breast cancer, colorectal cancer, pancreatic cancer and skin cancer.

Four of the receptors are called human epidermal growth factor receptor and are abbreviated HER1 through 4. Her antibody also works to downregulate another receptor tyrosine kinase called the insulin-like growth factor receptor.

With some of the treatments that knock out one specific HER receptor, cancers sometimes develop resistance to that therapy, using another receptor to continue in its destructive path.

“Since her therapy down-regulates many of the resistance pathways used by cancer cells, this treatment could be useful [with] certain drug resistant cancers,” said Sean Boykevisch, senior licensing associate in the Office of Technology Licensing and Industry Relations.

By attaching to this shed protein, the antibody has become effective at killing cancer in lab dishes and in preclinical mouse models of some human diseases.

The next step for Brouxhon is converting the antibody into a version that will work for humans. She estimates the timetable for this process at about two years.

Brouxhon has presented her promising results to several possible funding partners, including venture capital firms and pharmaceutical companies. Once she creates a human form of the antibody, Brouxhon will look for a specific group or patients for whom this treatment might be effective.

“We need to find that patient population that is amenable to this treatment,” she said. A possibility, she added, is a population of patients who develop resistance to cancer treatment.

Brouxhon has been at Stony Brook for five years. Previously, she had worked at the University of Rochester. She believes the support she received at Stony Brook has enabled her to advance her research. “There’s a lot of interest” in her research and she “couldn’t ask to be so lucky,” she said.

Some of Brouxhon’s colleagues praised her work and her approach. She is “charting new ground with her recent discoveries,” said Boykevisch, whose office is working with her to find a partner to take this innovation to the marketplace. She said her pursuit of a treatment for cancers is professional and personal. Her grandfather died of pancreatic cancer and that “hit home” with her.

When she was growing up, Brouxhon traveled all over the world with her family, living in New Guinea, Belgium, Australia, South Africa and Brazil, as her father worked for the United Nations and as an independent consultant. She used to hate all of the travel, but when she grew up, she realized her father “gave me a lot. I got to see a lot of different cultures. That made me stronger.”

Brouxhon and her husband, Stephanos Kyrkanides, the chair of the Department of Orthodontics and Pediatric Dentistry at Stony Brook, live in East Setauket with their 15-year-old son, James, and their 12-year-old daughter, Nicole.

They met in Rochester when she was working for Dave Felten and Kyrkanides was working for Felten’s wife, Susan. Kyrkanides had asked Brouxhon for help with an experiment.

Brouxhon puts many hours into her work. Boykevisch described her as “one of the most driven people I know.

As a scientist and medical doctor, she is eager to see her discoveries help the lives of those afflicted with cancer.”

The work “requires a lot of time,” she said. “I really want to see this go forward.”

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Soy may exacerbate hypothyroidism

It seems like everyone has heard of hypothyroidism. But do we really know what it is and why it is important? The thyroid is a butterfly-shaped organ responsible for maintaining our metabolism. It sits at the base of the neck, just below the laryngeal prominence or Adam’s apple. The prefix “hypo,” derived from Greek, means “under” (1). Therefore, hypothyroidism indicates an underactive thyroid and results in slowing of the metabolism. Many people get hypo- and hyperthyroidism confused, but they are complete opposites.

Blood tests determine if a person has hypothyroidism; they include thyroid stimulating hormone, which is usually increased, thyroxine (free T4), and triiodothyronine (free T3 or T3 uptake), which may both be suppressed (2).

There are two types of primary hypothyroidism: subclinical and overt. In the overt (more obvious) type, classic symptoms include weight gain, fatigue, thinning hair, cold intolerance, dry skin, and depression, as well as the changes in all three thyroid hormones on blood tests mentioned above. In the subclinical, there are may be less obvious or vague symptoms and only changes in the TSH. The subclinical can progress to the overt stage rapidly in some cases (3).  Subclinical is substantially more common than overt; its prevalence may be as high as 10 percent of the U.S. population (4).

What are potential causes or risk factors for hypothyroidism? There numerous factors, such as medications, including lithium; autoimmune diseases, whether personal or in the family history; pregnancy, though it tends to be transient; and treatments for hyperthyroidism (overactive thyroid), including surgery and radiation.

The most common type of hypothyroidism is Hashimoto’s thyroiditis (5). This is where antibodies attack thyroid gland tissues. Several blood tests are useful to determine if a patient has Hashimoto’s: thyroid peroxidase antibodies and antithyroglobulin antibodies.

Synopsis

I would like to separate the myths from the realities with hypothyroidism. Does treating hypothyroidism help with weight loss? Not necessarily. Is soy potentially bad for the thyroid? Yes. Does coffee affect thyroid medication? Maybe. Does subclinical hypothyroidism negatively impact cholesterol? There are studies that suggest this. And finally, do vegetables, specifically cruciferous vegetables, negatively impact the thyroid? Probably not. Let’s look at the evidence.

Treatments: medications and supplements

When it comes to hypothyroidism, there are two main medications: levothyroxine and Armour Thyroid. The difference is that Armour Thyroid converts T4 into T3, while levothyroxine does not. Therefore, one medication may be more appropriate than the other, depending on the circumstance. However, T3 can be given with levothyroxine, which is similar to using Armour Thyroid.

What about supplements? A recent study tested 10 different thyroid support supplements; the results were downright disappointing, if not a bit scary (6). Of the supplements tested, 90 percent contained actual medication, some to levels higher than what are found in prescription medications. This means that the supplements could cause toxic effects on the thyroid, called thyrotoxicosis. Supplements are not FDA-regulated, therefore they are not held to the same standards as medications. There is a narrow therapeutic window when it comes to the appropriate medication dosage for treating hypothyroidism, and it is sensitive. Therefore, if you are going to consider using supplements, check with your doctor and tread very lightly.

Soy impact

What role does soy play with the thyroid? In a randomized controlled trial, the gold standard of studies, the treatment group that received higher amounts of soy supplementation had a threefold greater risk of conversion from subclinical hypothyroidism to overt hypothyroidism than those who received considerably less supplementation (7). Thus, it seems that in this small yet well-designed study, soy has a negative impact on the thyroid. Therefore, those with hypothyroidism may want to minimize or avoid soy. Interestingly, those who received more soy supplementation did see improvements in blood pressure and inflammation and a reduction in insulin resistance but, ultimately, a negative impact on the thyroid.

The reason that soy may have this negative impact was illustrated in study involving rat thyrocytes (thyroid cells) (8). Researchers found that soy isoflavones, especially genistein, which are usually beneficial, may contribute to autoimmune thyroid disease, such as Hashimoto’s thyroiditis. They also found that soy may inhibit the absorption of iodide in the thyroid.

Weight loss

Since being overweight and obese is a growing epidemic, wouldn’t it be nice if the silver lining of hypothyroidism is that, with medication to treat the disease, we were guaranteed to lose weight? In a recent retrospective (looking in the past) study, results showed that only about half of those treated with medication for hypothyroidism lost weight (9). This has to be disappointing to patients. However, this was a small study, and we need a large randomized controlled trial to test it further.

WARNING: The FDA has a black box warning on thyroid medications — they should never be used as weight loss drugs (FDA.gov). They could put a patients in a hyperthyroid state and worse, have potentially catastrophic results.

Coffee

I am not allowed to take away my wife’s coffee; she draws the line here with lifestyle modifications. So I don’t even attempt to with my patients, since coffee may have some beneficial effects. But when it comes to hypothyroidism, taking levothyroxine and coffee together may decrease the absorption of levothyroxine significantly (10). It did not seem to matter whether they were taken together or an hour apart. This was a very small study involving only eight patients. Still, I recommend avoiding coffee for several hours after taking the medication. This should be okay, since the medication must be taken on an empty stomach.

Vegetables

There is a theory that vegetables, specifically cruciferous ones, may exacerbate hypothyroidism. In one animal study, results suggested that very high intake of these vegetables does reduce thyroid functioning (11). This study was done over 30 years ago, and it has not been had replicated.

Importantly, this may not be the case in humans. In the recently published Adventist Health Study-2, results showed that those who had a vegan-based diet were less likely to develop hypothyroidism than those who ate an omnivore diet (12). And those who added lactose and eggs to the vegan diet also had a small increased risk of developing hypothyroidism. However, this trial did not focus on raw cruciferous vegetables, which is much needed.

There are two take-home points: try to avoid soy products and don’t think that supplements that claim to be thyroid support are good for you or harmless because they are over the counter and “natural.” In my experience, an anti-inflammatory diet helps improve quality of life issues, especially fatigue and weight, for those with Hashimoto’s thyroiditis.

References:

(1) dictionary.com. (2) nlm.nih.gov. (3) Endocr Pract. 2005;11:115-119. (4) Arch Intern Med. 2000;160:526-534. (5) mayoclinic.org. (6) Thyroid. 2013;23:1233-1237. (7) J Clin Endocrinol Metab. 2011 May;96:1442-1449. (8) Exp Biol Med (Maywood). 2013;238:623-630. (9) American Thyroid Association. 2013;Abstract 185. (10) Thyroid. 2008;18:293-301. (11) Crit Rev Food Sci Nutr. 1983;18:123-201. (12) Nutrients. 2013 Nov. 20;5:4642-4652.

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 medicalcompassmd.com and/or consult your personal physician.

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Stonyfield Organic's O'Soy yogurt tries to fill the void left by WholeSoy's absence.

Stonyfield Organic O'Soy yogurt at Wild By Nature is one option to fill the hole left by WholeSoy.

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A man walked into the emergency room at Stony Brook recently with chest pain. At first, the doctors thought he might have a pulmonary embolism, or a blockage of the main artery in the lungs. It could also have been heart disease.

Unsure of the diagnosis from his symptoms, the doctors performed a procedure called coronary computed tomography angiography. Quickly, they realized the man had 90 percent obstruction of the coronary artery.
“He had a stent put in and he was fixed,” said Mark Henry, a professor and chairman of the Emergency Medicine Department at Stony Brook.

The CCTA test allowed the doctors to perform a procedure that likely kept him from having a heat attack that might have killed him.

Michael Poon, a professor of radiology, medicine and emergency medicine and director of advanced cardiovascular imaging at Stony Brook, helps make this test available seven days a week at the school.

“Dr. Poon deserves a lot of credit,” Henry said. “We’re really happy to be able to offer that to our population.”
Henry estimates that Stony Brook does more CCTAs than any other hospital in the country. Poon advanced the state of the art at the school in terms of imaging, Henry said, while also reducing the amount of radiation exposure to “the lowest possible level.”

Poon published a paper in 2013 showing that this technique saves money and cuts down on time in the emergency room.

“Nine out of 10 times, [chest pain] is a false alarm,” Poon said. “We didn’t have an accurate test to screen out that one out of 10. We ended up admitting everybody because we can’t afford to miss one.”

This test cuts down the length of stay in the ER dramatically, Poon said. Once patients get a clear diagnosis, they don’t tend to return with the same uncertainty to the ER with the same symptoms, Poon said.

Poon’s paper on this method recently won a Minnies award for Scientific Paper of the Year. The Minnies awards provide a way for radiology experts to recognize the contributions of their peers in medical imaging. Poon said he was honored to receive the recognition.

In 2002, Poon became intrigued by the possibilities of this imaging technique when he was at Mount Sinai Hospital. He was involved with research into noninvasive imaging of the coronary artery, the tube that supplies blood to the heart.

“When I saw the early images from Germany using CCTA, I said ‘I have to learn this,’” Poon recalled. He invited the University of Munich team to spend a year with him, during which he learned about the procedure.

The beauty of this test, Poon said, is that it gives a clear diagnosis with the highest negative predictive value among all noninvasive tests. This method is also a way of detecting plaque in the heart, which can be an early indication of heart disease.

In addition to conducting research, Poon sees patients three days a week. “I’m constantly looking for newer and better ways of doing things,” Poon said.

One of the areas he’s currently working on is called enhanced external counter pulsation. He calls the system “exercising without exercising.” It makes it easier to pump blood through the body at the same time that it sends blood back to the heart while it’s resting. “It’s all done automatically,” he said. “You lay there on the bed and the machine does all the work for you.”

This treatment is approved for angina and heart failure, but Poon believes it could improve the health of people who aren’t in cardiac stress. He uses it himself once or twice a week.

Poon suggests that this system enables blood to flow to other areas farther from the heart more easily.
Poon, who maintains an active lifestyle that includes snowboarding, lives in Harrington Park, N.J., with his wife, Mei. The couple have four children, who range in age from 16 to 27. Poon spends four days a week at university housing.

Poon said he believes a combination of early diagnosis, with tools like CCTA, and early intervention is the best way to help his patients.

“Making early diagnosis without offering some help is not that useful,” he said. “Using pills isn’t ideal, either. The best way is lifestyle modification. We can use really good science to do it.”

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By Linda M. Toga, Esq.

We all know that time flies by and that important things are sometimes put on the back burner as we rush around taking care of our day to day responsibilities. We have also all heard heartbreaking stories about people who had every intention of revising their estate plans but, failed to take the necessary steps while they were able to do so. The end result of not having an up-to-date estate plan that reflects their wishes and addresses all of the relevant issues facing their loved ones is sometimes devastating.

To avoid the stress, expense and emotional turmoil that their loved ones could face if they unexpectedly died without revising their estate plans to reflect changed circumstances, I urge my clients to periodically review their estate planning documents. Questions they should ask themselves include whether their named beneficiaries are, in fact, the people they want to inherit their assets. Relationships change, people die, marry and/or divorce, and fortunes come and go. Any one of these events could be the basis for making changes to an estate plan.

For example, if a client’s married son died prematurely without having children of his own, the client may want that son’s share of her estate to pass to her other children. However, if the client was very fond of the son’s wife, she may want her son’s inheritance to pass to the son’s widow. Unless she addressed this contingency when she initially had her Will prepared, the son’s wife will not be in line inherit anything from the client’s estate. Clearly, the death of a child is the sort of life changing event that should prompt a client to review her estate plan. A review and revision may also be appropriate upon the death or incapacity of the individuals who are named as executors, guardians and/or trustees in estate planning documents.

In addition to considering the factors named above, clients should ask themselves the following questions. Are any of their beneficiaries currently receiving government benefits that may be adversely impacted by an inheritance? Since signing their Wills, have any of their beneficiaries died leaving minor issue who may not be responsible enough to handle an inheritance? Do any of their beneficiaries currently have problems with drugs, alcohol or gambling? Have the tax laws changed in such a way that they should consider estate tax avoidance strategies? If the answer to any of these questions is “yes,” I recommend that my clients revise their estate plans to reflect the new reality.

Fortunately, there are ways to protect the inheritance of beneficiaries who are minors, as well as beneficiaries who suffer from disabilities, have drug or alcohol problems or who have creditors knocking on their doors. In addition, provisions can be included in Wills that create trusts designed to insure that the estate is not faced with unnecessary estate taxes and that beneficiaries do not suffer adverse effects from an inheritance. If warranted, planning can also insure a stream of income for a beneficiary who may not be in a position to handle his own finances or provide a mechanism through which a beneficiary may enjoy the exclusive use of an asset without the tax liability that may be associated with its ownership.

Even though revising an estate plan may be as simple as naming a new executor in a Will, certain formalities must be observed for the revisions to be effective and enforceable. Courts generally will not give effect to handwritten changes made to a Will and in some cases, such changes may actually result in the court refusing to admit the Will to probate. Since the result of not having an estate plan that is up-to-date, or having documents that have been improperly altered may be devastating to loved ones, revisions to an estate plan should only be made with the assistance of an experienced estate planning attorney.

Linda M. Toga, Esq. provides legal services in the areas of litigation, estate planning and real estate from her East Setauket office.

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