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Yearly Archives: 2014

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There may be a spectrum of gluten sensitivity

Gluten has been gaining in notoriety over the last several years. When we hear someone mention a gluten-free diet, several things tend to come to mind. One may be that this is a healthy diet. Along the same lines, we may think gluten is bad for us. However, gluten-free is not necessarily synonymous with healthy. There are many beneficial products containing gluten.

We might think that gluten-free diets are a fad, like low-fat or low-carb diets. Still, we keep hearing how more people feel better without gluten. Could this be a placebo effect? What is myth and what is reality in terms of gluten? In this article I will try to distill what we know about gluten and gluten-free diets, who may benefit and who may not.

But first, what is gluten? Most people I ask don’t know the answer, which is OK; it is part of the reason I am writing the article. Gluten is a plant protein found mainly in wheat, rye and barley.

Now to answer the question of whether going gluten-free is a fad. The answer is resounding “No,” since we know that patients who suffer from celiac disease, an autoimmune disease, benefit tremendously when gluten is removed.(1) In fact, it is the main treatment.

But what about people who don’t have celiac disease? There seems to be a spectrum of physiological reaction to gluten, from intolerance to gluten (sensitivity) to gluten tolerance (insensitivity). Obviously, celiac disease is the extreme of intolerance, but even these patients may be asymptomatic. Then, there is nonceliac gluten sensitivity, referring to those in the middle portion of the spectrum.(2) The prevalence of NCGS is half that of celiac disease, according to the NHANES data from 2009-2010.(3) However, many disagree with this assessment, indicating that it is much more prevalent and that its incidence is likely to rise.(4) The term was not even coined until 2011.

What is the difference between full-blown celiac disease and gluten sensitivity? They both may have intestinal symptoms, such as bloating, gas, cramping and diarrhea, as well as extraintestinal (outside the gut) symptoms, including gait ataxia (gait disturbance), malaise, fatigue and attention deficit disorder.(5) Surprisingly, they both may have the same results with serological (blood) tests, which may be positive or negative. The first line of testing includes antigliadin antibodies and tissue transglutaminase. These measure a reaction to gluten; however, they don’t have to be positive to have reaction to gluten. HLA–DQ phenotype testing is the second line of testing and tends to be more specific for celiac disease.

What is unique to celiac disease is a histological change in the small intestine, with atrophy of the villi (small fingerlike projections) contributing to gut permeability, what might be called “leaky gut.” Biopsy of the small intestine is the most definitive way to diagnose celiac disease.

Though the research has mainly focused on celiac disease, there is some evidence that shows NCGS has potential validity, especially in irritable bowel syndrome.

Before we look at the studies, what does it mean when a food says it’s “gluten-free”? Well, the FDA has recently weighed in by passing regulation that requires all gluten-free foods to have no more than 20 parts per million of gluten.(6) The agency has given food manufacturers a year to comply with the new standards. Now, let’s look at the evidence.

Irritable bowel syndrome

Irritable bowel syndrome (IBS) is a nebulous disease diagnosed through exclusion, and the treatments are not obvious. That is why the results from a randomized controlled trial, the gold standard of studies, showing that a gluten-free diet significantly improved symptoms in IBS patients, is so important.(7) Patients were given a muffin and bread on a daily basis.

Of course, one group was given gluten-free products and the other given products with gluten, though the texture and taste were identical. In six weeks, many of those who were gluten-free saw the pain associated with bloating and gas mostly resolve; significant improvement in stool composition, such that they were not suffering from diarrhea; and their fatigue diminished. In fact, in one week, those in the gluten group were in substantially more discomfort than those in the gluten-free group. There were 34 patients involved in this study.

As part of a well-written March 4, 2013 editorial in Medscape, by David Johnson, M.D., a professor of gastroenterology at Eastern Virginia Medical School, he questions whether this beneficial effect from the IBS trial was due to gluten withdrawal or to withdrawal of fermentable sugars because of the elimination of some grains, themselves.(8) In other words, gluten may be just one part of the picture. He believes that nonceliac gluten sensitivity is a valid concern.

Autism

Autism is a very difficult disease to quantify, diagnose and treat. Some have suggested gluten may play a role. Unfortunately, in a study with children who had autism spectrum disorder and who were undergoing intensive behavioral therapy, removing both gluten and casein, a protein found in dairy, had no positive impact on activity or sleep patterns.(9) These results were disappointing. However, this was a very small study involving 22 preschool children. Removing gluten may not be a panacea for all ailments.

Antibiotics

The microbiome in the gut may play a pivotal role as to whether a person develops celiac disease. In an observational study using data from the Swedish Prescribed Drug Register, results indicate that those who were given antibiotics within the last year had a 40 percent greater chance of developing celiac disease and a 90 percent greater risk of developing inflammation in the gut.(10) The researchers believe that this has to do with dysbyosis, a misbalance in the microbiota, or flora, of the gastrointestinal tract. It is interesting that celiac disease may be propagated by change in bacteria in the gut from the use of antibiotics.

Not everyone will benefit from a gluten-free diet. In fact, most of us will not. Ultimately, people who may benefit from this type of diet are those patients who have celiac disease and those who have symptomatic gluten sensitivity. Also patients who have positive serological tests, including tissue transglutaminase or antigliadin antibodies are good candidates for gluten-free diets.

There is a downside to a gluten-free diet: potential development of macronutrient and micronutrient deficiencies. Therefore, it would be wise to ask your doctor before starting gluten withdrawal. The research in patients with gluten sensitivity is relatively recent, and most gluten research has to do with celiac disease. Hopefully, we will see intriguing studies in the near future, since gluten-free products have grown to a $4 billion industry that the FDA now has begun to regulate.

References:

(1) Am J Gastroenterol. 2013;108:656-676. (2) Gut 2013;62:43–52. (3) Scand J Gastroenterol. (4) Neurogastroenterol Motil. 2013 Nov;25(11):864-71. (5) medscape.com. (6) fda.gov. (7) Am J Gastroenterol. 2011; 106(3):508-14. (8) medscape.com. (9) 9th annual AIM for Autism Research 2010; abstract 140.007. (10) BMC Gastroenterol. 2013:13(109).

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 or consult your personal physician.

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28-year-old skeleton racer will go to Sochi, Russia

John Daly competes in the World Cup in Lake Placid in December. Photo by Pat Hendrick

By Daniel Dunaief

Four years ago, he was just happy to be there. Weeks before the world turned its attention to Vancouver for the 2010 Winter Olympics, Smithtown’s John Daly had no idea whether he’d be watching the games from home or representing the country in the high-speed sport of skeleton racing.

Now, Daly, 28, is preparing for his second winter games in Sochi, Russia. He finished 17th in Vancouver and is approaching the competition, which is scheduled for Feb. 14 and 15, with a different attitude.

“I’m confident, I think I could do really well,” Daly said via Skype while in St. Moritz, Switzerland for one of the pre-Olympic qualifying races. “In the last game, I was a long shot. In this one, I’m truly prepared. If ever there was a race to win, it’s this one coming up.”

Daly competes in skeleton racing, where he digs his spiked shoes into an ice track, extends his arm and dives headfirst onto the sled. He races at speeds of more than 80 miles per hour, his chin inches above the frozen track. He steers by shifting his weight slightly, as spectators hear something akin to a freight train seconds before he becomes a bullet blazing down the bluff.

Daly said the four years of training and living have helped him maintain his focus in a race where the difference between a medal and fourth place is measured in hundredths of a second.

Thoughts about the action, the crowd and “how crazy would it be if I medal” may have hurt him in Vancouver.

“That’s when you start to put yourself days and hours ahead. I’m staying in the moment. I will take it one day at a time, one curve at a time.”

Tuffy Latour, the coach of the men’s and women’s skeleton team for the United States, suggested that the focus shouldn’t be on winning medals. Instead, his team needs to have “good starts and good drives” while “believing in themselves.”

As the number of days dwindle until he takes those last deep breaths before diving down the mountain, Daly and his family are preparing for a trip that’s more than 5,200 miles from their home.

His mother, Bennarda, a nurse at St. Catherine of Siena Medical Center in Smithtown, is thinking about “all the silly little things,” including making sure her husband, James, son, James, daughter, Kristen and sister, Sabina Rezza of Kew Gardens, make their flights.

The designers of the Sochi track originally wanted to make the course among the fastest in the world. A fatal accident in Vancouver, however, caused them to redesign their course, which now includes uphill sections that cut down on a slider’s speed.

“They wanted [the racers] to go to 100 miles per hour,” Daly said. “But they slowed it down to 83 miles per hour.” It makes the track especially unforgiving of any mistakes.

“With those uphill sections, you can’t mess up, or it’ll mess up the race,” Daly said. ‘You don’t want to teach perfection, but you need to be pretty close.”

Still, Daly has a short, but encouraging, history with this track. He placed fourth last February in a test run, a mere seven hundredths of a second behind third place. He also finished ahead of Latvian Tomass Dukurs, one of the two brothers who have been the dominant force in skeleton racing.

This year, Daly said, everyone on Team USA, including his friends Matt Antoine and Kyle Tress, has beaten at least one of the powerful tandem.

“It shows they are human,” Daly said. “It’s anyone’s game.”

Latour is encouraged by the way his competitors have performed.

“The Dukurs are beatable,” he said through an emailed statement. “Our team has had some fantastic races despite some small mistakes. If we’re going to beat those guys, we have to be at our best. I think we can get there.”

Daly said the only one of his entourage who might want a medal more than he does is his father James, a retired EMS worker for the FDNY.

The elder Daly said he’s so eager to see his son succeed because “when his dreams come true, so do mine.”
In addition to safety, Bennarda Daly has another goal for her son.

“If he knows he did his best, that’s all that matters,” she said.

James Daly said the agony of standing near the track, watching his son prepare for a race, is almost unbearable.

“You almost don’t know how to act,” he said. “There’s so much I want to do. Clapping my hands is all I can do.”

Daly’s mom plans to bring a cowbell to the other side of the world. Lining the track like pieces of metal drawn to a magnet, spectators shout encouragement and clang their cowbells, amplifying their sound and warming up their arms on mountains where icy winds seem intent on defeating wool sweaters, socks and hats.

Daly’s family and friends have been instrumental in getting him to Sochi, he said. When he needed money or he had to change a plane ticket, no matter what the hour, his father would get it done. Daly said he hopes he’s as helpful to his children some day.

James Daly said he learned how to support his family from his father, the late Joe Daly, a police officer in New York City.

As for what Daly will do after the Olympics, he’s considering a career in advertising.

“That’ll be my first actual job,” he said.

The trail from frozen tracks all over the world to the white-hot lights of the Winter Olympics has included its share of financial, physical and emotional sacrifices. He said he still has unaffordable college loans from Plattsburgh State University, where he was an All-American in the decathlon in 2007.

He has also bumped into walls during competitions and finished the races with bruises or blood dripping down his ankle.

Each year, he missed important personal events, including his mother’s birthday early in January, Thanksgiving and weddings. He couldn’t attend seven weddings in recent years.

Still, the opportunity to race down a mountain and represent the country is worth the trade-off.

“I get to be a kid and ride a sleigh,” he said. “How many other 28-year-olds can say that?”

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While wines are his passion, it was the martinis that changed James Muckerman’s life. Ten years ago, the senior chemist at Brookhaven National Laboratory attended a memorial symposium for the former chairman in his department, Richard Dodson.

Muckerman was at a table with Cal Tech’s Harry Gray, who was the keynote speaker. The waiters had mixed up some of the water pitchers with the martinis, a favorite drink of the late chemistry chairman. As Muckerman described it, a “well-lubricated (Gray) explained the plan to sell the Bush administration on the importance of solar energy.” Gray suggested that everyone in the scientific community ought to get behind this effort.

“By the time he was finished,” Muckerman recalled, “I was ready to sign on the dotted line.”

Muckerman said he didn’t want to continue to burn hydrocarbon reserves, adding to the increase of carbon dioxide in the atmosphere. A goal of artificial photosynthesis that appealed to him was that it recycles the greenhouse gas.

Muckerman and his colleagues investigate new basic photo- and electrochemistry for carrying out the various steps in artificial photosynthesis, which include light absorption, charge separation, water oxidation, hydrogen production and carbon dioxide reduction.

The change in career direction had its risks. Muckerman had become an expert in his field and already had a regular stream of funding for his studies. It was as if he had a long-running show on television and he had to go back to the pilot stage, waiting to see if the early results merited more money.

Fortunately, following his passion and interest in this new area worked out for Muckerman, who dedicates his professional energy to working on artificial photosynthesis as a theoretical chemist.

That means he uses quantum chemistry to figure out the critical but often unknown intermediate steps in between the beginning and end of a chemical reaction.

He works in close collaboration with others in the department who do hands-on laboratory research, including Etsuko Fujita, who is the leader of the artificial photosynthesis group.

The connection between the theoretical and the practical chemistry has “a history of using basic understanding of how chemistry processes work to design better molecules for artificial photosynthesis,” said Alex Harris, the chairman of the chemistry department.

Muckerman and Fujita aren’t just scientific collaborators, but are also partners in life.

Harris said Muckerman and Fujita have an “extremely productive collaboration.” Muckerman developed theories to help explain her results, while also predicting ways to improve her performance. He also was able to learn a new field by working closely with an established experimentalist, Harris added.

Wei-Fu Chen, a research associate at BNL who has worked with both of them, described the team as “solid and highly united and has become the most pioneering in the field of artificial photosynthesis.” On top of that, Chen felt the tandem served as “wonderful supervisors and friends.”

The couple, who live in Port Jefferson, have been together since 1985. Each of them have children from previous marriages, which means all the children “regard us as their parents,” he said. Muckerman said the two of them have an unofficial game of chicken, where the first to leave the lab has to cook dinner.

“I always lose,” Muckerman laughed, although Fujita does the cooking on the weekends.

Muckerman said the couple, whose work travels have allowed them to pursue their shared interest in wine tasting (his favorite is a red burgundy, while she expressed a preference for champagne and Japanese sake), complement each other’s professional interests.

Muckerman praised Fujita’s work ethic. That incredible focus enabled Fujita to earn her doctorate from Georgia Tech in an astoundingly quick two-year period.

In addition to contributing his theoretical chemistry and weekday culinary skills to their partnership, Muckerman also offers editing advice to Fujita and the rest of the artificial intelligence group. “I’ve been correcting the same mistakes in (Fujita’s) English for 30 years,” he said.

Fujita and Muckerman realize what’s at stake in the work they’re doing. Alternative energy, including the use of artificial photosynthesis, is an area that has to succeed, Muckerman said.

“The energy problem,” offered Fujita, who has worked on artificial photosynthesis for 25 years, “is the most important issue in this century.”

Muckerman shared similar sentiments. “I firmly believe that our survival depends on developing new ways to harness clean energy,” he said, “but it’s not going to be easy.”

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Losing weight may decrease AFib episode frequency and duration

Atrial fibrillation is the most common arrhythmia, an abnormal or irregular heartbeat, found in the U.S. Unfortunately, it is very complicated to treat. Though there are several options, including medications and invasive procedures, it mostly boils down to symptomatic treatment, rather than treating or reversing underlying causes.

What is AFib? It is an electrical malfunction that affects the atria, the two upper chambers of the heart, causing them to beat “irregularly irregular,” or with no set pattern affecting the rhythm and potentially causing a rapid rate. The result of this may be insufficient blood supply throughout the body.

Complications that may occur can be severely debilitating, such as stroke or even death. Its prevalence is expected to more than double in the next 16 years (1). Risk factors include age (the older we get, the higher the probability), obesity, high blood pressure, premature atrial contractions and diabetes.

AFib is not always symptomatic; however, when it is symptoms include shortness of breath, chest discomfort, light-headedness, fatigue and confusion. This arrhythmia can be diagnosed by electrocardiogram, but more likely with a 24-hour halter monitor. The difficulty in diagnosing AFib sometimes is because it can be intermittent.

There may be a better way to diagnose AFib. In a recent study, the Zio patch, worn for 14 days, was more likely to show arrhythmia than a 24-hour halter monitor (2). The Zio patch is a waterproof adhesive patch on the chest, worn like a Band-Aid, with one ECG lead.  While 50 percent of patients found the halter monitor to be unobtrusive, almost all patients found the Zio patch comfortable.

There are two main types of AFib, paroxysmal and persistent. Paroxysmal is acute, or sudden, and lasts for less than seven days, usually less than 24 hours. It tends to occur with greater frequency over time, but comes and goes. Persistent AFib is when a patient has AFib that continues past seven days (3). AFib is a progressive disease, meaning it only gets worse especially without treatment.

Medications are meant to treat either the rate or rhythm or prevent strokes from occurring. Medications that treat rate include beta blockers, like metoprolol, and calcium channel blockers, such as diltiazem (Cardizem). Examples of medications that treat rhythm are amiodarone and sotalol. Then there are anticoagulants that are meant to prevent stroke, such as warfarin and some newer medications, dabigatran (Pradaxa), rivaroxaban (Xarelto) and apixaban (Eliquis). The newer anticoagulants are easier to administer, but may have higher bleeding risks in some circumstances with no antidote.

There is also an invasive procedure, ablation, that requires threading a catheter through an artery, usually the femoral artery located in the groin, to reach the heart. In one type of ablation, the inappropriate nodes firing in the walls of the atria are ablated, or destroyed, using radiofrequency. This procedure causes scarring of the tissue in the atria. When successful, patients may no longer need medication. Let’s look at the evidence.

Premature atrial contractions

Premature atrial contractions, abnormal extra beats that occur in the atrium, may be a predictor of atrial fibrillation. In a recent study, PACs alone, when compared to the Framingham AF risk algorithm (a conglomeration of risk factors that excludes PACs) resulted in higher risk of AFib (4). When there were greater than 32 abnormal beats/hour, there was a significantly greater risk of AFib after 15 years of PACs. When taken together, PACs and the Framingham model were able to predict AFib risk better at 10 years out as well. Also, overall when the number of PACs doubled in patients, there was a 17 percent increased risk of AFib.

The role of obesity

There is good news and bad news with obesity in regards to AFib. Let’s first talk about the bad news. In studies, those who are obese are at significantly increased risk. In the Framingham Heart Study, the risk of developing AFib was 52 percent greater in men who were obese and 46 percent greater in women who were obese when compared to those of normal weight (5). Obesity was a BMI >30 kg/m2, and normal weight was a BMI <25 kg/m2. There were over 5,000 participants in this study with a follow-up of 13 years.

The Danish Diet, Cancer and Health Study reinforces these results by showing that obese men were at a greater than twofold increased risk of developing AFib, and obese women were at a twofold increased risk (6).

Now the good news: weight loss may help reduce the frequency of AFib episodes. That’s right, weight loss could be a simple treatment for this very dangerous arrhythmia. In a recent randomized controlled trial, the gold standard of studies, those in the intervention group lost significantly more weight, 14 kg (32 pounds) versus 3.6 kg (eight pounds), and saw a significant reduction in atrial fibrillation severity score compared to those in the control group (7). There were 150 patients involved in the study.

AFSS includes duration, severity and frequency of atrial fibrillation. All three components in the AFSS were reduced in the intervention group compared to the control group. There was a 692-minute decrease in the time spent in AFib over 12 months in the intervention arm, whereas there was 419-minute increase in the time in AFib in the control group. These results are potentially very powerful; this is the first study to demonstrate that managing risk factors may actually help manage the disease.

Caffeine

According to a recent meta-analysis (a group of six population-based studies) done in China, caffeine does not increase, and may even decrease, the risk of AFib (8). The study did not reach statistical significance. The authors surmised that drinking coffee on a regular basis may be beneficial because caffeine has antifibrosis properties. Fibrosis is the occurrence of excess fibrous tissue, in this case, in the atria, which most likely have deleterious effects. Atrial fibrosis could be a preliminary contributing step to AFib. Since these were population-based studies, only an association can be made with this discovery, rather than a hard and fast link. Still this is a surprising result.

However, in those who already have AFib, it seems that caffeine may exacerbate the frequency of symptomatic occurrences, at least anecdotally. With my patients, when we reduce or discontinue substances that have caffeine, such as coffee, tea and chocolate, the number of episodes of AFib seems to decline. I have also heard similar stories from my colleagues and their patients. So think twice before running out and getting a cup of caffeinated coffee if you have AFib.  What we really need are RCT studies done in patients with AFib, comparing people who consume caffeine regularly to those who have decreased or discontinued the substance.

The bottom line is this: if there were ever a reason needed for obese patients to lose weight, treating atrial fibrillation should be on the top of the list, especially since it is such a dangerous disease with potentially severe complications.

References:

(1) Am J Cardiol. 2013 Oct. 15;112:1142-1147. (2) Am J Med. 2014 Jan.;127:95.e11-7. (3) Uptodate.com. (4) Ann Intern Med. 2013;159:721-728. (5) JAMA. 2004;292:2471-2477. (6) Am J Med. 2005;118:489-495. (7) JAMA. 2013;310:2050-2060. (8) Canadian J Cardiol online. 2014 Jan. 6.

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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The Russian Orthodox Monastery of the Holy Cross on Main Street. File photo by Rachel Shapiro

By Mallika Mitra

A Boy Scout at Ward Melville High School has completed an Eagle service project that beautifies and benefits the Russian Orthodox Monastery of the Holy Cross on Main Street in East Setauket. Justin Russo, 15, got a gazebo donated by John T. Mather Memorial Hospital installed at the church.

Justin said he was on his way home from searching for possible projects when he decided to see if the church could find something for him to work on. Father John, a priest at the Brotherhood of the Holy Cross, explained to Justin that the church used to baptize under a tree that was destroyed by Hurricane Sandy, and that they were looking for a gazebo for baptisms.

The 10th-grade Boy Scout of Troop 117 began searching for a gazebo for the church.

When he called Gera Gardens in Mount Sinai, he was told that they had sold a gazebo to the hospital and that the hospital was now getting rid of it. With the help of his father, the assistant Scoutmaster of the troop who knew a Mather Hospital board member, Justin was able to get the gazebo donated to the church.

They hired East Setauket-based Hurricane Tree Experts Inc. to remove the stump of the tree that had been there since the tree was destroyed during Hurricane Sandy and a local roofing company to restore the gazebo’s roofing.

Justin was able to raise money by collecting donations from friends and family.

“Thankfully I had a lot of support,” he said.

He worked after school and on the weekends doing paperwork and completing business transactions for the service project, with the help of his father.

At the end of November, the Boy Scout organized younger members of his troop to help put in and power wash the gazebo, and put in new banisters and railings, which were destroyed when they got the gazebo from Mather Hospital.

“To teach, you’ve got to be a good leader,” Justin said about organizing the younger Scouts to help him with his project, and added that working with the younger boys was a great experience.

The original plan was to stain the gazebo as well, but they ended up not doing so because “The people at the church said it was perfect the way it was,” Justin said.

Now that the project is completed, Justin, who has been a Boy Scout for about six years, still keeps in touch with Father John at the Brotherhood of the Holy Cross. He said that because he still has some funds left over from the project, he will be able to help Father John with future projects related to the gazebo, if they come up.

The Boy Scout still has a few tasks to finish before he officially becomes an Eagle Scout, but his service project is now complete.

“It was a really good experience,” he said. “I’ve never been involved in anything like it.”

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Betty Bezas celebrated her birthday on Christmas

Betty Bezas photo by Mallika Mitra

By Mallika Mitra

In her 101 years of life, Betty Bezas has seen a lot of the world. Bezas, who just celebrated her birthday on Christmas Day, was born on Dec. 25, 1912, in Greece, where she lived until she was 15 years old.

After her father died in a fire when she was only 1 month old, Bezas lived with her mother, grandmother and uncle.

On Oct. 20, 1929, she had an arranged marriage to Zachary Bezas in Salonika, a city in northern Greece. After honeymooning in Paris, the couple moved to the United States, where Bezas knew no one but her husband’s family.

On Oct. 28, 1930, Bezas gave birth to her first of three daughters. Her daughters Catherine Krusos, Irene Usher and Loretta Janelis currently live in Huntington, Setauket and South Carolina, respectively.

With five grandchildren, 10 great-grandchildren and twin great-great-grandchildren expected any day now, Bezas is excited to have five generations in the family.

When she first came to the United States, Bezas lived in Brooklyn where her husband worked in a bank until he lost his job during the Great Depression. The couple then moved to Dix Hills, where Bezas worked as an assistant district manager in food services at the Half Hollow Hills school district for 25 years, and her husband ran a chicken farm. His business of selling eggs and chickens lasted until the beginning of World War II, when he went to work at Republic Aviation in Farmingdale, an aircraft manufacturing company that is now Republic Airport.

When her husband died of leukemia, Bezas moved to North Babylon and now lives at Sunrise Senior Living in East Setauket.

Bezas loves to travel and has done quite a bit of it, including trips to Italy, France, Spain and Canada.

“You see all different cultures. You learn a lot,” Bezas said. “People who live in every country have something to offer.”

In her spare time, Bezas likes to crochet and knit. For much of her life she has made hats and blankets for premature babies, which she donates to hospitals, and blankets for senior citizens.

Bezas celebrated her 101st birthday with fellow Sunrise residents and friends from the Greek Orthodox Church of the Assumption in Port Jefferson, where she is a member. She has also been a member of Saint Paraskevi Greek Orthodox Shrine Church in Greenlawn for more than 50 years.

Of the Sunrise staff members who organized her birthday party with decorations, good food and many friends — “They went out of their way,” Bezas said.

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Frustration was mounting as the rejections poured in. His finding could potentially force a rewriting of textbooks and a rethinking of conventional wisdom on something near and dear to people: human evolution.

Sergio Almécija, a researcher in the Department of Anatomical Sciences at Stony Brook Medical School, had used state-of-the-art three-dimensional imaging to look at the femur (the thick thigh bone) of so-called Millennial Man, a fossil that was discovered in 2000. His finding was sufficiently different from what other scientists believed that some of them probably figured he was wrong, he said.

The bone was from an ape that lived about six million years ago, during the end of the Miocene period. These extinct apes haven’t exactly commanded the spotlight, especially in human evolution. Chimpanzees, who are the most closely linked to humans in DNA resemblance, are considered the most likely human cousins.

An analysis of this femur, however, suggests that human ancestors may have looked less like an earlier version of chimpanzees and more like a version of a fossil ape that doesn’t exist today.

Millennial Man, who was bipedal, is widely accepted as an early member of the human lineage, Almécija said. In the past, it was considered human-like in this femur bone. It has also been considered more similar to Australopithicus, like Lucy, and in between living apes and modern humans.

This study, however, shows that the femur is intermediate in time and shape between Lucy and previous apes that lived in the Miocene period, but not to chimpanzees.

“Our study shows that we should focus more attention on and understand those ancient fossil apes,” Almécija said.

He compared the femur of Millennial Man, known by its scientific name as Orrorin tugenensis, to all the living apes — gibbons, siamangs, orangutans, gorillas and chimps, as well as to modern humans, fossil humans and fossil apes. “I believe Orrorin represents a very good model of how the earliest bipeds would look,” he said.

The research paper has been translated into several languages, with people from the United States, Spain and France contacting the Stony Brook professor to discuss the implications of his finding.

Almécija came up with this idea about the apes back in 2010, but it took almost three years to find a publication that would share his work. “We tried to publish this in other journals, but some wouldn’t even allow us to share this with reviewers,” he said.

In some ways, what didn’t kill the idea made it stronger, Almécija suggested. Each rejection created an opportunity to improve the work and clarify the message. The paper has evolved and the researchers have learned a great deal along the way, he said.

Almécija received the support of department chair William Jungers, a distinguished teaching professor in Anatomical Sciences at Stony Brook Medical School. Jungers discussed the results and encouraged Almécija to continue to move forward, despite the roadblocks.
Calling Almécija’s data, methods and results “novel, refreshing and profound,” Jungers said he “offered encouragement and some suggestions to improve his message because I was confident that reason and good science would ultimately prevail. And it did.”

Jungers suggested that textbooks will need to move away from the idea that living apes are the best window into early human evolution. Living apes, he continued, are specialized because they’ve been evolving for millions of years.

The chimpanzee is not a time machine that allows humans to look at a living ancestor. Miocene apes are much better candidates for what human ancestors likely looked like, Jungers said.

When the paper finally moved closer to publication, Almécija celebrated with members of his department, including his girlfriend Ashley Hammond, who is a research instructor. “She knows how hard it was for me to get this thing through,” Almécija said of Hammond, who lives with him in Port Jefferson. When the couple met two years ago while they were both working at the American Museum of Natural History, Almécija was already conducting an analysis of the femur.

The couple, who enjoy the beaches and being close to water, is thrilled to be a part of the Anatomical Sciences Department at Stony Brook, which Almécija described as the “top department in the world in functional morphology and human evolution.”

As for the next step with his research, Almécija said he wants to “understand the evolutionary changes in the skeleton of fossil apes and early hominins. Connecting the dots between a chimp and a human is not going to tell us most of the story, but only the last chapter of the book.”

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Guidelines loosen initial levels for blood pressure treatment

A few weeks ago, a patient walked in to my office with a newspaper article touting the release of new guidelines for the treatment of hypertension, or high blood pressure. The patient wanted to get my feedback on these guidelines released on Dec. 18, 2013, by the Eighth Joint National Committee (JNC 8). The big change is that treatment levels are relaxed. The previous version, JNC 7, was released a decade ago in 2003. Usually they are updated every five or six years, and it has been 10.

My initial reaction was excitement: the JNC 8 was trying to avoid the pitfalls of overtreatment, especially for older patients and those with diabetes and/or chronic kidney disease. However, it’s more complicated than that.

High blood pressure may lead to unwanted consequences, such as cardiovascular events (strokes and heart attacks), heart failure and premature death. The goal of treatment, whether with medication and/or lifestyle changes, is to prevent these complications from developing and, ultimately, lowering risk. Does raising the initial treatment levels impact these goals? Let’s look at the guidelines in more detail.

Previously, anyone with a blood pressure >140/90 mmHg was considered to have elevated levels. However, this is not the case with JNC 8 (1). According to the guidelines, people who are greater than 60 years old should not start blood pressure medications until their levels are >150/90 mmHg. Thus, the parameters for the treatment of systolic blood pressure, the top number, representing blood pumping from the heart to the rest of the body, was relaxed by 10 mmHg. The authors warn that this is not an opportunity to let the SBP rise above 150 mmHg. If you already are well controlled with blood pressure medications, the authors advise not changing the regimen.

For those who have diabetes or chronic kidney disease, the target goal for treatment also became more lenient, rising from a SBP of <130 mmHg to a suggested level of <140 mmHg. To make things a little more confusing, the guidelines go on to say that it is unclear what the cutoff for SBP should be to start treatment for those under 60.

There was dissension in the JNC 8 ranks relating to age. Though the American Society of Hypertension and the International Society of Hypertension agree that the initial treatment target should be changed, it should only be changed for those who are greater than 80 years of age, not older than 60 (2).

The reason for the less strict cutoff to treat high blood pressure is based on the dearth of randomized controlled trials for those who are greater than 60 years of age. In fact, there are only two RCT studies for this age group and only one RCT for patients greater than 80 years old. Obviously, we need more studies that focus on older populations, especially since our population is aging. Also, ironically, JNC 8 loosened SBP treatment levels for the population at greatest risk. Approximately two-thirds of patients greater than 60 years old will develop high blood pressure (3).

The easing of guidelines with diabetes patients was influenced by the results from the ACCORD trial, a large RCT (4). One part of the trial involved researchers looking at intensive treatment of SBP with medications to levels <120 mmHg. The goal was to reduce the risk of cardiovascular events. There were over 4,500 patients involved in this investigation into intensive blood pressure treatment over 4.3 years. After the first year, although they achieved the goal of a SBP of <120 mmHg in the intensive group, clinical outcomes did not pan out. Results showed no significant reduction in death from any cause between the intensive group and the standard treatment group. The conclusion was that intensive therapy had no more benefit than standard therapy for fatal and nonfatal cardiovascular events, though there were significantly more side effects with intensive therapy. This was disappointing.

Dr. Harlan Krumholz, professor of medicine and director of the Yale-New Haven Hospital Center for Outcomes Research and Evaluation, wrote an intriguing article in the New York Times on Dec. 18, 2013, entitled “3 Things To Know About the New Blood Pressure Guidelines” (5). I want to highlight his third point: even though we may lower blood pressure with medications, specifically borderline high blood pressure, it may not reduce subsequent risk of premature death, stroke or heart attacks.

To reduce the risk of cardiovascular events, there are several factors involved. To learn more, please look at my March 13, 2012, article entitled “Seven highly effective habits for preventing heart disease.” Of course, normal blood pressure of <120/80 mmHg is only one component in making cardiovascular disease much less significant (6).

There are a number of studies that show the impact that lifestyle modifications may have on hypertension. A recent population-based study involving over 3,000 participants in Sicily looked at different levels of adherence to the Mediterranean-type diet. Those who were in the top third for compliance noticed significant reductions in the risks for high blood pressure, diabetes and obesity (7). Though population studies are not as stringent as randomized controlled trials, they still can provide an association between diet and potential reduction in disease risk.

In the Nurses’ Health Study, those who followed a healthy lifestyle, including a nutrient-dense approach with significant amounts of fruit and vegetables called the DASH (dietary approaches to stop hypertension) diet, saw an 80% reduction in the risk of developing high blood pressure (8). Though this is an observational study, it is a very large trial with more than 80,000 women followed over a long duration of 14 years.

Though medications may help reduce SBP levels, they may or may not alter the clinical outcomes. Also, the lack of clinical trials in older patients suggests that the new JNC 8 guidelines are an improvement. I am especially impressed with their emphasis on lifestyle modifications; studies indicate that a nutrient-dense diet may reduce SBP to normal levels with hypertension and prevent high blood pressure for those who have yet to develop the disease.

I don’t agree that older patients should live with higher SBP levels just because we don’t have enough studies showing benefit with medications. Nutrient-dense diets, such as the Mediterranean-type and DASH diets, have shown potentially powerful effects with blood pressure control in the population at large. Thus, it behooves physicians to discuss and stress lifestyle changes, such as diet, exercise and smoking cessation. Patients should not stop blood pressure medications without first discussing it with their doctors. These are only guidelines, and each case may be different.

References:

(1) JAMA online. 2013 Dec. 18. (2) J Hypertens. 2014;32:3-15. (3) Circulation. 2013;127:e6-e245. (4) N Engl J Med. 2010;362:1575-1585. (5) nytimes.com. (6) N Engl J Med. 2012;366:321-329. (7) Nutr Metab Cardiovasc Dis online. 2013 Nov. 1. (8) JAMA. 2009;302:401-411.

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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By Mallika Mitra

Three eighth-grade girls in the Huntington school district have made a difference this holiday season by raising money for the Make-A-Wish Foundation of Suffolk County.

Maggie Giles, Erica Vazquez, and Gaia D’Anna, who attend J. Taylor Finley Middle School, have spent the past several weeks selling holiday cards at the school. The girls raised more than $1,000, which has been sent to Make-A-Wish, an organization that grants the wishes of children diagnosed with life-threatening medical conditions.

Finley PTA President Julie LaBella said Vazquez was watching a television show a little over a year ago in which a Make-A-Wish child had her wish granted, according to a school press release. The story inspired her to start this fundraiser with her two friends. This is the second year the girls have sold the holiday cards, which exhibit original work by Patrick Giles, Maggie Giles’s father.

Finley students Gaia D’Anna, Maggie Giles and Erica Vazquez. Photo from Jim Hoops
Finley students Gaia D’Anna, Maggie Giles and Erica Vazquez. Photo from Jim Hoops

Last year, the girls raised $350. This year the girls’ original goal was $700, but they surpassed that and made more than $1,000, LaBella said.

“They are an amazing group of girls,” LaBella said in the press release. “It’s so refreshing to see young kids put so much effort into such a wonderful cause.”

The girls have received help from their parents, Finley Middle School Principal John Amato and Sharon Holly, a family and consumer science teacher at the school.

According to LaBella, the cards that the girls have been selling are popular with kids, teachers and parents. The eighth-graders sold so many cards that a second printing was required.

Jim Polansky, the Huntington school district superintendent, bought a package of cards from the girls.

“When listening to Gaia, Maggie and Erica describe their efforts, their caring, compassion, and selflessness simply jumped off the page,” Polansky said in a phone interview. “It was easy to discern how much they wish to make a difference. I was beyond pleased to purchase a package of cards and help contribute to their initiative, which was to do what they could to brighten the lives of others through the Make-A-Wish Foundation.”

Jim Hoops, the Huntington school district public information coordinator, said he believes the girls plan to make this fundraiser an annual event during the holiday season.

“This is an account of three incredible young people who are destined to make a difference,” Polansky said in a statement. “It is refreshing and energizing to speak with them about the initiative, to learn how much it means to them, and how readily they will place the needs of others before their own.”

The Make-A-Wish Foundation relies on donations from fundraisers, such as the one Maggie, Erica and Gaia hosted, to grant wishes and change lives.

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Members of UNICO Islip/Smithtown with the Good Samaritan Hospital staff at an Easter event. Photo from Joan Alpers

By Mallika Mitra

While educating their communities on Italian culture and heritage, UNICO members participate in civic engagement to help those in need. And last month, the Islip/Smithtown chapter of UNICO celebrated its 10th anniversary.

Dr. Anthony P. Vastola, who was discriminated against in the United States because he was Italian, founded UNICO  — meaning “unique” in Italian — in 1922. The nationwide organization is focused on funding education of Italian heritage and language, research for cancer and Cooley’s anemia — a type of anemia that occurs in people of predominantly Mediterranean descent — and grants for people with mental challenges, said Pat Pelonero, the office manger of UNICO national and editor of the organization’s publication.

The group also promotes positive images and opposes negative stereotypes of Italian Americans.

According to Pelonero, the 128 chapters of UNICO hold their own events, which range from pasta dinners to gala balls, but all donate to national causes.

Members of the North Shore chapter and Islip/Smithtown chapter, which are within the same district, attend one another’s events, said Ellen Leone, president of the North Shore chapter.

The Islip/Smithtown chapter, chartered in 2003, holds fundraisers and events throughout the year for the Smithtown Emergency Food Pantry, the Bay Shore United Methodist Church’s soup kitchen, the Good Samaritan Hospital Medical Center Pediatric Unit, among others, said Elizabeth Hansen, president of the UNICO Islip/Smithtown chapter.

The chapter also funds six scholarships for high school students of Italian descent.

According to Hansen, some of the fundraising events throughout the year include wine tasting and raffles, but their main fundraising event is an annual golf outing that takes place in July. The UNICO Islip/Smithtown chapter meets once a month at La Famiglia Italian Restaurant in Smithtown, where the members welcome Italian language lessons and speakers who discuss Italian heritage.

Hansen said her family members in Pennsylvania have been UNICO members for generations and convinced her to join her local chapter.

Pat Westlake, the executive coordinator of the Smithtown Emergency Food Pantry, said of UNICO, “They’re very caring people. They always ask what we need help with.”

The chapter’s members also visit the pediatric unit at Good Samaritan Hospital at Easter, when a member of the chapter dresses up as a bunny and passes out stuffed bunnies to all the children.

“It is even more stressful for children and their families when children are hospitalized [during the holidays]” said Joan Alpers, the director of the Child Life Program at the hospital, and UNICO members recognized that and wanted to help out.

It is “a group that loves to give back to the community,” Alpers said.

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