Blast from the Past:
Do you know where this bowling alley was located? Do you know when it was built and how long it was in existence? Email your answers to [email protected]. To see more wonderful vintage photographs like this, visit The Ward Melville Heritage Organization’s ongoing exhibit, It Takes a Team to Build a Village, at The WMHO’s Educational & Cultural Center, 97P Main Street, Stony Brook. For more information, call 631-751-2244.
The Mustang and Shelby Club of Long Island will present its 9th annual Mustang Car Show at the Port Jefferson Village Center, 101 E. Broadway, Port Jefferson Sunday, Aug. 28 from 10 a.m. to 4 p.m. Over 50 cars from 1965 to present will be on view inside and outside the center with live music by Our Generation (’60s, ’70s, ’80s rock and roll). Free admission. Sponsored by the Port Jefferson Conservancy and Ramp Ford. For more information, call 631-371-1432 or 631-802-2160.
By Daniel Dunaief
Wei Zhu’s long personal and professional journey began in China. Devoted to her mother, Shenzhen Du, Zhu watched her hero fight through a long illness with chronic kidney disease. Shortly before she died, her mother woke from a coma and suggested that her daughter become a doctor, like the people who were helping her in the hospital.
Driven to fulfill her mother’s request, Zhu attended college where, despite aspirations to become a writer like Charles Dickens or Charlotte Bronte, she studied math. She found the subject challenging but stuck with it. “Math was absolutely hard work,” she recalled. “We had to devote longer time to our study than many other majors. It all paid off in my case.”
Indeed, after she completed a one-year graduate program in math, she and her husband, Yeming Ma, came to the United States, where she used her experience in math to explore ways to understand how statistics can provide a perspective on everything from drug dosage to global warming to the causes of cancer.
“You can use math to improve people’s health,” said Zhu, who is now the deputy chair and professor in the Department of Applied Mathematics & Statistics at Stony Brook University.
At the beginning of the year, Yusuf Hannun, the director of the Stony Brook Cancer Center, emailed Zhu to ask her to pitch in to help understand a major question about cancer. In the prestigious journal Science, several researchers had concluded that the “bad luck” hypothesis suggested cancer was something that was written in a person’s genes. This scientific conclusion was akin to suggesting that a character’s fate in a play may have been written in the stars.
Hannun, Song Wu, an assistant professor in her department, Scott Powers, a professor in the Department of Pathology and Zhu came to a different conclusion, which they published in the equally prestigious magazine Nature.
Putting the data and the theory together, the group suggested that lifestyle choices and environmental exposure were also instrumental in this disease. The argument is the equivalent of nature versus nurture for a deadly disease.
“We were able to quantify what we observed,” Zhu said. For most cancers, the group concluded, the majority of the risk was due to lifestyle and environmental factors other than pure intrinsic genetic mutations. The disease debate, scientists recognize, doesn’t end there.
“The entire cancer research community still has a long way to go in order to perfectly understand the causes, prevention and treatments for each cancer, for each individual,” Zhu explained.
Hannun suggested that the direction cancer research is going requires advanced expertise in several areas of applied mathematics, physics and related disciplines. These are now needed for working with large data sets, for modeling pathways and events and for generating new hypotheses and organizing principles, Hannun wrote in a recent email. Hannun described Zhu as “terrific, highly dedicated and very collaborative” and suggested that the work has been “rewarding.”
Zhu is hoping that the recent Nature publication will trigger additional funding to support more research with this team of Stony Brook University scientists.
Wu, who was the first author on the Nature article, described Zhu as “well respected in the scientific community. She has done a lot of work on the analyses of brain image and proteomics data,” he wrote in an email.
Throughout her career, Zhu has sought to use statistics, bioinfomatics and other modern tools to enhance a scientific understanding of complex questions. She recently worked with Ellen Li, a professor of medicine and chief of the Division of Gastroenterology and Hepatology at Stony Brook University School of Medicine, who wanted to understand the development of digestive diseases such as inflammatory bowel disease and colon cancer. Putting the numbers together could provide the kind of information that offers an understanding of how lifestyle and food choices contribute to some diseases over time, Zhu said.
“We have published several papers together over the years,” Zhu said. “We are still in the data collecting stage for the diet analysis.” In her career, which spans 24 years, Zhu has worked on a wide range of topics. She has helped analyze data on the regions of the brain that are active in addiction and helped refine and enhance global climate models. In her early work, she also help pharmaceutical companies come up with optimal drug dosage. Numbers have been a part of Zhu’s life wherever she goes. “You do see numbers in the air,” she said. “When it’s getting hot,” she asks, “what does it have to do with my climate model? Does it fit the data?”
In more recent years, Zhu has struggled with the tension between contributing to larger projects and budgetary constraints. She worries that the “funding situation has changed the dynamics of the job market for the young generation of statisticians,” she said. “Now the majority of my doctoral students hope to focus their research on financial models, instead of biological models.”
Zhu and her husband Ma, who is a financial manager for GE, live in Setauket. Their son Victor, 24, recently earned his graduate degree in finance, while their daughter Merry, 11, attends Mount Elementary School. Zhu appreciates living on Long Island, where she can be close to the ocean.
As she looks back on the developments in her life that brought her to this point in her career, Zhu recognizes that the decision to learn more about math and statistics provided her with the kind of background that allowed her to fulfill her mother’s wish. “I can always honestly tell young students that it is a good idea to choose mathematics or statistics as their undergraduate majors,” she said. It will pave the way for them to have “a solid foundation for a variety of future graduate studies.”
By Joseph Wolkin
A new administrator will be walking the halls of Commack High School next week.
Michael Larson was appointed assistant principal of Commack High School this week, after working at the school since 2007.
Larson said he has been set on being an educator since he graduated high school.
Growing up, Larson wasn’t sure what he wanted to do in life. Over time, his love for American history developed into a greater passion for social studies, and eventually it led to him wanting to share his knowledge with others.
Working through the rankings at Commack High School since 2007, Larson went from serving as a secondary social studies teacher, to teaching history, economics and government to being named the school’s newest assistant principal.
Effective Aug. 15, Larson took over the position previously held by Commack High School’s newest principal, Leslie Boritz.
“I’m honored and humbled and honored to serve Commack in this capacity,” Larson said. “One of the things I’ve learned about working in this district for the past few years is that the leaders work very closely together.”
Last year, Larson was promoted to coordinator of student affairs, a position he says helped develop his friendship with Boritz. The job consisted of overseeing discipline and attendance, working with students who have conduct or attendance issues, along with any potential problems with student life at the high school.
“His experience working one-on-one as both a class and student council advisor and as coordinator of student affairs and attendance has provided insight into the culture and views of our children at the high school.”
—Donald James
No longer in the classroom when he was given the new role, Larson admittedly missed developing relationships with kids, which he worked with for 180 days out of the year. However, he said he was able to find a way to still connect with Commack students, even if he was no longer in the classroom with them.
“Having those experiences last year really helped advance my development as an administrator,” Larson said. “The fact that I’m now working as an assistant principal with some of the people who played an instrumental role in my development is truly a blessing.”
The Stony Brook native attended Stony Brook University for his undergraduate degree in 2004, and received a graduate degree from Plymouth State University in special education in 2006.
Superintendent Donald James said Larson will do great things for Commack.
“Michael is a dynamic educator, who is compassionate and committed to our students,” he said in an email. “His experience working one-on-one as both a class and student council advisor and as coordinator of student affairs and attendance has provided insight into the culture and views of our children at the high school. Michael’s commitment to the students, their parents and his fellow staff members is evident in his many accomplishments at Commack High.”
The decision to make Larson the school’s newest assistant principal, along with naming Boritz as the principal, was part of a ripple effect caused by the retirement news of Commack’s last principal, Catherine Nolan.
In June, Boritz was named as the school’s new principal, replacing Nolan, who retired after holding the position for the last five years. She was the assistant principal at the school since July 2011, in addition to serving as the assistant principal of Commack Middle School for 11 years.
According to U.S. News and World Report, Commack High School is ranked as the 87th best high school in New York out of over 1,200 listed.
Larson lives in Stony Brook and will continue making the approximately 20-minute commute daily to the school that has given him the opportunity to advance in the education world. For that, he said he is indeed thankful.
“The priority for me this year is the continuation of the excellence that has come to represent the Commack School District,” he said. “I want to make efforts to continue an excellent program that’s great in athletics, academics, extracurricular and co-curricular, and expand on the opportunities we’re presenting our students and enhance them as we move forward.”
By Dan Aronson
Smithtown native Brendan Martin, 27, is set to make his debut in the New York City Marathon this November.
“It’s one [race] I feel like I have to do before I retire from competitive running,” Martin said. “It’s my hometown race.”
This 26.2 mile-marathon is one the most popular races in the United States. It draws runners and spectators from all over the world, and takes competitors through all five boroughs of New York City. The race was first held in 1970, with only 127 runners competing.
Martin did not find his passion for running until high school — he always thought he would be a big lacrosse player. The Smithtown resident played lacrosse competitively until the end of 10th grade and then decided to put it aside so he could focus on running.
His father Bill Martin said one of the reasons he made the switch from lacrosse to running was his size.
“The only thing that has hampered him, in pretty much anything he has done, is his size,” the father said.
Both of Martin’s parents will be attending the race in November and are very excited to see how he performs.
“I don’t think I can keep my wife away,” Bill Martin said. “[Brendan] has taken things to a whole new level. We are not surprised he has made it this far. He works very hard towards his goals and has done that since high school — he puts together a good plan and executes it.”
Len Carolan, Martin’s coach at Smithtown High School West, had a significant impact on the runner. He has now been retired for eight years, but still keeps in touch with Martin.
“When I first met Brendan, he was so enthusiastic about running and I knew he was going to be something special” Carolan said. “His love of running and his desire to do well, plus his talent, is what really makes Brendan stand out. He was by far the most talented runner I ever coached.”
Martin led his cross-country team at Smithtown to three consecutive Suffolk County championships from 2003-06. He clearly set his team up well for future years, as without him the Bulls went on to win the title in 2007. The Bulls teams in 2007 and 2008 also won back-to-back divisional championships.
“He was instrumental in getting us to that competitive level,” Carolan said.
And Martin has similar feelings for his old coach.
“When I first met Brendan, he was so enthusiastic about running and I knew he was going to be something special.”
— Len Carolan
“He gave me a good feeling about running,” Martin said of Carolan. “He made it really fun and team-oriented for us. That made it a blast. He was really good at coaching the fundamentals, working hard, being dedicated and working together with your teammates, and I think that really stuck with me.”
Each athlete prepares himself in a different way, and for Martin, that’s running year-round.
He said he spends eight to nine weeks preparing for the race. In the first five to six weeks, he runs about 120 to 130 miles a week. Once he gets closer to race day, Martin said he tries to run 20 to 22 miles per day, at marathon pace.
“I’m going to make sure I’m doing a lot of hills in my training, because New York is a notoriously difficult course, with lots of ups and downs,” Martin said.
But that doesn’t mean he’s not up to the task.
“I need to study on my own a little bit what to expect, and as long as I do that and I run patiently — very tough at the end — I expect to do pretty well,” he said.
The unique challenge that comes with running in the marathon is that you can’t run the course in preparation, because the only time the roads are closed is for the marathon.
He’s still ready to take on the course, and is looking forward to taking on New York City.
“A hilly race suits my strengths and as long as I run smart, have good confidence in myself,” he said, “[I could] be one of the top Americans and hopefully the top New Yorker.”
As summer comes to an end and the reality of back-to-school season sets in, it can be challenging to get organized and jump back into your day-to-day routine. But even as things get hectic, it’s still possible to create delicious dishes — such as Pan-Roasted Maple Dijon Chicken and Chicken Thighs and Tomatoes — that leave you plenty of time to savor meals together as a family.
Chicken Thighs and Tomatoes
YIELD: Serves 4
INGREDIENTS:
1 pint cherry tomatoes
pepper
kosher salt
olive oil
4 chicken thighs (skin-on, bone-in)
1 cup white wine
1 clove garlic
1 lemon, juice only
DIRECTIONS: Heat oven to 400 F. In cast iron skillet, toss tomatoes with pinch of pepper, kosher salt and light drizzle of olive oil and place in oven. Roast tomatoes for 20 minutes. Set aside. Heat skillet on stove top. Once hot, sear chicken thighs. Flip chicken and sear bottom side for about 1 minute. Remove chicken from pan and set aside. With pan still hot, pour in white wine. Once wine has settled, add minced garlic. Add juice of one lemon. Return chicken thighs and tomatoes to skillet. Bake for 35 to 40 minutes and serve.
Source: Edna Valley Vineyard
Pan-Roasted Maple Dijon Chicken with Butternut Squash and Brussels Sprouts
YIELD: Serves 4
INGREDIENTS:
1 tablespoon olive oil
4 chicken thighs
4 chicken drumsticks
3/4 teaspoon kosher salt
1/2 teaspoon freshly ground pepper
1 tablespoon unsalted butter
16 Brussels sprouts (about 8 ounces), bottom trimmed, outer leaves removed and halved
2 cups diced (1/2 inch) butternut squash
1 1/2 cups chicken stock
2 tablespoons maple syrup
2 teaspoons Dijon mustard
DIRECTIONS: In saute pan large enough to hold chicken in single layer, heat olive oil over medium-high heat. Season chicken with salt and pepper. Add chicken to pan, skin side down, and saute about 4 to 5 minutes per side, or until chicken is browned. Remove chicken from pan and reserve. In same pan, add butter. Allow butter to melt over medium heat. Add sprouts and squash to pan and saute, tossing occasionally, until outsides are golden brown, about 3 to 4 minutes. Remove from pan and hold separately from chicken.
Turn heat to high and add stock, syrup and mustard. Stir and bring to boil, stirring to scrape up brown bits on bottom of pan. Add chicken back to pan, cover and reduce heat to medium-low. Cook over medium-low heat 20 to 25 minutes, or until chicken registers 170 F with instant read thermometer. Add vegetables back to pan, cover again and cook another 8 to 10 minutes until vegetables are tender. Move chicken and vegetables to serving platter, placing vegetables around chicken. Turn heat to high and boil sauce until it is reduced and slightly thickened, about 2 to 3 minutes. Spoon sauce over chicken and serve.
By Bea Ruberto
Sound Beach, nestled between Miller Place and Rocky Point, had a population of 7,612 as of 2010. When I first became involved with the Sound Beach Civic Association, I often heard that our hamlet was forgotten by all levels of government. I can honestly say that in recent years, this has begun to change. Among other projects, the Town of Brookhaven was instrumental in revitalizing Echo Avenue and paving this road to lower Rocky Point Road and is currently working on restoring the East Beach.
Several years ago, Suffolk County recognized the need for better bus service through Sound Beach and added two new runs of the 5A. Now, they’re getting ready to take this back and more — eliminate the 5A. This will mean there will be no service north of 25A and east of Echo Avenue. The only “service” will be the S62, which skirts our community and only runs twice a day — in the a.m. eastbound and p.m. westbound — to allow people to get to Suffolk County offices during rush hour.
Suffolk County is planning to eliminate eight routes throughout the system to help close a looming $78 million deficit, and, yes, the 5A is not a busy route, but it is the only public transportation in Sound Beach. People use this to get to work and to doctors’ appointments and to connect with other routes in Port Jefferson and Middle Island. In addition, an increasingly aging population may need to do things as basic as get to the grocery store. At this point, I don’t use the bus system, but, having just turned 70, I foresee a time in the not-too-distant future when I may need to give up my car.
According to the county, in some cases there may be alternate routes for passengers. In Sound Beach, this only applies to those living within walking distance of 25A, and most Sound Beachers live too far to walk to 25A. In other cases, existing routes may be altered to cover key destinations on the routes subject to elimination.
We then ask that the route of the 5A be modified instead of eliminated.
Barring this, perhaps the S62 can be modified so that it runs through Sound Beach proper and more often than once in the morning and once in the evening.
Public hearings on this will be held from 3 to 7 p.m. on the following dates/locations:
• Thursday, Sept. 8, Riverhead Legislative Auditorium, Evans K. Griffing Building, 300 Center Drive, Riverhead.
• Friday, Sept. 9, Hauppauge Legislative Auditorium, W. H. Rogers Building, 725 Veterans Memorial Highway, Smithtown.
Written comments may be submitted up to five days following the hearings to Suffolk County Transit, 335 Yaphank Ave., Yaphank 11980-9774.
Members of the Sound Beach Civic Association will attend the Sept. 8 meeting. If this route is removed, it won’t be easy to get the service back. We urge everyone in Sound Beach to join us whether you ride the bus or not. We will also be crafting a written comment that will be made available for use by the community. For more information, to get a copy of the written comment or if you need a ride to the Sept. 8 meeting, email [email protected] or call 631-744-6952.
Bea Ruberto is a Sound Beach resident and current president of the Sound Beach Civic Association.
By Erin Dueñas
Nineteen-year-old Rose Andrews has no idea what it means to be bored. Part of the sixth generation of Andrews who work the land at Andrews Family Farm in Wading River, there is work to be done from sunrise till sunset.
Up by 6 a.m., Andrews’ days begin by collecting eggs from the farm’s hens. Throughout the day, she might cut sunflowers to sell at the stand, deliver fresh-picked corn, zucchini or tomatoes to a neighboring farm, help customers or tend to the animals, including goats and rabbits.
“Being bored just doesn’t exist when you farm,” said Andrews. “There’s not much you can do after sundown, but even then you are planning for the next day.”
Working alongside her three older brothers and her parents, the constant work that goes into farm life doesn’t faze the Wading River resident in the least. She currently attends the University of Connecticut, where she studies agriculture and natural resources and agribusiness. Before graduating from Shoreham-Wading River High School in 2015, she said she recalls hearing classmates make weekend plans to hit the mall or the beach. But being in the family business, Andrews knew she would be at the farm instead.
“It’s just always been what my life is — the constant responsibility of the farm,” she said. “Being a farmer, it never stops.”
According to Andrews, she’s never resented the farm life and constant workflow to maintain it, even while others her age might be out at a party or with friends.
“I’ve always been pretty different and I feel fortunate to be brought up this way,” she said. “I never cared what other people do. This place doesn’t make me feel like I’m missing anything. It’s my favorite place in the world.”
Andrews credits her parents with instilling a strong work ethic in her, calling them the hardest working people she ever met.
“They brought us up that family matters and the farm matters,” Andrews said. “It’s hard work, but at the end of the day, you love what you do.”
Her mother Denise Andrews concedes that there was little downtime for her kids growing up farmers. “There was no such thing as sleeping in past 7 a.m.,” she said. “The kids never had time for video games or television.”
Her children joined her at work on the farm as soon as they were old enough — a playpen was a common sight at the stand when the kids were still babies, and as young children, they pitched in.
Those early days working the land helped inspire Rose Andrews to begin Farm Days with Rose, a tour offered monthly to children interested in seeing how the farm operates.
“I want kids to see the farm as I did — as the best place in the world,” she said.
But there’s a larger lesson she is trying to spread through the tours. She wants people to know where food comes from and why others should care, especially, she said, because when she talks to children about farming, most don’t know where their food comes from, or even what certain vegetables are.
Andrews added that the kids are fascinated to see that an onion is pulled right from the ground.
“They always love that and it’s something people should know,” she said.
Her mother also tries to educate people any chance she gets about food origins and why buying local is better.
“The food we sell here at the farm traveled 20 feet,” she said. “That should make you feel safe. The stuff from the grocery store could have traveled halfway around the world before you get it. That has such a big environmental impact.”
“Family matters and the farm matters. It’s hard work, but at the end of the day, you love what you do.”
— Rose Andrews
According to the Rose Andrews, sustainability is one of the most important issues facing farmers and consumers alike.
“How can we sustain the environment and still feed a massive population around the world?” she asked. She thinks purchasing local food is one way to do that.
She also noted the benefits of keeping dollars in the local economy, as well as the higher nutrient content of preservative-free produce that is fresh picked. Then there’s the flavor.
“There’s a big difference in taste,” Andrews said. “Farm fresh is just better taste-wise.”
Longtime customer Claudia Schappert of Wading River is a big fan of that taste difference. She said the tomatoes she gets from Andrews Farm are her favorite.
“They are so sweet and delicious — I make fresh sauce from them,” she said. “[The Andrews] are just the best people with incredible produce and flowers.”
Schappert also added that she feels like she has watched Rose Andrews grow up over the years.
“I would describe her as a gentle soul,” she said, noting that her granddaughter has been on one of Rose’s farm tours. “She has become so knowledgeable in her profession and her dedication to eating good food.”
By Nancy Burner, Esq.
In my practice as an elder law attorney, clients often inquire about the benefits of gifting to reduce taxes or to qualify for Medicaid. As a senior with the unexpected need for long-term care in the future, the consequences of gifting may have unexpected results.
It is a common myth that everyone should be gifting monies during their life to avoid taxation later. Currently, a person can give away during life or die with $5.45 million before any federal estate tax is due. For married couples, this means that so long as your estate is less than $10.9 million, federal estate taxes are not a problem. For New York State estate tax, the current exemption is $4.1875 million and is currently slated to reach the federal estate tax exemption by 2019.
While it is true that there are gifting estate plans that can reduce estate taxes, any gift that exceeds the annual gift exclusion must be reported on a gift tax return during the decedent’s life and is deducted from their lifetime exemption. In 2016, that exclusion is $14,000. However, while gifting may be good if the goal is to reduce estate tax, it can be detrimental if the donor needs Medicaid to cover the cost of long-term care within five years of any gifts.
It is important to remember that the $14,000 only refers to the annual gift tax exclusion under the Internal Revenue Code. The Medicaid rules and regulations are different. In New York, Medicaid requires that all applicants and their spouses account for transfers made in the five years prior to applying for Institutional Medicaid. These gifts are totaled, and for each $12,633 that was gifted, one month of Medicaid ineligibility is imposed for Long Island applicants. It is also important to note that the ineligibility begins to run on the day that the applicant enters the nursing home and is “otherwise eligible for Medicaid” rather than on the day that the gift was made.
For example, if a grandfather gifted $100,000 over the course of five years to his grandchildren and then needed nursing home care, those gifts would be considered transfers and, if they cannot be returned, would create a period of ineligibility for Medicaid benefits for approximately eight months. What makes this even more difficult for some families is that an inability to give the money back or help the grandfather pay for his care is not taken into consideration, causing many families great hardship.
It would have been far better for the grandfather to have put assets into a Medicaid-qualified trust five years ago to start the period of ineligibility and allow the trustee to make the annual gifts. Another concern when gifting is considering to whom you are gifting? Once a gift is made to a person, it becomes subject to their creditors, legal status and can adversely affect their government benefits.
Accordingly, if you make a gift to a person who has creditors or who later gets a divorce, that gift could be lost to those debts. Consider creating a trust for the benefit of the debtor-beneficiary to ensure that their monies are protected. Another problem arises when making gifts to minors. Because a minor cannot hold property, if gifted substantial sums, someone would have to be appointed as the guardian of the property for that child before the funds could be used.
To avoid this problem, consider creating a trust for the minor beneficiary and designate a trustworthy trustee who will manage the money for the minor until they are old enough to manage it themselves.
Finally, if gifting to a disabled beneficiary, make sure to review what government benefits they may be receiving. If any of the benefits are “needs based,” even small gifts may disqualify them for their benefits. In order to maintain eligibility, a Supplemental Needs Trust could be created to preserve benefits for the disabled beneficiary.
A common phrase comes to mind “do not try this at home.” Before doing any kind of substantial gifting, or even if you have begun gifting, see an elder law attorney who concentrates their practice in Medicaid and estate planning to help optimize your chances of qualifying for Medicaid and/or reduce estate taxes, while still preserving the greatest amount of assets.
Nancy Burner, Esq. practices elder law and estate planning from her East Setauket office.
By David Dunaief, M.D.
Some research shows that obesity may be reaching a plateau. Is this true? It depends on how the data is analyzed. According to one study, yes; it has plateaued when looking at short, two-year periods from 2003 to 2011 (1).
However, another published study shows a picture that is not as positive (2). The study’s authors believe obesity has not plateaued; when looking over a longer period of time, statistics suggest that obesity has reached a new milestone. There are now more obese patients in the United States than there are overweight patients. And no, it is not because we have fewer overweight patients. This is based on a study that reviewed data from the National Health and Nutrition Examination Survey (NHANES). These results were in adults over the age of 20. This should be an eye-opener.
Unfortunately, according to one study, the probability is not very good for someone to go from obese to “normal” weight in terms of body mass index (3). In this observational trial, results show that an obese man has a 0.5 percent chance of achieving normal weight, while a woman has a slightly better chance, 1 percent. This study used data from the UK Clinical Practice Datalink. The data were still not great for men and women trying to achieve at least a 5 percent weight loss, but better than the prior data. Patients who were more obese actually had an easier time losing 5 percent of their body weight.
What are two major problems with being obese? One, obesity is a disease in and of itself, as noted by the American Medical Association in 2013 (4). Two, obesity is associated with — and is even potentially a significant contributor to — many chronic diseases such as cardiovascular disease (heart disease and stroke), high blood pressure, high cholesterol, atrial fibrillation, diabetes, cancer, cognitive decline and dementia. When I attended the 28th Blackburn Course in Obesity Medicine in June 2015 at Harvard Medical School, a panel of experts noted that there are over 180 chronic diseases associated with obesity.
In this article, we will focus on one significant multifaceted disease, cancer. Watch out for cancer One of the more unpredictable diseases to treat is cancer.
What are the risk factors?
Beyond family history and personal history, obesity seems to be important. In fact, obesity may be a direct contributor to 4 percent of cancer in men and 7 percent of cancer in women (5). This translates into 84,000 cases per year (6). On top of these stunning statistics, there is about a 50 percent increased risk of death associated with cancer patients who are obese compared to those with normal BMIs (7).
What about with breast cancer?
The story may be surprising and disappointing. According to an analysis of the Women’s Health Initiative, those who were obese had increased risks of invasive breast cancer and of death once the diagnosis was made (8). The severity of the breast cancer and its complications were directly related to the severity of the obesity. There was a 58 percent increased risk of advanced breast cancer in those with a BMI of >35 kg/m2 versus those with normal BMI of <25 kg/m2. And this obese group also had a strong association with estrogen-receptor-positive breast cancer.
However, those who lost weight did not reduce their risk of breast cancer during the study. There were 67,000 postmenopausal women between the ages of 50 and 79 involved in this prospective (forward-looking) study. The researchers do not know why patients who lost weight did not reduce their risk profile for cancer and suggest the need for further studies. This does not imply that lifestyle changes do not have a beneficial impact on breast cancer.
What can we do?
We find that fat is not an inert or static substance, far from it. Fat contains adipokines, cell-signaling (communicating) proteins that ultimately may release inflammatory factors in those who have excessive fat. Inflammation increases the risk of tumor development and growth (9).
There is a potentially simple step that obese cancer patients may be able to take — the addition of vitamin D. In a study in older overweight women, those who lost weight and received vitamin D supplementation were more likely to reduce inflammatory factor IL-6 than those who had weight loss without supplementation (10). This was only the case if the women were vitamin D insufficient. This means blood levels were between 10 and 32 ng/mL to receive vitamin D.
Interestingly, it has been suggested that overweight patients are more likely to have low levels of vitamin D, since it gets sequestered in the fat cells and, thus, may reduce its bioavailability. Weight loss helps reduce inflammation, but the authors also surmise that it may also help release sequestered vitamin D. The duration of this randomized controlled trial, the gold standard of studies, was one year, involving 218 postmenopausal women with a mean age of 59.
All of the women were placed on lifestyle modifications involving diet and exercise. The treatment group received 2,000 IU of vitamin D3 daily. Those women who received vitamin D3 and lost 5 to 10 percent of body weight reduced their inflammation more than those in the vitamin D group who did not lose weight.
What does medicine have to offer?
There are a host of options ranging from lifestyle modifications to medications to medical devices to bariatric surgery. In 2015, the FDA approved two medical devices that are intragastric (stomach) balloons (11). The balloons are filled with 500 mL of saline after inserting them in the stomach via upper endoscopy. They need to be removed after six months, but they give the sense of being satiated more easily and help with weight loss.
One, the ReShape Dual Balloon, is intended to go hand-in-hand with diet and exercise. It is meant for obese patients with a BMI of 30-40 kg/m2 and a comorbidity, such as diabetes, who have failed to lose weight through diet and exercise. In a randomized controlled trial involving 326 obese patients, those who received the balloon insertion lost an average of 14.3 lb in six months, compared 7.2 lb for those who underwent a sham operation.
Lifestyle modifications
In an ode to lifestyle modifications, a study of type 2 diabetes patients showed that diet helped reduce weight, while exercise helped maintain weight loss for five years. In this trial, 53 percent of patients who had initially lost 23 lb (9 percent of body weight) over 12 weeks and maintained it over one year were able to continue to maintain this weight loss and preserve muscle mass through diet and exercise over five years (12). They also benefited from a reduction in cardiovascular risk factors. In the initial 12-week period, the patients’ HbA1C was reduced from 7.5 to 6.5 percent, along with a 50 percent reduction in medications.
We know that obesity is overwhelming. It’s difficult to lose weight and even harder to reach a normal weight; however, the benefits far outweigh the risks of remaining obese. Lifestyle modifications are a must that should be discussed with your doctor. In addition, there are a range of procedures available to either help jump start the process, to accelerate progress or to help maintain your desired weight.
References: (1) JAMA 2014;311:806-814. (2) JAMA Intern Med 2015;175(8):1412-1413. (3) Am J Public Health 2015;105(9):e54-59. (4) ama-assn.org. (6) cancer.gov/cancertopics/factsheet/risk/obesity. (7) N Engl J Med 2003;348:1625-1638. (8) JAMA Oncol online June 11, 2015. (9) Clin Endocrinol 2015;83(2):147-156. (10) Cancer Prev Res 2015;8(7):1-8. (11) fda.gov. (12) ADA 2015 Abstract 58-OR.
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, visit www.medicalcompassmd.com or consult your personal physician.
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