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SBU's David Wrobel with Wolfie. Photo by Anna Maria Gounaris

By Daniel Dunaief

David Wrobel, dean of the College of Arts and Sciences at Stony Brook University since August, can relate to the school’s students.

Like about a third of the students at the downstate flagship SUNY university, Wrobel is the first member of his family to attend college.

David Wrobel. Photo by John Griffin

“I’ve had the advantage of that social mobility that higher education can provide,” said Wrobel, who grew up in England. To have the opportunity to facilitate that for thousands of other students is “hugely important and meaningful.”

Provost Carl Lejuez appreciates Wrobel’s passion for education and for providing opportunities to students from a wide array of backgrounds and experiences.

“For first generation students, there are some challenges that even the most empathetic, well-meaning person may want to help with, but because they don’t have that experience, they don’t know,” said Provost Carl Lejuez. “He brings both the experience of some of the things these students are going through as well as the humanity and personality that is very empathetic.”

Indeed, for Wrobel, who was dean at the University of Oklahoma for six years before joining Stony Brook, his new job appealed to him because of the opportunity to use education to help students expand their horizons and seek new opportunities.

Stony Brook has been successful in the area of social mobility, enabling students “from more disadvantaged backgrounds coming to the university” to complete their degrees at a high rate, said Wrobel. Higher education can perform the role it should as an “engine of democracy.”

Wrobel, who is a tenured professor in the Departent of History, oversees the breadth and depth of offerings at Stony Brook.

Lejuez suggested that Wrobel relates well to students from every background.

“You never see him at an event talking to other administrators,” said Lejuez. “He’s trying to really get in there and talk to people and make them feel welcome.”

Indeed, within his first few weeks of arriving, Wrobel met with several students who shared their concerns about visual arts, particularly as the music and art departments are about to move during an HVAC renovation project.

Wrobel worked with the students and partners around the university, including staff, the fire marshal and others, to see where they can display artwork and perform music.

The Arts Everywhere effort, which is “big in spirit” but “small in funding” provides an opportunities for the “work of students to be better understood by other students on campus,” Wrobel said.

Research opportunities

As a member of the Association of American Universities, an exclusive club that recognizes universities committed to research and education, Stony Brook provides students with opportunities to contribute to the forefront of new information.

“We have undergraduates doing research on genes that are led by some of the most important scientists in the world,” said Wrobel. These students are “not doing research that is tangentially associated with important science. They are contributing to the research teams” that lead to societal and life improvements.

These research contributions across a wide range of fields can and should address the question some people have asked about the return on investment of a college education.

Students are working in fields such as quantum science, artificial intelligence, climate and health.

“We should take great pride in the fact that, as a university, we are answering that question: why does a degree matter,” said Wrobel.

‘Not a spectator sport’

From left to right: Bonita London, associate dean of research development and communications; Danielle Papaspyrou, senior administrator for staff and faculty affairs; AnnaMaria Gounaris, assistant to the dean; Michael d’Ambrosio, senior director of development; Lois Carter, assistant dean for faculty affairs and personnel; Rachel Rodriguez, director of communications; Carol Davies, assistant director for budget and finance, and David Wrobel, dean of the College of Arts and Sciences. Photo courtesy Stony Brook University

The university is incorporating into the degree programs the kind of learning experiences that prepare students for success in areas ranging from private and industry positions to government jobs.

Wrobel is eager to demonstrate how “education is not a spectator sport” with every prospective student and their parents. Students become a “full participant not just in learning existing knowledge, but in the process of creating new knowledge.”

At the same time, the university is committed to enhancing the abilities of its educators.

“You work to reward teaching excellence at every level,” said Wrobel. “You make it clear that teaching does matter.”

Teachers need to refine their approaches and methods based on the way students learn, which includes working with technology and its possibilities more effectively than in the past

Wrobel meets with the Dean’s Student Advisory Committee, which includes students from numerous majors, to learn about student needs. These can include expanding quieter study spaces or finding places for more collaborative work.

Additionally, the committee helps select outstanding teaching faculty.

“Faculty go to conferences to improve their research skills,” said Lejuez. “We want to think about teaching in the same way.”

Lejuez appreciates how Wrobel engages with students to understand what would improve the university’s learning environment.

The Center for Excellence in Learning and Teaching provides opportunities not only for those educators who might be struggling to connect with their students, but also for those who want to improve their craft, Lejuez said.

As a part of student evaluations of their educators, Stony Brook has improved the quality of questions in its educator evaluations for the spring semester, which Lejuez hopes encourages more students to offer valuable feedback.

A dedicated educator

In addition to serving as an administrator, Wrobel hopes to put his experience to work as an educator himself by next spring.

Wrobel could imagine leading or contributing to several possible classes.

He would enjoy teaching a graduate seminar that addresses the history of American thought and culture from the end of Reconstruction after the Civil War in the 1870’s to the end of the New Deal in the 1940s.

At the University of Oklahoma, he also taught an introductory survey class that first year students typically took. The course covered the period from the end of the Civil War to the present.

“I love the idea that I have the opportunity to engage with brand new students when they come to the university,” he said.

Wrobel would like to share a view of America from the Great Depression through the Vietnam War, focusing on John Steinbecks view of the core political and social debates of the time.

Steinbeck was “better than just about any other author at finding what is extraordinary in the lives of ordinary Americans,” said Wrobel.

As for his roles at Stony Brook, Wrobel is “thrilled to have the opportunity to help first generation students and other financially disadvantaged students find their way.”

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David McCandlish, center, with postdoctoral researchers Anna Posfai and Juannan Zhou. Photo by Gina Motisi, 2020/ CSHL

By Daniel Dunaief

If cancer were simple, scientists would have solved the riddle and moved on to other challenges.

Often, each type of the disease involves a combination of changes that, taken together, not only lead to the progression of cancer, but also to the potential resistance to specific types of treatment.

Using math, David McCandlish, Assistant Professor at Cold Spring Harbor Laboratory, is studying how the combination of various disruptions to the genome contribute to the development of cancer.

McCandlish recently published a study with colleagues at Cold Spring Harbor Laboratory in the journal Proceedings of the National Academy of Sciences.

David McCandlish. Photo by Gina Motisi, 2020/CSHL

The research didn’t explore any single type of cancer, but, rather applied the method looking for patterns across a range of types of cancers. The notion of understanding the way these genetic alterations affect cancer is a “key motivating idea behind this work,” McCandlish said.

So far, the method has identified several candidates that need further work to confirm.

“Cancer would be a lot easier to treat if it was just one gene,” said Justin Kinney, Associate Professor at CSHL and a collaborator on the work. “It’s the combination that makes it so hard to understand.”

Ultimately, this kind of research could lead researchers and, eventually, health care professionals, to search for genetic biomarkers that indicate the likely effect of the cancer on the body. This disease playbook could help doctors anticipate and head off the next moves with various types of treatments.

“This could potentially lead to a more fundamental understanding of what makes cancer progress and that understanding would very likely open up new possibilities in cancer treatments,” Kinney said.

To be sure, at this point, the approach thus far informs basic research, which, in future years, could lead to clinical improvements.

“We are working on this method, which is very general and applicable to many different types of data,” McCandlish said. “Applications to making decisions about patients are really down the road.”

McCandlish described how he is trying to map out the space that cancer evolves in by understanding the shape of that space and integrating that with other information, such as drug susceptibility or survival time.

“We are trying to ask: how do these variables behave in different regions of this space of possibilities?” he said.

McCandlish is making this approach available to scientists in a range of fields, from those scientists interpreting and understanding the effects of mutations on the development of cancer to those researchers pursuing a more basic appreciation of how such changes affect the development and functioning of proteins.

“This is accessible to a wide array of biologists who are interested in genetics and, specifically in genetic interactions,” said McCandlish.

The main advance in this research is to take a framework called maximum entropy estimation  and improve its flexibility by using math to capture more of the underlying biological principals at work. Maximum entropy estimation is based on the idea of inferring the most uniform distribution of behaviors or outcomes with the least information that’s compatible with specific aspects of experimental observations.

Using this philosophy, scientists can derive familiar probability distributions like the bell curve and the exponential distribution. By relaxing these estimates, scientists can infer more complicated shapes.

This more subtle approach enhances the predictive value, which captures the distributions of data better, McCandlish explained. “We’re trying to capture and model cancer progression in a new and more expressive way that we hope will be able to tell us more about the underlying biology.”

The idea for this paper started when McCandlish, Kinney and  Jason Sheltzer, a former fellow at Cold Spring Harbor Laboratory and a current Assistant Professor of Surgery at Yale School of Medicine, discussed the possibilities after McCandlish attended a talk by Wei-Chia Chen, a post doctoral researcher in Kinney’s lab.

Chen will continue to pursue questions related to this effort when he starts a faculty position in the physics department at National Chung Cheng University in Taiwan this spring.

Chen will use artificial intelligence to handle higher dimensional data sets, which will allow him “to implement effective approximations” of the effect of specific combinations of genetic alterations, Kinney said.

Kinney believes teamwork made this new approach, which the high-impact, high-profile journal PNAS published, possible.

“This problem was an absolutely collaborative work that none of us individually could have done,” Kinney said. He described the work as having a “new exploratory impact” that provides a way of looking at the combination of genomic changes that “we haven’t had before.”

Working at Cold Spring Harbor Laboratory, which McCandlish has done since 2017, enables collaborations across different disciplines.

“We have this quantitative biology group, we also have people working on neuroscience, cancer, and plant biology,” McCandlish added.

McCandlish is also currently also working with Professor Zachary Lippman and his graduate student Lyndsey Aguirre to understand how multiple mutations interact to influence how the fruit on tomato plants develop.

“The idea is that there are these huge spaces of genetic possibilities where you can combine different mutations in different ways,” McCandlish explained. “We want to find those key places in that space where there’s a tipping point or a fork in the road. We want to be able to identify those places to follow up or to ask what’s special about this set of mutations that makes it such a critical decision point.”

A native of Highland Park, New Jersey, McCandlish was interested in math and science during his formative years. 

As for the work, McCandlish appreciates how it developed from the way these collative researchers interacted.

“This would never have happened if we weren’t going to each other’s talks,” he said.

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David Thanassi. Photo by Jeanne Neville
*Please note: This article was updated on Oct. 15 to include a reference to former President Bill Clinton (D) in the fifth paragraph.

By Daniel Dunaief

David Thanassi wants to give dangerous bacteria in the kidney a haircut.

No, not exactly, but Thanassi, Zhang Family Professor and Chair of the Department of Microbiology and Immunology at the Renaissance School of Medicine at Stony Brook University, has studied how hair-like structures called P pili in the bacteria Escherichia coli are assembled on the bacterial surface. 

These pili allow bacteria to hang on to the walls of the kidney, where urine would otherwise flush them out.

Learning about pili at different stages of development could provide a way to keep them from attaching themselves to the kidney and from entering the bloodstream, which could lead to the potentially lethal problem of bacterial sepsis. Indeed, this week, former President Bill Clinton (D) checked into the intensive care unit at the University of California Irvine Medical Center after a urinary tract infection spread to his bloodstream.

“We have been looking at this as a really important aspect of initiating infection from a bacteria’s point of view,” Thanassi said. “How do they build these structures” that lead to infection and illness?

Recently, Thanassi published the structure of these pili in the journal Nature Communication.

The current work builds on previous efforts from Thanassi to determine the structure of these pili in the bladder. He has been exploring how the thousands of proteins that make up the pili get transported and assembled in the correct order. “If we can understand that aspect, we can disrupt their assembly or function,” he said.

Urinary tract infections are a major infectious disease, particularly for women. Indeed, about half of all women will have at least one urinary tract infection, which can be uncomfortable and can require some form of medication. 

In some cases, the infections can be recurrent, leading to frequent infections and the repeated need for antibiotics.

The bacteria that cause these infections can become resistant to antibiotics, increasing the importance of finding alternative approaches to these infections, such as interfering with pili.

To be sure, the solution to reducing the bacteria’s ability to colonize the kidney or urinary tract would likely require other steps, as these invaders have additional ways beyond the pili to colonize these organs. Nonetheless, disrupting the way they adhere to the kidney could be a constructive advance that could lead to improved infection prevention and treatment.

One likely strategy could involve using an anti-pilus treatment in combination with other antibiotics, Thanassi explained.

For people who have recurrent infections, anti-pilus therapeutics could offer a solution without resorting to long-term antibiotics.

In his lab, Thanassi is interested in small molecules or chemicals that would disrupt the early stage in pili assembly. “We think of these as protein-protein interactions that are required to build these” pili, he said.

By using a fluorescence reporter, Thanassi and his colleagues can screen libraries of chemicals to determine what might inhibit the process.

As with many biological systems, numerous compounds may seem appropriate for the job, but might not work, as medicine often requires a specific molecule that functions within the context of the dynamic of a living system.

For the helpful bacteria in the gut, pili are not as important as they are for the harmful ones in the kidney, which could mean that an approach that blocked the formation of these structures may not have the same intestinal and stomach side effects as some antibiotics.

To determine the way these pili develop structurally, Thanassi and his lab used molecular and biochemical techniques to stop the assembly of pili at specific stages.

Bacteria assemble these pili during the course of about 30 minutes. An usher proteins serves as the pilus assembly site and pilus secretion channel in the bacterial outer membrane. The usher acts as a nanomachine, putting the pilus proteins into their proper order. A chaperone protein brings the pilus subunits to the usher protein.

In their development, the pili require a protein channel, which is an assembly site.

Thanassi started by working on the usher protein in isolation. The usher proteins function to assemble the thousands of pilus subunits that make up each pilus fiber. The process also involves chaperone proteins, which bind to nascent subunit proteins and help the subunits fold. The chaperone then delivers the subunit proteins to the usher for assembly into the pilus fiber. He used molecular and biochemical methods to express and purify the usher protein.

The assembly process involves interactions between chaperone-subunit complexes and the usher. Over the years, Thanassi has determined how the different proteins work together to build and secrete a pilus.

He was able to force the bacteria to express only one version of the assembly step and then isolate that developmental process.

The majority of the pilus is like a spring or a coil, which can stretch and become longer and straighter to act as a shock absorber, allowing the bacteria to grab on to the kidney cells rather than breaking.

Other researchers are studying how they might make the pili more brittle, preventing that spring-like action from working and compromising its ability to function.

“We’re trying to prevent the pili from assembling in the first place,” Thanassi explained. “Our approach is to try and get molecules that prevent the interaction from occurring.” He is looking at the specific function of one molecule that prevents the usher assembly platform from developing properly, which would wipe out the assembly site.

Thanassi credits former Stony Brook Professor Huilin Li, who is now Chair in the Department of Structural Biology at the Van Andel Institute in Grand Rapids, Michigan, with providing structural insights from his work with the cryo-electron microscoipe. The technology has “revolutionized the work we do,” said Thanassi.

Residents of Smithtown, Thanassi and his wife Kate Kaming, who is Senior Director of Cancer Development at Northwell Health Foundation, have two children. Joseph, 22, attends Northeastern University. Miles, 20, is studying at the Massachusetts Institute of Technology.

Thanassi grew up in South Burlington, Vermont and is an avid skier. He also enjoys mountain biking, walking and music.

Thanassi hopes this latest structural work may one day offer help either with the prevention of infections or with their treatment.

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Long-term PPI use increases serious risks. Stock photo
PPIs may increase your fracture risk

By David Dunaief, M.D.

Dr. David Dunaief

After a meal, do you sometimes have “reflux” or “heartburn?” Many of us experience these symptoms occasionally. When it happens more frequently, it could be a sign of gastroesophageal reflux disease (GERD).

Between 18.1 and 27.8 percent of U.S. adults have GERD, according to estimates; however, since many people self-treat with over-the-counter (OTC) medications, the real numbers could be higher (1).

If you take OTC proton pump inhibitors (PPIs), you could be among the uncounted. Familiar brands include Prilosec (omeprazole), Nexium (esomeprazole), and Prevacid (lansoprazole), among others. They are also available by prescription.

PPIs are not intended for long-term use, because of their robust potential side effects. Currently, the FDA suggests that OTC PPIs should be taken for no more than a 14-day treatment once every four months. Prescription PPIs should be taken for 4 to 8 weeks (2).

Unfortunately, many take them too long or too often, and some experience reflux rebound effects when they try to discontinue PPIs without physician oversight.

Among potential associations with long-term use are chronic kidney disease, dementia, bone fractures, increased cardiac and vascular risks, vitamin malabsorption issues and Clostridium difficile (C. diff), a bacterial infection of the gastrointestinal tract.

PPIs can also interfere with other drugs you are taking, such as Plavix (clopidogrel).

PPIs and chronic kidney disease

Two separate studies showed that there was an increase in chronic kidney disease with prolonged PPI use (3). All patients started the study with normal kidney function, assessed by measuring glomerular filtration rate (GFR). The Atherosclerosis Risk in Communities (ARIC) study showed a 50 percent increased risk of chronic kidney disease, while the Geisinger Health System cohort study found there was a 17 percent increased risk.

The medications were used on a chronic basis for years: the first study had a 13-year duration, and the second had about a six-year duration. Both demonstrated modest, but statistically significant, increased risk of chronic kidney disease. In an accompanying editorial to these published studies, the author suggests that there is overuse of the medications or that they are used beyond the resolution of symptoms and suggests starting with diet and lifestyle modifications and a milder drug class, H2 blockers (4).

PPIs and dementia risk

A German study looked at health records from a large public insurer and found a 44 percent increased risk of dementia in those aged 75 or older who were using PPIs, compared to those who were not (5). The authors surmise that PPIs may cross the blood-brain barrier and potentially increase beta-amyloid levels, markers for dementia. With occasional use, meaning once every 18 months for a few weeks to a few months, there was a much lower, 16 percent, increased risk.

The researchers also suggested that PPIs may be significantly overprescribed in the elderly. The research was not perfect, however. Researchers did not consider high blood pressure, excessive alcohol use or family history of dementia, all of which can influence dementia occurrence.

PPIs and fracture risk

In a meta-analysis of 18 observational studies, results showed that PPIs can increase the risk of hip fractures, spine fractures and any-site fractures (6). With bone fractures, it did not make a difference whether patients were taking PPIs for more or less than a year.

They found increased fracture risks of 58, 26 and 33 percent for spine, hip, and any-site, respectively. It is not clear what may potentially increase the risk; however, it has been proposed that it may have to do with calcium absorption. PPIs reduce acid, which may be needed to absorb insoluble calcium salts. In another study, seven days of PPIs were shown to lower the absorption of calcium carbonate supplements when taken without food (7).

PPIs and vitamin absorption

In addition to calcium absorption issues, PPIs may lower absorption of magnesium and B12. In one observational study, PPIs combined with diuretics caused a 73 percent increased risk of hospitalization due to low magnesium (8). Diuretics are commonly prescribed for high blood pressure, heart failure and swelling.

Another study’s results showed use of over two years increased vitamin B12 deficiency risk by 65 percent (9).

Takeaways

Before taking OTC PPIs, consult with your physician. A milder medication, such as an H2 blocker (Zantac, Pepcid), might be a better option.

Even better, start with lifestyle changes. Try to avoid eating later at night, raising the head of the bed, losing weight and stopping smoking, if needed, before you try medications (10).

If you do need medication, recognize that PPIs don’t provide immediate relief and should only be taken for a short duration to minimize their side effects.

References: 

(1) nih.gov. (2) fda.gov. (3) JAMA Intern Med. 2016;176(2). (4) JAMA Intern Med. 2016;176(2):172-174. (5) JAMA Neurol. online Feb 15, 2016. (6) Osteoporos Int. online Oct 13, 2015. (7) Am J Med. 118:778-781. (8) PLoS Med. 2014;11(9):e1001736. (9) Mayo Clinic Proceedings. 2018 Feb;93(2):240-246. (10) Am J Gastroenterol 2015; 110:393–400.

Dr. David 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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Deer ticks aka blacklegged ticks typically carry Lyme disease.METRO photo
The effects of Lyme disease can be debilitating

By David Dunaief, M.D.

Dr. David Dunaief

Warm weather is imminent and, if you’re like me, you’re looking forward to enjoying more time outside this summer.  

Summer’s arrival also means that tick season is in full swing, although “season” is becoming a misnomer when we refer to ticks. A June 16th New York Times article shared some of the challenges of changing tick behavior and the expansion of tick types and overlapping tick-borne diseases we’re now seeing in the Northeast (1).

The most common of these is Lyme disease, which is typically carried by deer ticks, also known as blacklegged ticks. Deer ticks can be as small as the period at the end of this sentence. The CDC site is a great resource for tick images and typical regions (2).

If a tick bites you, you should remove it with forceps, tweezers or protected fingers (paper) as close to the skin as possible and pull slow and steady straight up. Do not crush or squeeze the tick; doing so may spread infectious disease (3). In a study, petroleum jelly, fingernail polish, a hot kitchen match and 70 percent isopropyl alcohol all failed to properly remove a tick. The National Institutes of Health recommends not removing a tick with oil (4).

When you remove a tick within 36 to 48 hours, your risk of infection is low. However, you can take a prophylactic dose of the antibiotic doxycycline within 72 hours of tick removal if you are not experiencing a bulls-eye rash — a red outer ring and red spot in the center (5). This can significantly lower your risk of developing Lyme disease, although doxycycline does sometimes cause nausea.

Know Lyme symptoms

The three stages of Lyme disease are: early stage, where the bacteria are localized; early disseminated disease, where the bacteria have spread throughout the body; and late stage disseminated disease. Symptoms for early localized stage and early disseminated disease include the bulls-eye rash, which occurs in about 80 percent of patients, with or without systemic symptoms of fatigue, muscle pain and joint pain, headache, neck stiffness, swollen glands, and fever (6).

Early disseminated disease may cause neurological symptoms such as meningitis, cranial neuropathy (Bell’s palsy) and motor or sensory issues. Late disseminated disease can cause Lyme arthritis, heart problems, facial paralysis, impaired memory, numbness, pain and decreased concentration (4).

Lyme carditis is a rare complication affecting 1.1 percent of those with disseminated disease, but it can result in sudden cardiac death (7). If there are symptoms of chest pain, palpitations, light-headedness, shortness of breath or fainting, clinicians should suspect Lyme carditis.

Check for ticks 

The CDC suggests wearing protective clothing, using insect repellent with at least 20 percent DEET and treating your yard. Always check your skin and hair for ticks after spending time outside. Also, remember to check your pets; even if treated, they can carry ticks into the house.

Check for Lyme infection

Lyme disease often can be diagnosed within the clinical setting or with a blood test. However, testing immediately after being bitten by a tick is not useful. It takes about one to two weeks for IgM antibodies to appear and two to six weeks for IgG antibodies (6). These antibodies sometimes will remain elevated even after successful antibiotics treatment.

Remember that a single tick can transfer more than one disease, so you might need testing for other common tick-borne diseases, as well.

Monitor for post-Lyme effects

There is an ongoing debate about whether “chronic Lyme” disease exists. In one analysis of several prospective studies, researchers recognize that there are prolonged neurologic symptoms in a subset population that may be debilitating even after Lyme disease treatment (8). These authors also suggest that there may be post-Lyme disease syndromes with joint pain, muscle pain, neck and back pain, fatigue and cognitive impairment. They note, however, that extended durations of antibiotics do not prevent or alleviate post-Lyme syndromes.

The lingering effects of Lyme can debilitate you and might be a result of systemic inflammation (9). Systemic inflammation and its symptoms can be improved significantly with dietary and other lifestyle modifications.

Prevention is key to helping stem Lyme and other tick-borne diseases. Become diligent about performing tick checks any time you’ve been outside. If you do find a tick, contact your physician immediately about prophylactic treatment.

References: 

(1) “The Tick Situation is Getting Worse. Here’s How to Protect Yourself.” New York Times. 16 June 2025. online. (2) https://www.cdc.gov/ticks/about/where-ticks-live.html. (3) Pediatrics. 1985;75(6):997. (4) nlm.nih.gov. (5) Clin Infect Dis. 2008;47(2):188. (6) uptodate.com. (7) MMWR. 2014;63(43):982-983. (8) Expert Rev Anti Infect Ther. 2011;9(7):787-797. (9) J Infect Dis. 2009;199(9:1379-1388).

Dr. David 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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METRO photo
Taking calcium may only help if you’re deficient

By David M. Dunaief, M.D.

Dr. David Dunaief

We should all be concerned about osteoporosis risk. According to the Bone Health & Osteoporosis Foundation, 50 percent of women and 25 percent of men will break at least one bone due to osteoporosis (1). Hip fractures are especially concerning, because they increase mortality risk dramatically. More than 50 percent of hip fracture survivors are no longer able to live independently (2).

Do we need to consume more dairy?

Studies suggest that milk and other dairy products may not be as beneficial as we have been raised to believe.

Studies have shown milk may not be beneficial for preventing osteoporotic fractures. Specifically, in a meta-analysis that used data from the Nurses’ Health Study for women and the Health Professionals Follow-up Study for men, neither men nor women saw any benefit from milk consumption in preventing hip fractures (3).

In a 2020 meta-analysis of several past studies, researchers concluded that increased consumption of milk and other dairy products did not lower osteoporosis and hip fracture risks (4).

Generally, studies suggest that dairy may cause additional health problems. The results of a large, 20-year, observational study involving men and women in Sweden showed that milk may be harmful (5). When comparing those who consumed three or more cups of milk daily to those who consumed less than one, there was a 93 percent increased risk of mortality in women between the ages of 39 and 74. 

Dosage also mattered. For every one glass of milk consumed, there was a 15 percent increased risk of death for women. There was a much smaller, but significant, three percent per glass increased risk of death in men. For both women and men, researchers found biomarkers in the urine that indicated higher levels of oxidative stress and inflammation.

Remember: these are only associations, not decisive conclusions. The researchers surmise that milk has high levels of D-galactose, a simple sugar that may increase inflammation.

Interestingly, the USDA recommends that, from the age of 9 through adulthood, we consume about three cups of dairy per day (6).

Should we take calcium supplements?

We know calcium is a required element for strong bones, but do supplements really prevent osteoporosis and subsequent fractures? While the data are mixed, it suggests supplements may not be the answer for those who are not calcium deficient.

In a meta-analysis involving a group of observational studies, there was no statistically significant improvement in hip fracture risk in those men or women ingesting at least 300 mg of calcium from supplements and/or food daily (7).

The researchers did not differentiate among the types of foods containing calcium. In a group of randomized controlled trials analyzed in the same study, those taking 800 to 1,600 mg of calcium supplements per day also saw no increased benefit in reducing nonvertebral fractures. In four clinical trials, the researchers saw an increase in hip fractures among those who took calcium supplements. A weakness of this large study is that vitamin D baseline levels, exercise and phosphate levels were not considered in the analysis.

Does vitamin D supplementation reduce risk?

Finally, though the data are not always consistent for vitamin D, it appears it may be valuable when it comes to fracture prevention. In a meta-analysis involving 11 randomized controlled trials, vitamin D supplementation resulted in fewer fractures (8). When patients were given a median dose of 800 IUs (ranging from 792 to 2,000 IUs) of vitamin D daily, those who were aged 65 and over experienced a 14 percent reduction in nonvertebral fractures and an even greater 30 percent reduction in hip fractures. However, vitamin D in lower levels did not significantly reduce fracture risk.

Where does that leave us?

Our knowledge of dietary approaches is continually evolving. Dairy’s role may be an example of this. No definitive statement can be made about calcium, although even in randomized controlled trials with supplements, there was no significant benefit. However, the patients in these trials were not necessarily deficient in calcium nor vitamin D.

To prevent fracture, older patients may need at least 800 IUs of vitamin D supplementation per day.

Remember that treatment and prevention approaches should be individualized, and deficiencies in vitamin D or calcium should usually be treated, of course. Please, talk to your doctor before adding or changing any supplements.

References: 

(1) www.bonehealthandosteoporosis.org. (2) EndocrinePractice. 2020 May;26(supp 1):1-46. (3) JAMA Pediatr. 2014;168(1):54-60. (4) Crit Rev Food Sci Nutr. 2020;60(10):1722-1737. (5) BMJ 2014;349:g6015. (6) health.gov. (7) Am J Clin Nutr. 2007 Dec;86(6):1780-1790. (8) N Engl J Med. 2012 Aug. 2;367(5):481.

Dr. David 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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Fiber-rich foods, including whole grains, seeds and legumes, as well as some beverages, such as coffee and wine, contain measurable amounts of lignans. Stock photo
Ozempic/Mounjaro don’t substitute for lifestyle changes

By David Dunaief, M.D.

Dr. David Dunaief

Type 2 diabetes management knowledge is always evolving. Here, we will examine how some diabetes management myths hold up against recent research.

Myth: Fruit can raise your sugars

Diabetes patients are often advised to limit whole, juiced, and dried fruit, because it can raise your sugars. This is only partly true. 

Yes, you should avoid fruit juice and dried fruit, because they do raise or spike glucose (sugar) levels. This includes dates, raisins, and apple juice, which are often added to “no sugar” packaged foods to sweeten them.

This is not true for whole fruit, which can be fresh or frozen. Studies have shown that patients with diabetes don’t experience sugar level spikes from whole fruit, even when they consume them in abundance (1). Another study showed that consuming whole fruit reduces type 2 diabetes risk (2).

In a third study, researchers considered the impacts of different types of whole fruits on glucose levels. They found that berries reduced glucose levels the most, but even bananas and grapes reduced these levels (3). The only fruit tested that seemed to have a mildly negative impact on sugars was cantaloupe.

Whole fruit is not synonymous with sugar. One reason for the beneficial effect is the fruits’ flavonoids, or plant micronutrients, but another is their fiber.

Myth: You should avoid all carbohydrates

Fiber is one type of carbohydrate that has important benefits. It can reduce risks for an array of diseases and improve outcomes. This holds true for type 2 diabetes risk. 

Two very large prospective observational studies, the Nurses’ Health Study (NHS) and NHS II, showed that plant fiber helped reduce the risk of type 2 diabetes (4). Researchers looked at lignans, a type of plant fiber, specifically examining the metabolites enterodiol and enterolactone. They found that patients with type 2 diabetes have substantially lower levels of these metabolites in their urine when compared to the control group without diabetes. There was a direct relationship between the level of metabolites and the reduction in diabetes risk: the more they consumed and the more metabolites in their urine, the lower the risk. The authors encourage patients to eat a plant-based diet to get this benefit.

Foods with lignans include cruciferous vegetables, such as broccoli and cauliflower; an assortment of fruits and whole grains; flaxseed; and sesame seeds (5). The researchers could not determine which plants contributed the greatest benefit; however, they believe antioxidant activity drives this effect.

Myth: You should avoid soy

In diabetes patients with nephropathy (kidney damage or disease), consuming soy has been associated with kidney function improvements (6). There were significant reductions in urinary creatinine levels and proteinuria (protein in the urine), both signs that the kidneys are functioning better.

This was a four-year, small, randomized control trial with 41 participants. The control group’s diet included 70 percent animal protein and 30 percent vegetable protein, while the treatment group’s diet consisted of 35 percent animal protein, 35 percent textured soy protein and 30 percent vegetable protein.

This is important, since diabetes patients are 20 to 40 times more likely to develop nephropathy than those without diabetes (7). It appears that soy protein may put substantially less stress on the kidneys than animal protein. However, those who have hypothyroidism and low iodine levels should be cautious about soy consumption; some studies suggest it might interfere with synthetic thyroid medications’ effectiveness (8).

Myth: Ozempic/Mounjaro helps with weight loss

One of the latest entrants in diabetes sugar-control/weight loss pursuit is GLP-1 receptor agonists, including tirzepatide (Mounjaro/Zepbound) and semaglutide (Ozempic/Wegovy). They have a primary focus on glucose control and a secondary effect of weight loss. It sounds like a dream, right? Unfortunately, it’s not that simple. It’s important to recognize that the phase III clinical trial of these drugs’ weight loss capabilities actually excluded patients with diabetes (9). While the trials did measure lean body mass at different points and doses, they did not report muscle loss.

In clinical use since their approval, further studies have found patients can lose significant muscle mass during treatment. Quoted numbers range between 10 and 25 percent muscle loss (10, 11). In my practice, I have seen an average of 50 percent muscle loss. Because of this tendency, those taking tirzepatide and semaglutide need to make lifestyle changes to offset this, including weight training and diet.

We still have a lot to learn with diabetes, but our understanding of how to manage lifestyle modifications is becoming clearer. Emphasizing a plant-based diet focused on whole fruits, vegetables, beans and legumes can improve your outcomes. 

If you choose a medical approach, you still need to make significant lifestyle changes to overcome its risks.

References: 

(1) Nutr J. 2013 Mar. 5;12:29. (2) Am J Clin Nutr. 2012 Apr.;95:925-933. (3) BMJ online 2013 Aug. 29. (4) Diabetes Care. online 2014 Feb. 18. (5) Br J Nutr. 2005;93:393–402. (6) Diabetes Care. 2008;31:648-654. (7) N Engl J Med. 1993;328:1676–1685. (8) Thyroid. 2006 Mar;16(3):249-58. (9) N Engl J Med 2022;387:205-216. (10) AACE Clin Case Reports. 2025 Mar-Apr.;11(2):98-101. (11) Diabetes, Obesity and Metabolism. 2025 May. 27(5): 2720-2729.

Dr. David Dunaief is a speaker, author and local lifestyle medicine physician focusing on the integration of medicine, nutrition, fitness and stress management.

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Kidney health. METRO photo
Regular screening for CKD can help identify early stage kidney disease

By David Dunaief, M.D.

Dr. David Dunaief

In last week’s article about chronic kidney disease (CKD), we learned that roughly 90 percent of U.S. adults who have CKD are not even aware they have it (1). How can this be?

CKD can be asymptomatic in its early stages. Once it reaches moderate stages, vague symptoms like fatigue, malaise and loss of appetite typically surface. When CKD reaches advanced stages, symptoms become more obvious and troublesome.

Your kidneys are basically blood filters. They remove waste, toxins, and excess fluid from your body. They also play roles in controlling your blood pressure, producing red blood cells, maintaining bone health, and regulating natural chemicals in your blood.

When your kidneys aren’t operating at full capacity, you can experience heart disease, stroke, anemia, infection, and depression – among others.

When should you be screened for CKD?

Those at highest risk for CKD include patients with diabetes, high blood pressure and those with first-degree relatives who have advanced disease.

If you have diabetes, you should have your kidney function checked annually (2). If you have other risk factors, like high blood pressure, heart disease, or a family history of kidney failure, talk to your physician about establishing a regular screening schedule.

A 2023 study by Stanford School of Medicine recommends screening all U.S. adults over age 35. The authors conclude that the costs for screening and early treatment are lower than the long-term cost of treatment for those who are undiagnosed until they have advanced CKD (3). They also project that early screening and treatment will improve life expectancy.

How can you protect your kidneys?

Walking regularly and reducing protein and sodium consumption can help. One study shows that walking reduces the risk of death by 33 percent and the need for dialysis by 21 percent (4). Those who walked more often saw better results: participants who walked one or two times a week had a 17 percent reduction in death and a 19 percent reduction in kidney replacement therapy, while those who walked at least seven times per week experienced a 59 percent reduction in death and a 44 percent reduction in the risk of dialysis. The study included 6,363 participants with an average age of 70 who were followed for an average of 1.3 years.

With CKD, more dietary protein may be harmful. In a meta-analysis of 17 studies of non-diabetic CKD patients who were not on dialysis, results showed that the risk of progression to end-stage kidney disease, including the need for dialysis or a kidney transplant, was reduced 36 percent in those who consumed a very low-protein diet, rather than a low-protein or a normal protein diet (5).

How much sodium is too much? Results of one study showed that modest sodium reduction in our diet may be sufficient to help prevent proteinuria (protein in the urine) (6). Here, less than 2000 mg per day was shown to be beneficial.

What role do high blood pressure medications play?

Certain medications, ACE inhibitors or ARBs, are regularly prescribed to patients who have diabetes to protect their kidneys. ACEs and ARBs are two classes of high blood pressure medications that work on the kidney systems responsible for blood pressure and water balance (7). 

What about patients who do not have diabetes? Study results show that these medications reduced the risk of death significantly in patients with moderate CKD. Most of the patients were considered hypertensive. However, there was a high discontinuation rate among those taking the medications. If you exclude discontinuations, the results are robust with a 63 percent reduction in mortality risk.

What about NSAIDs?

Non-steroidal anti-inflammatory drugs (NSAIDs), which include ibuprofen and naproxen, have been associated with CKD progression and with kidney injury in those without CKD (1). NSAIDs can also interfere with the effectiveness of ACE inhibitors or ARBs. Talk to your doctor about your prescription NSAIDs and any other over-the-counter medications and supplements you are taking.

What should I focus on?

It’s critical to protect your kidneys. Fortunately, basic lifestyle modifications can help; lowering sodium modestly, lowering your protein consumption, and walking frequently may all be viable options. Talk to your physician about your medications and supplements and about whether you need regular screening. 

References:

(1) cdc.gov. (2) niddk.nih.gov (3) Annals of Int Med. 2023;176(6):online. (4) Clin J Am Soc Nephrol. 2014;9(7):1183-9. (5) Cochrane Database Syst Rev. 2020;(10):CD001892. (6) Curr Opin Nephrol Hypertens. 2014;23(6):533-540. (7) J Am Coll Cardiol. 2014;63(7):650-658.

Dr. David 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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METRO photo

By David Dunaief M.D.

Dr. David Dunaief

Your kidneys do far more than filter waste and fluid from your body. They maintain your blood’s health, help control your blood pressure, make red blood cells and vitamin D, and control your body’s acid levels. With all these functions relying on them, it’s crucial to keep them operating well.

When kidney function degrades, you can experience hypertension or cardiovascular problems. In later stages of chronic kidney disease (CKD), you may require dialysis or a kidney transplant. For the best outcomes, it’s critical to identify CKD early and arrest its progression to more serious stages. However, of the estimated 35.5 million U.S. adults who have CKD, as many as 9 in 10 are not even aware they have it (1).

Unfortunately, early-stage CKD symptoms are not obvious and can be overlooked. Among them are foamy urine, urinating more or less frequently than usual, itchy or dry skin, fatigue, nausea, appetite loss, and unintended weight loss (2).

Fortunately, simple tests, such as a basic metabolic panel and a urinalysis, can confirm your kidney function. These indices include an estimated glomerular filtration rate (eGFR), creatinine level and protein in the urine. eGFR is a calculation and, while the other two indices have varying ranges depending on the laboratory used, a patient with an eGFR of 30 to 59 is classified as having mild disease. The eGFR and the kidney function are inversely related, meaning as eGFR declines, the severity of CKD increases.

What can be done to address early-stage CKD, before you experience complications? Several studies have evaluated different lifestyle modifications and their impacts on its prevention, treatment and reversal.

What creates the greatest kidney risks?

Among the greatest risks for your kidneys are uncontrolled diseases and medical disorders, such as diabetes and hypertension (1). If you have — or are at risk for — diabetes, control your blood sugar levels to limit kidney damage. Similarly, if you have hypertension, controlling it will put less stress on your kidneys. For these diseases, it’s important to have your kidney function tested at least once a year.

In addition, obesity and smoking are risk factors and can be managed by making lifestyle changes.

How can diet help protect your kidneys?

Fruits and vegetables may play a role in helping patients with CKD. In a one-year study with 77 patients, results showed that fruits and vegetables work as well as sodium bicarbonate in improving kidney function by reducing metabolic acidosis levels (3).

What is the significance of metabolic acidosis? Body fluids become acidic, and it is associated with CKD. The authors concluded that both sodium bicarbonate and diets including fruits and vegetables helped protect the kidneys from further damage in patients with CKD. Alkali diets are primarily plant-based, although not necessarily vegetarian or vegan. Animal products tend to cause an acidic environment.

In the Nurses’ Health Study, results show that animal fat, red meat and sodium all negatively impact kidney function (4). The risk of protein in the urine, a potential indicator of CKD, increased by 72 percent in those participants who consumed the highest amounts of animal fat compared to the lowest, and by 51 percent in those who ate red meat at least twice a week. With higher amounts of sodium, there was a 52 percent increased risk of having lower eGFR levels.

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

The National Kidney Foundation recommends diets that are higher in fruit and vegetable content and lower in animal protein, including the Dietary Approaches to Stop Hypertension (DASH) diet and plant-based diets (2). 

In my practice, when CKD patients follow a vegetable-rich, nutrient-dense diet, they experience substantial kidney function improvements. For instance, one patient improved his baseline eGFR from 54 to 63 after one month of dietary changes, putting him in the range of “normal” kidney functioning. Note that this is one patient, not a rigorous study.

How often should you have your kidney function tested?

It is important to have your kidney function checked as part of your regular physical. If your levels are low, you should address the issue through medications and lifestyle modifications to manage and reverse early-stage CKD. If you have common risk factors, such as diabetes, smoking, obesity or high blood pressure, or if you are over 60 years old, talk to your doctor about regular testing. 

Don’t wait until symptoms and complications occur. In my experience, it is much easier to treat and reverse CKD in its earlier stages.

References:

(1) CDC.gov. (2) kidney.org. (3) Clin J Am Soc Nephrol. 2013;8:371-381. (4) Clin J Am Soc Nephrol. 2010; 5:836-843.

Dr. David 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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Increasing potassium may improve health outcomes

By David Dunaief, M.D.

Dr. David Dunaief

Most Americans consume far too much sodium — an average of 3400 mg per day, which is well over the 2300 mg per day recommended upper limit for teens and adults (1). It’s become such an issue that the FDA is working with food manufacturers and restaurants to drive these numbers down (2).

If you don’t have hypertension, what difference does it make? Sodium can have a dramatic effect on your health, regardless of your blood pressure.

It’s hard to avoid, with sodium hiding even in foods that don’t taste salty, like bread products and salad dressings. Other foods with substantial amounts of sodium include cold cuts and cured meats, cheeses, poultry, soups, pasta, sauces and, of course, snack foods. Packaged foods and restaurant meals are where most of our consumption occurs.

In contrast, only about two percent of people consume enough potassium in their diets (3). According to the National Institutes of Health, target potassium intake is between 2600 mg and 3400 mg for adult women and men, respectively.

How are sodium and potassium related?

A high sodium-to-potassium ratio increases your cardiovascular disease risk by 46 percent, according to a 15-year study of more than 12,000 participants (4).

A more recent analysis of over 10,000 participants followed for almost nine years tested sodium and potassium excretion, a more reliable measure of intake, and found that higher sodium excretion, lower potassium excretion, and a higher sodium-to-potassium ratio were all associated with a higher cardiovascular risk (5). Each daily incremental increase of 1000 mg in sodium excretion was associated with an 18 percent increase in cardiovascular risk.

To improve your overall health, you might need to shift your sodium-to-potassium balance so that you consume more potassium and less sodium. And if you struggle with — or are at risk for — high blood pressure, this approach could help.

Why lower your sodium consumption?

Two studies illuminate the benefits of reducing sodium in high and normal blood pressure patients, ultimately preventing cardiovascular disease, including heart disease and stroke.

The first was a meta-analysis that evaluated data from 34 randomized clinical trials, totaling more than 3,200 participants. It demonstrated that salt reduction from 9-to-12 grams per day to 5-to-6 grams per day had a dramatic effect. Blood pressure in both normotensive and hypertensive participants was reduced by a significant mean of −4.18 mm Hg systolic (top number) and −2.06 mm Hg diastolic (bottom number) (6).

When looking solely at hypertensive patients, the reduction was even greater, with a systolic blood pressure reduction of −5.39 mm Hg and a diastolic reduction of −2.82 mm Hg.

The researchers believe that the more we reduce salt intake, the greater the blood pressure reduction. The authors recommend further reduction to 3 grams per day as a long-term target and hypothesize that the effects on blood pressure will most likely result in a decrease in cardiovascular disease.

In the second study, a meta-analysis of 42 clinical trials including both adults and children, there was a similarly significant reduction in both systolic and diastolic blood pressures (7). Both demographics experienced a blood pressure reduction, although the effect was greater in adults. Interestingly, an increase in sodium caused a 24 percent increased risk of stroke incidence but, more importantly, a 63 percent increased risk of stroke mortality. The risk of mortality from heart disease increased by 32 percent alongside an increase in sodium.

Isn’t too little sodium a risk?

Some experts warn that sodium levels that are too low can be a problem. While this is true, it’s very rare, unless you have a health condition or take medication that depletes sodium. Since sodium is hiding everywhere, even if you don’t add salt to your food, you’re probably consuming more than the recommended amount of sodium.

Why focus on potassium consumption?

In a meta-analysis involving 32 studies, results showed that as the amount of potassium was increased, systolic blood pressure decreased significantly (8). When high blood pressure patients consumed foods containing 3.5 to 4.7 grams of potassium, they experienced an impressive −7.16 mm Hg reduction in systolic blood pressure. Anything more than this amount of potassium did not provide additional benefit. Increased potassium intake also reduced stroke risk by 24 percent.

Blood pressure reduction was greater with increased potassium consumption than with sodium restriction, although this was not a head-to-head comparison. The good news is that it’s easy to increase your potassium intake; it’s found in many whole foods and is richest in fruits, vegetables, beans and legumes.

So, what’s the bottom line? Decrease your sodium intake and increase your potassium intake from foods to strike a better sodium-to-potassium balance. As you reduce your sodium intake, give yourself a brief period to adapt; it takes about six weeks to retrain your taste buds.

References:

(1) Dietary Reference Intakes for Sodium and Potassium. Washington (DC): National Academies Press (US); 2019 Mar. (2) fda.gov. (3) nih.gov. (4) Arch Intern Med. 2011;171(13):1183-1191. (5) N Engl J Med 2022;386:252-263. (6) BMJ. 2013 Apr 3;346:f1325. (7) BMJ. 2013 Apr 3;346:f1326. (8) BMJ. 2013; 346:f1378.

Dr. David 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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