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Stress management and diet can have positive effects

By David Dunaief, MD

Dr. David Dunaief

According to estimates, 10 to 15 percent of the population suffers from irritable bowel syndrome (IBS) symptoms, although only five to seven percent have been diagnosed (1).

Symptoms can directly affect quality of life. They include abdominal pain, cramping, bloating, constipation and diarrhea.

Diagnosing IBS is challenging. While the general perception is that IBS symptoms are somewhat vague, there are discrete criteria physicians use to provide a diagnosis it and eliminate more serious possibilities.

The Rome IV criteria comprise an international effort to help diagnose and treat functional gastrointestinal disorders. Using these criteria in combination with a careful history and physical exam helps provide a diagnosis.

So, what can be done to improve IBS? There are a number of possibilities.

Mental state

The “brain-gut” connection is real. It refers to the direct connection between mental state, such as nervousness or anxiety, to gastrointestinal issues, and vice versa.

Mindfulness-based stress reduction was used in a small, but randomized, eight-week clinical trial with IBS (2). Those in the mindfulness group (treatment group) showed statistically significant results in decreased severity of symptoms compared to the control group, both immediately after training and three months post-therapy.

Those in the treatment group were instructed to do meditation, gentle yoga and “body scanning” — focusing on one area of the body for muscle tension detection. The control group attended an IBS support group once a week.

A preliminary study has suggested there may be a link between IBS and migraine and tension-type headaches. The study of 320 participants, 107 with migraine, 107 with IBS, 53 with episodic tension-type headaches (ETTH), and 53 healthy individuals, identified significant occurrence crossover among those with migraine, IBS and ETTH. Researchers also found that these three groups had at least one gene that was different from that of healthy participants. Their hope is that this information will lead to more robust studies that could result in new treatment options (3).

Gluten

In a small randomized clinical trial, patients who were given gluten were more likely to complain of uncontrolled symptoms than those who were given a placebo, 68 percent vs. 40 percent, respectively.

These results were highly statistically significant (4). The authors concluded that nonceliac gluten intolerance may exist. Gluten sensitivity may be an important factor in the pathogenesis of some IBS patients (5).

I suggest to my patients that they might want to start avoiding gluten and then add it back into their diets slowly to see the results.

Fructose

Some IBS patients may suffer from fructose intolerance. In a prospective (forward-looking) study, IBS researchers used a breath test to examine this possibility. The results were dose dependent. When patients were given a 10 percent fructose solution, only 39 percent tested positive for fructose intolerance, but when they were given a 33 percent solution, 88 percent of patients tested positive.

The symptoms of fructose intolerance included flatus, abdominal pain, bloating, belching and alternating bowel habits. The authors concluded that avoidance of fructose may reduce symptoms in IBS patients (6).

According to another study, about one-third of IBS patients are fructose intolerant. When on a fructose-restricted diet, symptoms appeared to improve (7). Foods with high levels of fructose include certain fruits, like apples and pears, but not bananas.

Lactose

Another small study found that about one-quarter of patients with IBS also have lactose intolerance. Two things are at play here. One, it is very difficult to differentiate the symptoms of lactose intolerance from IBS. The other is that most IBS trials are small and there is a need for larger trials.

Of the IBS patients who were also lactose intolerant, there was a marked improvement in symptomatology at both six weeks and five years when placed on a lactose-restrictive diet (8).

Though small, the trial results were statistical significant, which is impressive. Both the durability and the compliance were excellent, and visits to outpatient clinics were reduced by 75 percent. This demonstrates that it is most probably worthwhile to test patients for lactose intolerance who have IBS.

Probiotics

Treatment with probiotics from a study that reviewed 42 trials shows that there may be a benefit to probiotics, although the endpoints were different in each trial. The good news is that most of the trials reached one of their endpoints (9).

Probiotics do show promise, including the two most common strains, Lactobacilli and Bifidobacteri, which were covered in the review.

All of the above gives IBS patients a sense of hope that there are options for treatments that involve modest lifestyle changes. I believe there needs to be a strong patient-doctor connection in order to choose the appropriate options that result in the greatest symptom reduction.

References:

(1) American College of Gastroenterology [GI.org]. (2) Am J Gastroenterol. 2011 Sep;106(9):1678-1688. (3) American Academy of Neurology 2016, Abstract 3367. (4) Am J Gastroenterol. 2011 Mar;106(3):508-514. (5) Am J Gastroenterol. 2011 Mar;106(3):516-518. (6) Am J Gastroenterol. 2003 June;98(6):1348-1353. (7) J Clin Gastroenterol. 2008 Mar;42(3):233-238. (8) Eur J Gastroen-terol Hepatol. 2001 Aug;13(8):941-944. (9) Aliment Pharmacol Ther. 2012 Feb;35(4):403-413.

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. 

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Cilantro. Photo from Unsplash

By Barbara Beltrami

The world is divided into two groups of people: those who love cilantro aka coriander and use it in all sorts of dishes and those who cannot abide it and say it tastes like soap. If you belong to the first group read on. Cilantro lends its distinct flavor to salsa, marinades, sauces, pestos, salads and even coolers and cocktails.

Pico de Gallo

YIELD: Makes 2 1/2 cups

INGREDIENTS:

4 tomatoes, diced

1/2 onion, minced

1 serrano chile, minced

2 tablespoons freshly squeezed lime juice

2 heaping tablespoons freshly chopped cilantro leaves

Salt and freshly ground pepper to taste

DIRECTIONS:

In medium bowl toss all ingredients together and let sit at room temperature for one hour or cover and refrigerate overnight, then bring to room temperature before serving. Serve with tacos, chili or grilled meat or poultry.

Cilantro Marinated Chicken or Pork

YIELD: Makes 4 servings

INGREDIENTS:

2 jalapeno peppers, seeded

4 garlic cloves, chopped

1/2 cup fresh cilantro leaves and stems

2 tablespoons Asian fish sauce

1 tablespoon vegetable oil

1 teaspoon sesame oil

Salt and crushed red pepper flakes to taste

4 boneless chicken breasts or 4 pork chops

DIRECTIONS:

In a blender puree the jalapeño peppers, garlic, cilantro, fish sauce, vegetable oil, sesame oil, salt and pepper flakes. Place meat in a shallow dish and coat it with cilantro puree. Cover and refrigerate for one to three hours. Bring back to room temperature.  Grill or broil meat for 5 minutes each side until no longer pink in center. Serve with rice and stir-fried veggies.

Cilantro-Pistachio Pesto

YIELD: Makes about one cup

INGREDIENTS:

2 garlic cloves

3 serrano chiles, seeded and charred

2 tightly packed cups fresh flat leaf parsley

2 cups fresh cilantro

2/3 cup shelled pistachio nuts

1/2 cup extra virgin olive oil

Salt and freshly ground pepper to taste

DIRECTIONS:

Peel the garlic cloves; coarsely chop the chiles. Transfer garlic, chiles, parsley, cilantro, pistachios, oil and salt and pepper to bowl of electric food processor or jar of blender. Puree until fairly smooth; transfer to small glass bowl, cover with plastic wrap and refrigerate for up to one month. When ready to serve bring to room temperature.  Serve with pasta, scrambled eggs, grilled veggies, meat, fowl or fish.

Cilantro-Lime Sauce

YIELD: Makes 1 to 1 1/2 cups

INGREDIENTS:

1 cup sour cream

1/2 cup milk or cream

1/4 cup chopped cilantro

2 tablespoons lime juice

Salt and freshly ground pepper to taste

DIRECTIONS:

In a small bowl vigorously whisk together all the ingredients. Cover and refrigerate up to 4 hours until ready to use. Serve with tacos, chili or grilled beef.

Cilantro Margarita Spritz

YIELD: Makes 3 to 4 cocktails

INGREDIENTS:

4 ounces Triple Sec

6 ounces tequila

6 ounces prosecco

15 cilantro leaves

1 1/2 cups pureed peeled and seeded cucumber

2 ounces freshly squeezed lime juice

2 ounces simple syrup

3 ounces chilled sparkling water

3 cilantro sprigs for garnish

DIRECTIONS:

In a cocktail shaker, vigorously shake all ingredients except sparkling water. Fill tall chilled glasses one-quarter up with crushed ice. Pour mix over ice into glasses, then add sparkling water and give a stir. Garnish with cilantro sprigs. Serve with cocktail nuts.

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H. Reşit Akçakaya during a recent bird watching expedition. Photo by T. Lybvig

By Daniel Dunaief

In the world of conservation, scientists and policy makers have relied on the International Union for Conservation of Nature Red List of Threatened Species to understand just how likely species are to go extinct, often as a result of human actions.

When a species moves from one threat level to another, conservationists typically spring into action, taking steps to protect individuals within a species and the habitat in which that species lives.

A team of over 200 scientists in 171 institutions tested a new measure, called the Green Status, that is designed to measure how effective those conservation efforts have been.

“There are always stories about conservation successes,” said H. Reşit Akçakaya, one of the leaders of the effort who helped develop the methodology for this new metric. The scientists wanted to “create a standard, objective way of recognizing the success and effectiveness of conservation measures. That is very important. We need optimism. People don’t act unless there is hope.”

The Green Status monitors a species recovery, measuring the impact of past and future conservation efforts. Researchers including Akçakaya, who is a Professor in the Department of Ecology and Evolution at Stony Brook University, came up with a formula to determine Green Status. 

The formula includes elements conservations consider important: it should be safe from extinction, it should have a large enough population to have all its natural interactions with the other parts of the ecosystem, and it should be represented in every ecosystem in which it naturally exists and has existed.

The scientists considered the trade-offs between practicality in aiming for a system that is feasible to apply to many species and comprehensiveness, which incorporates relevant aspects of, and factors involved in, species recovery, Akçakaya explained in an email.

The International Union for Conservation of Nature Green Status of Species will join the IUCN Red List to provide a more complete update on a species’ conservation condition, which includes their extinction risk and recovery process.

In a new paper, published in Conservation Biology, scientists from around the world contributed to creating preliminary Green Status for 181 species.

It took seven years from the time the scientists came up with the method, developed it further to make it applicable to all species, published papers, organized workshops and other consultations to get feedback and tested the method.

Akçakaya, who has been involved with the Red List since 1999, said the new system provides information about the status of the species that goes beyond the risk of extinction.

“It’s not sufficient to prevent extinction,” Akçakaya said. “We want them to recover as well.”

One of the challenges in developing this method was in deriving definitions that apply across all species and that are not specific to the conditions and threats any one species faces.

Extinction is difficult to measure but easy to conceptualize, he explained. Recovery, on the other hand, is “not as clear cut.”

The first goal of this enterprise was to come up with ways of standardizing how to measure the recovery of a species that would reflect whether conservation efforts were working.

A species on the Red List might have been critically endangered over a decade earlier. After considerable conservation effort, that species may still be critically endangered, according to the same Red List.

That, however, does not indicate anything specific about whether the conservation efforts are working.

The Red List “doesn’t tell us how much more we need to work to get to a level that we can call recovered,” Akçakaya explained.

The Green Status is not currently a part of conservation policy decisions, particularly because it has only been applied to 181 species. The IUCN, however, which is the world’s largest network of conservationists and conservation scientists, has approved it.

Getting from 181 to tens of thousands will take several years, although Akçakaya said he “has a good start” and he has interest from different people who are involved in conservation.

“We are on our way” towards creating a metric that affects conservation policy, he said. “It will take several years to be used” to affect conservation policies for threatened species.

When the Green Status is more broadly available for a wider collection of species, Akçakaya believes it will provide a way for government officials to make informed decisions.

The IUCN, however, does not tell local and national officials what to do with the information provided with the Red List or with the Green Status.

In developing the Green Status, Akçakaya worked with numerous scientists and conservationists. For this methodology, the researchers received hundreds of comments from people who  shared insights online. They also announced the work within the IUCN network, through which they received feedback.

Part of the larger advances in the context of the Green Status came from looking not only at the resilience of the species, but also at what the species is doing in the ecosystem. “Is it fulfilling its ecological role and its function in the ecosystem?” Akçakaya asked.

The Stony Brook scientist is pleased with the Green Status work. The intelligence of the group is larger than the intelligence of any one person, he said.

The group “had the same goal,” he added. “It was a really satisfying experience in terms of how we came up with a system.”

The Green Status can help balance the conservation news. While conserving biodiversity is urgent, one of the things this measure can achieve is to formalize the successes.

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Photo from Smithtown Animal Shelter

MEET WABBIT!

This week’s shelter pet is Wabbit, a 5-year-old tabby cat currently up for adoption at the Smithtown Animal Shelter. Poor Wabbit found himself abandoned in a feral colony and being beat up by more dominant cats. He has a crinkled ear from chronic ear issues and/or an ear injury and may need a home that can clean his ears on occasion. 

Wabbit is very timid and needs a quiet home that will give him time and patience. We know that he will reward you with love.

If you are interested in meeting Wabbit, please call ahead to schedule an hour to properly interact with him in a domestic setting, which includes a Meet and Greet Room.  

The Smithtown Animal & Adoption Shelter is located at 410 Middle Country Road, Smithtown. Shelter operating hours are currently Monday to Saturday from 10 a.m. to 3 p.m. (Sundays and Wednesday evenings by appointment only). For more information, call 631-360-7575. or visit www.smithtownanimalshelter.com.

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By Matthew Kearns, DVM

Luckily, with more people getting vaccinated, things are opening up and people are going back to work. This also means many dog owners previously working from home are leaving some distressed (and possibly destructive) doggies. The term separation anxiety refers to the anxiety your pet feels when you leave. The frustration of behaviors associated with this condition is a common cause of surrendering pets. This two-article series should hopefully give an overview of the disorder and treatment options.

Separation anxiety occurs in dogs of any age, breed (even mixed breeds), and gender. The disorder is seen in a higher percentage of dogs adopted from shelters. Previously, it was theorized that separation from mom and littermates and changes in environment (surrender to a shelter) may play a major role. More recently, we’ve seen owners that are spending almost all their time sheltering in place with their dogs having the same problems. 

Stock photo

When my son turned two I learned very quickly what separation anxiety is in humans and what triggers it. He would scream and cry when his mother left the room. When we spoke to his pediatrician about this behavior the doctor explained that at that age my son was aware enough to understand that his mom was leaving, but still too young to understand when (and if) she was coming back. 

Dogs that suffer from separation anxiety are the same way. It may manifest as “spiteful” and this behavior is unacceptable, but these dogs are purposely “spiteful” or “bad dogs.” They are actually having the equivalent of a nervous breakdown every time you leave.  

The most common sign of separation anxiety is destructiveness (scratching, biting, urination, defecation) when you are not home, especially if it is aimed at the door you just exited or windows near the door. One pet owner described their dog as running upstairs every time they left. One time the dog became so agitated it broke through a screen and jumped from an upstairs balcony. 

Another common sign is vocalization (barking, howling, whining) after you have left (this will not make you popular with your neighbors). Self-trauma (the pet licking or chewing at itself sometimes until bleeding) is also very common.  

DO NOT GIVE UP HOPE.  THERE IS HELP AVAILABLE. First speak to your veterinarian about making sure there is not a medical/neurologic disorder mimicking these behaviors (seizures, pain, etc). An exam and certain diagnostics (bloodwork, X-rays, fecal analysis) are a good baseline to make sure nothing else is going on. If that is ok, help with a trainer or animal behaviorist are a real good idea (especially one that can assess your dog in his/her home environment). Sometimes medication in conjunction with behavioral modification is needed. 

The next article will focus on behavioral modification and medications to treat separation anxiety. 

Dr. Kearns practices veterinary medicine from his Port Jefferson office and is pictured with his son Matthew and his dog Jasmine. 

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Pixabay photo

Imagine the hope in newsrooms across the nation to know that a bill introduced in the U.S. House of Representatives and Senate may resuscitate the news business on local levels.

New outlets, especially print media, have been suffering for decades. In the late 1990s, computers became a staple in homes and gathering information became easier than ever for readers. The introduction of smartphones, social media and apps helped hasten the downward slope of print. The pandemic was the final nail in the coffin of many magazines and newspapers across this nation as they saw advertising dollars diminish due to many businesses shutting down. Even if temporarily, they felt there was no reason to place an ad.

Sponsored by U.S. Reps. Ann Kirkpatrick (D-AZ) and Dan Newhouse (R-WA), the Local Journalism Sustainability Act, if passed, will help local newspapers as well as digital platforms and local radio and television stations on multiple levels, as subscribers, advertisers and news outlets will be able to take advantage of tax credits for five years.

Americans who subscribe to a local nonprofit news publisher will be eligible for a five-year credit of up to $250 annually. That credit means covering 80% of subscription costs in the first year and 50% in the following four years. That credit can even be used when making a donation to a local nonprofit news publishing company.

Businesses will have more financial flexibility to spend on advertising with local newspapers, television, radio stations and digital-only platforms as well as nonprofit news organizations with a five-year credit of up to $5,000 in the first year and up to $2,500 in the next four years.

Local news outlets will be able to retain and hire more journalists as their five-year credit will be up to $25,000 per journalist in year one and $15,000 in the following four years. This can cover 50% of compensation up to a $50,000 salary in the first year and 30% of the salary up to $50,000 in the last four years.

The federal government providing tax credits helps news outlets and, at the same time, keeps its distance by not being closely aligned to any media platform. This allows journalists to continue providing unbiased reporting.    

For local publishers and journalists, whose job it is to keep readers up to date on what’s going on in their town and share their neighbors’ achievements, the task has become difficult as the number of newsroom employees has shrunk to a small percentage of what it once was and resources are stretched thin. At times the financial constraints prevent reporters to be everywhere they need to be to ask important questions.

So, it’s no surprise that many newspaper journalists support the Local Journalism Sustainability Act as the bipartisan bill can be the answer in helping to keep jobs.

One problem with tax credits is that they only go to businesses that show profits, because credits come off the top of the taxes they pay. Small businesses can have no profits or razor-thin ones at this time.

With that being said, we applaud our local congressmen Tom Suozzi (D-NY3) and Lee Zeldin (R-NY1) who are co-sponsors of the bill. And, we urge our readers who believe in local journalism to contact their federal representatives and ask them to support this act.

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Pixabay photo

By Daniel Dunaief

Daniel Dunaief

Welcome to the casino. Just by being alive today, you’ve all punched your ticket to the worldwide slot machine.

Now, the machines operate the way people expect, most of the time. They follow their programming, they make the loud noises as the three wheels inside of them spin and then show images on those three wheels.

The machine doesn’t cost anything to play. You don’t have to put in quarters or tokens or anything else. You just sit down and a machine starts spinning.

In fact, when you sit in one of our relatively unclean chairs, because we’re much more about playing the game than we are about cleanliness or safety, the process begins.

The chairs are close together, so you and your neighbor can compare notes on how you’re doing in this game, can share stories about your lives and can enjoy time out, away from the limitations of quarantine and all the other frustrations that you’ve had to endure for so long.

We do everything we can to discourage masks. We want you to be able to share the freedom that comes from seeing each other’s faces clearly.

And, if you should happen to need to use the bathroom, we don’t have any annoying signs about washing your hands. In fact, we don’t even recommend soap. What is the value of soap, after all? It’s probably some corporate scheme to boost profits somewhere.

We mean, come on, right? The cavemen didn’t have soap and they lived long enough to become fossils. That should be good enough for you, too, right? Before they died, they drew cool things on the wall, sharing stories that survived years after they did.

Now, we want to share a few details about our cool slot machines. You want to know a secret? We didn’t build these machines. We know, it’s hard to believe, but they just appeared one day, as if a stork or another kind of flying creature brought them. Well, not all of them. That’s the incredible thing. A few of them appeared and, after we started playing them, they copied themselves. The more we played them, the more they produced new copies.

Now, you might have heard that these machines can be bad for you. But, hey, so many other things are bad for you, too, and you still do them, right? You have a little too much to eat or drink now and then, and you maybe put a recycling bottle in the wrong trash can, but who pays attention to those things?

Anyway, so, these original machines built themselves the same way, most of the time. Each time a new machine appeared, they worked the same way, with images flying across the screen.

Every so often, when the machines made enough copies of themselves, they changed slightly. We’re not exactly sure why or how that happened, but it’s perfectly normal, we think.

The newest versions of these machines spin at a faster rate and also copy themselves more rapidly. One of them, which is now the most common type, has a big D on its side. That’s the dominant machine.

Actually, at this point, we’d kind of prefer people stop playing the game. You see, each time you play the game, not only does that D version copy itself, but our people are telling us that we run the risk of creating other types of the machine that might have worse features.

But, wait, how can you stop playing? What can keep you out of a casino that’s everywhere? Well, there’s a special thing you can get at any local drug store that someone puts in your arm. After you get it, you become almost invisible to the machine. That may be the best way to get away from these monsters.

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By Leah S. Dunaief

Leah Dunaief

Intuitively we know that our behavior changed in just about every way during the unprecedented events of last year. The American Time Use Survey, a responsibility of the U.S. Bureau of Labor Statistics, asks thousands of people annually to record how they spend their daily minutes, and they came up with some research to back up our intuition on how we adapted to COVID-19 in 2020. The New York Times covered the story last Thursday, breaking out a number of categories for comparison.

As far as non-work and non-school time, the data was divided into sleeping; watching TV, movies or videos; playing games; cooking; doing housework; grooming; exercising; and texting, phone calls and video chats. It was further broken down by demographic groups: 15-24; 25-44; 45-64; and 65+. As far as sleeping goes, all the age groups slept more, with those 25-44 and 45-64 getting the most rest and both the 15-24 and the 65+ cohorts having the smallest increases. That makes sense to me because those getting more sleep are probably the primary workforce. The ones who did not have to commute as much and could sleep a little later.

The 45-64 and the 15-24 groups also spent the most extra time watching TV, movies and videos, about 25 minutes more per day. Yay for Netflix and the other streaming services who introduced us to binging. By far and away the most increase playing games was among the 15-24 folks, averaging 24 more minutes a day.  Mostly all four groups didn’t change much in the amount of cooking they did, but while the others increased slightly, the 15-24 category decreased six minutes a day.

Doing housework wasn’t much different from 2019, with the oldest category completely unchanged.

So what went down? Are you surprised to know it was grooming? The others dropped from four to seven minutes a day, but the youngest members increased four-tenths of a minute. Exercising increased four to five minutes, except for the oldest set, who decreased their exercising by five minutes daily. And everybody spent more time texting, phoning and participating in video chats, with the youngest crowd up eight minutes a day.

Last year was a difficult time for those forced to be alone. The survey tracks people during waking hours by how much time spent with people outside the household, with household members only and with those alone. The numbers for time with outsiders sank to one hour and 33 minutes less a day, while for household members, the amount rose by 31 minutes. The amount of alone time rose 57 minutes on average out of an eight-hour day. Remember all these numbers measure increases, not absolute time. For those in nursing homes, for example, who were unable to receive visitors, it was a miserably lonely year. And socializing among children was severely limited.

The greatest disruption caused by the coronavirus was in the lives of parents. With schools closed, parents became homeschoolers, particularly for children in elementary school. This burden could be in addition to working on a job from home and it affected women more than men because in most cases they carry the greater responsibility for child care. Sometimes it forced women to quit their jobs. Single mothers were particularly disrupted by the situation.

The nature of work also changed. For starters, in 2019, only one in seven people worked remotely. Last year it was one in three. And the changes laid bare disparities among workers.  Hispanic workers were more likely to lose their jobs. Black workers were most often required to go to their jobs in person, thus being more exposed to infection. White and Asian workers were often able to work from home.

There were also stark differences depending on educational levels. Those with graduate and professional degrees generally spent more hours last year working from home than in the office. Those with a high school diploma or less were often considered “essential workers” and had to function in person in the workplace, 

Will this data cause change in the future?

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About 70% of people with Parkinson’s experience a tremor at some point in the disease. Stock photo
Much new research focuses on dietary approaches

By David Dunaief

Dr. David Dunaief

Parkinson’s disease is a neurodegenerative disease, most often associated with a movement disorder, or tremors. According to the Parkinson’s Foundation, roughly 60,000 Americans are diagnosed with Parkinson’s disease (PD) each year, and approximately one million Americans are living with PD (1).

Patients with PD suffer from a collection of symptoms caused by the breakdown of brain neurons. In medicine, we know the most common symptoms by the mnemonic TRAP: tremors while resting, rigidity, akinesia/bradykinesia (inability/difficulty to move or slow movements) and postural instability or balance issues. It can also result in a masked face, one that has become expressionless, and potentially dementia.

There are several different subtypes of PD; the diffuse/malignant phenotype has the highest propensity toward cognitive decline (2).

There’s a lot we still don’t know about the causes of PD; however, risk factors may include head trauma, reduced vitamin D, milk intake, well water, being overweight, high levels of dietary iron, and migraine with aura in middle age.

The part of the brain most affected is the basal ganglia, and the prime culprit is dopamine deficiency that occurs in this brain region (3). Adding back dopamine has been the mainstay of medical treatment, but eventually the neurons themselves break down, and the medication becomes less effective. Is there hope? Yes, in the form of medications and deep brain stimulatory surgery, but also with lifestyle modifications. Lifestyle factors include iron, vitamin D and CoQ10. The research, unfortunately, is not conclusive, though it is intriguing.

Reducing iron in the brain

This heavy metal is potentially harmful for neurodegenerative diseases such as Alzheimer’s disease, macular degeneration, multiple sclerosis and, yes, Parkinson’s disease. The problem is that this heavy metal can cause oxidative damage.

In a small, yet well-designed, randomized controlled trial (RCT), researchers used a chelator to remove iron from the substantia nigra, a specific part of the brain where iron breakdown may be dysfunctional. An iron chelator is a drug that removes the iron. Here, deferiprone (DFP) was used at a modest dose of 30 mg/kg/d (4). This drug was mostly well-tolerated.

The chelator reduced the risk of disease progression significantly on the Unified Parkinson Disease Rating Scale (UPDRS) during the 12-month study. Participants who were treated sooner had lower levels of iron compared to a group that used the chelator six months later. A specialized MRI was used to measure levels of iron in the brain.

The iron chelator does not affect, nor should it affect, systemic levels of iron, only those in the brain specifically focused on the substantia nigra region. The chelator may work by preventing degradation of the dopamine-containing neurons. It also may be recommended to consume foods that contain less iron.

Does CoQ10 slow progression?

When we typically think of using CoQ10, a coenzyme found in over-the-counter supplements, it is to compensate for depletion from statin drugs or due to heart failure. Typical doses range from 100 to 300 mg. However, there is evidence that CoQ10 may be beneficial in Parkinson’s at much higher doses.

In an RCT, results showed that those given 1,200 mg of CoQ10 daily reduced the progression of the disease significantly based on UPDRS changes, compared to the placebo group (5). Other doses of 300 and 600 mg showed trends toward benefit, but were not significant. This was a 16-month trial in a small population of 80 patients. Unfortunately, results for other CoQ10 studies have been mixed. In this study, CoQ10 was well-tolerated at even the highest dose. Thus, there may be no downside to trying CoQ10 in those with PD.

Is Vitamin D part of the puzzle?

In a prospective study, results show that vitamin D levels measured in the highest quartile reduced the risk of developing Parkinson’s disease by 65 percent, compared to the lowest quartile (6). This is quite impressive, especially since the highest quartile patients had vitamin D levels that were what we would qualify as insufficient, with blood levels of 20 ng/ml, while those in the lowest quartile had deficient blood levels of 10 ng/ml or less. There were over 3,000 patients involved in this study with an age range of 50 to 79.

While many times we are deficient in vitamin D and have a disease, replacing the vitamin does nothing to help the disease. Here, it does. Vitamin D may play dual roles of both reducing the risk of Parkinson’s disease and slowing its progression.

In an RCT, results showed that 1,200 IU of vitamin D taken daily may have reduced the progression of Parkinson’s disease significantly on the UPDRS compared to a placebo over a 12-month duration (7). Also, this amount of vitamin D increased the blood levels by almost two times from 22.5 to 41.7 ng/ml. There were 121 patients involved in this study with a mean age of 72.

So, what have we learned? Though medication with dopamine agonists is the gold standard for the treatment of Parkinson’s disease, lifestyle modifications can have a significant impact on both prevention and treatment of this disease. Each lifestyle change in isolation may have modest effects, but cumulatively their impact could be significant. The most exciting part is that lifestyle modifications have the potential to slow the disease progression and thus have a protective effect.

References:

(1) parkinson.org. (2) JAMA Neurol. 2015;72:863-873. (3) uptodate.com. (4) Antioxid Redox Signal. 2014;10;21(2):195-210. (5) Arch Neurol. 2002;59(10):1541-1550. (6) Arch Neurol. 2010;67(7):808-811. (7) Am J Clin Nutr. 2013;97(5):1004-1013.

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. 

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Attendees at a conference at CSHL, an in-person tradition started in 1933. These conferences were suspended from 1943 to 1945 during WWII and were virtual during the pandemic in 2020 and for most of 2021. Photo by Miriam Chuai/CSHL

By Daniel Dunaief

For scientists, meetings and conferences aren’t just a chance to catch up on the latest research, gossip and see old friends: they can also provide an intellectual spark that enhances their careers and leads to new collaborations.

Amid the pandemic, almost all of those in-person conferences stopped, including the annual courses and meetings that Cold Spring Harbor Laboratory hosts. The internationally renowned lab has run meetings since 1933, with a few years off between 1943 and 1945 during World War II.

CSHL’s David Stewart. Photo by Gina Motisi/CSHL

While scientists made progress on everything from basic to translational research, including in laboratories that pivoted towards work on the SARS-CoV-2 virus, which causes COVID-19, they missed out on the kinds of opportunities that come from in-person interactions.

Assuming COVID infection rates are low enough this fall, CSHL is hoping to restart in-person conferences and courses, with the first conference that will address fifty years of the enzyme reverse transcriptase scheduled for Oct. 20th through the 23rd. That event was originally scheduled for October of 2020.

One of the planned guest speakers for that conference, David Baltimore, who discovered the enzyme that enables RNA to transfer information to DNA and is involved in retroviruses like HIV, won the Nobel Prize.

“I am hoping that there will be significant participation by many eminent scientists, so that is in itself somewhat [of] a ceremonial start,” wrote David Stewart, Executive Director of meetings and courses at Cold Spring Harbor Laboratory.

To attend any of the seven in-person meetings on the calendar before the end of the year, participants need to have vaccinations from either Pfizer, Moderna, Johnson & Johnson or AstraZeneca.

Attendees will have to complete an online form and bring a vaccination card or certificate. Scientists who don’t provide that information “will not be admitted and will not get a key to their room or be able to attend the event,” Stewart said.

CSHL also plans to maintain the thorough and deep cleaning procedures the lab developed. 

Stewart hopes that 75 to 80 percent or more of the talks presented will be live, with a virtual audience that could be larger than the in-person attendance.

“It is important to have a critical mass of presenters and audience in-person, but there’s no real limit on how large the virtual audience could be,” he explained.

Typically, the courses attract participants from over 50 countries. Even this year, especially with travel restrictions for some countries still in place, Stewart expects that the majority of participants will travel from locations within the United States.

The Executive Director explained that CSHL was planning to introduce a carbon offset program for all travel to conferences and courses that the facility reimburses starting in 2020. After evaluating several options, they plan to purchase carbon offsets from Cool Effect and will encourage participants paying their own way to do the same or through a similar program.

The courses, meanwhile, will begin on October 4th, with macromolecular crystallography and programming for biology. CSHL hopes to run six of these courses before the end of the year, including a scientific writing retreat.

“We are looking to 100 percent enrollment for our courses, so likely this year that will largely be domestic,” Stewart explained.

The courses, which normally have 16 participants, may have 12 students, as the lab tries to run these training opportunities safely without masks or social distancing.

From March of 2020 through the end of last year, the lab had planned 25 meetings and 25 courses. As the pandemic spread, the lab pivoted to virtual meetings. “I felt like a car salesman trying to sell virtual conferences,” Stewart recalled. For the most part, the lab was able to keep to its original schedule of conferences, albeit through a virtual format.

In addition to the scheduled meetings, CSHL decided to add meetings to discuss the latest scientific information related to COVID research. 

Stewart approached Hung Fan, a retired virologist at the University of California at Irvine, to help put together these COVID exchanges. Those meetings occurred in June, July, August, October, and January. The sixth one recently concluded.

The meetings addressed “everything around the science of the virus,” Stewart said, which included the biology, the origin, the genomics, the immune response, vaccines, therapeutics and diagnostics, among other scientific issues.

“There was a lot of excellent work being done around SARS-CoV-2,” Stewart said. “We were trying to identify that early on. It was helpful to have people who knew the field well.”

Fan said he combed through preprints like the CSHL-based bioRxiv and related medRxiv every day for important updates on the disease.

Fan described the scientific focus and effort of the research community as being akin to the Manhattan Project which built the atomic bomb during World War II, where “everybody said, ‘We have a common enemy and we want to apply all our capabilities to combating that.”

While Fan is pleased with the productive and valuable exchanges that occurred amid the virtual conferences, he recognized the benefit of sharing a room and a drink with scientific colleagues.

“A lot of the productive interactions at meetings take place in a social setting, at the bar, over dinner” and in other unstructured gatherings, he said. “People are relaxed and can share their scientific thoughts.”

After presentations, Fan described how researchers discuss the work presented and compare that to their own efforts. It’s easier to talk with people in person “as opposed to making a formalized approach through letters and emails.”

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