When was the last time before the coronavirus quarantine that you and your family had breakfast together, except maybe on Sunday morning? How long has it been since everyone didn’t bolt out the door, coffee cup or bagel in hand and dash off? Late for work, late for school, just plain late and barely time for a goodbye. Along with the many togetherness opportunities afforded us by our domestic isolation, weekday breakfast has got to be the most novel. It’s a chance to whip up a batch of special pancakes, French toast or a savory breakfast hero; a time to let the aroma of sizzling bacon and fresh coffee waft upstairs or down the hall to lure the rumpled late sleepers to the table for conversation, monosyllabic as it’s likely to be, and to get to know each other in a relaxed morning mode.
Dutch Baby Pancake
Dutch Baby Pancake
YIELD: Makes 2 to 4 servings
INGREDIENTS:
2 eggs
1/2 cup flour
1/2 cup milk
Pinch nutmeg
Pinch cinnamon
2 tablespoons unsalted butter
2 tablespoons confectioners’ sugar
DIRECTIONS:
Preheat oven to 475 F. Place heavy 10” skillet in oven to heat. In a medium bowl, whisk eggs until frothy; then whisk flour, milk, nutmeg and cinnamon into eggs. Lower oven to 425 F. Remove skillet and swirl butter to completely coat bottom and sides. Pour batter into hot skillet; place back in oven and bake 20 minutes or until golden and puffy. Remove from oven, slide pancake onto warm plate and sift confectioners’ sugar on top. Serve immediately with hot coffee and fresh fruit.
Oven-baked French Toast
YIELD: Makes 4 servings
INGREDIENTS:
6 jumbo eggs
1 1/2 cups milk
1 teaspoon vanilla extract
1 tablespoon maple syrup
1/2 teaspoon salt
1 loaf challah, cut into 1” slices
3 tablespoons unsalted butter
3 tablespoons vegetable oil
DIRECTIONS:
Preheat oven to 250 F. In a medium bowl, whisk together the eggs, milk, vanilla extract, maple syrup and salt. Transfer to large shallow dish. Soak bread slices, as many at a time as will fit, in egg mixture, turning once, until both sides are well coated and soaked. In large skillet, heat one tablespoon butter and one tablespoon oil over medium-high heat; add bread and cook, turning once, until golden brown on both sides, about 3 to 5 minutes; transfer to cookie sheet and place in oven to keep warm. Repeat procedure with remaining butter, oil and bread. When all slices are cooked, serve immediately with maple syrup, honey, jam or preserves or powdered sugar.
Breakfast Hero Ranchero
YIELD: Makes 4 to 6 servings
INGREDIENTS:
1/4 cup olive oil
1 large onion, diced
2 fresh jalapeno peppers, cleaned and diced
1 loaf Italian bread or French baguette, sliced lengthwise and toasted
1/2 stick unsalted butter, softened
1/2 pound bacon, fried and drained
4 to 6 eggs, scrambled
3 breakfast sausages, cooked, drained, sliced
Half a 14-ounce can black beans, rinsed, drained
Salt and freshly ground black pepper to taste
1 cup Manchego cheese, shredded
1 cup tomato salsa
1 cup sour cream
DIRECTIONS:
In a medium skillet over medium-high heat, warm oil. Add onion and jalapeno and sauté, stirring often, over medium-high heat until onion is opaque and pepper is tender, about 5 to 10 minutes. Meanwhile, toast bread halves and assemble precooked ingredients. When bread is toasted, spread top half with butter, top bottom half with bacon, then eggs, sausage slices, beans, pepper and salt, cheese, salsa and sour cream. Place buttered top over fillings, press gently with heel of hand, slice into desired portions and serve immediately with citrus fruit and hot chocolate.
This week’s shelter pet is a loving happy guy named Kobe, a three-year-old male English Bulldog and Pit mix currently waiting at the Smithtown Animal Shelter for a new family. Kobe is an adorable pup who has a face that makes you instantly fall in love with him. He’s a total goofball, and will perform to get your attention. He has lots of energy inside him, and will let it all out with lots of playtime and love to anyone he meets. He gets along great with children, but would prefer to be the only pet in the household.
Kobe unfortunately suffers from a chronic heart condition, so he requires an owner to go the extra mile. He requires daily medication and a yearly checkup with a cardiologist. He also should not be permitted to go on long walks or be out in the hot weather. Despite his heart problems, and a tough start of his life, Kobe is sweet, affectionate and extremely outgoing. He has an amazing attitude through it all.
*Due to the health risk presented by the Covid-19 pandemic, there will be limited public access to the shelter. If you are interested in meeting Kobe please fill out an adoption application online. The Smithtown Animal & Adoption Shelter is located at 410 Middle Country Road, Smithtown. For more information, call 631-360-7575.
From left, Kerstin Kleese van Dam, Brand Development Manager at BNL Diana Murphy, and John Hill at the Practical Quantum Computing Conference (Q2B) in San Jose, CA, Dec. 2019. Photo courtesy of Kerstin Kleese van Dam
By Daniel Dunaief
Brookhaven National Laboratory is putting its considerable human and technical resources behind the global effort to combat the coronavirus.
John Hill, the director of the National Synchrotron Lightsource II, is leading a working group to coordinate the lab’s COVID-19 science and technology initiatives. He is also working on a team to coordinate COVID-19 research across all the Department of Energy labs.
“We are proud that the tools we built at BNL, which include the NSLS II, which took 10 years to build and cost about a billion dollars,” will contribute to the public health effort, Hill said. “We feel that science will solve this problem, and hopefully soon. It’s great that BNL is a part of that fight.”
In addition to using high-technology equipment like the NSLS II to study the atomic structure of the virus and any possible treatments or vaccines, BNL is also engaging a team led by Kerstin Kleese van Dam, who is the director of BNL’s Computational Science Initiative.
According to Hill, the combination of the physical experiments and the computing expertise will provide a feedback loop that informs the efforts with each team. Kleese van Dam’s team is using supercomputers to run simulated experiments, matching up the atomic structure of the viral proteins with any potential drugs or small molecules that might interfere with its self-copying and life-destroying efforts.
The computer simulations will enable researchers to narrow down the list of potential drug candidates to a more manageable number. Experimental scientists can then test the most likelytreatments the computer helped select.
Across the world, the scale of the science to which BNL is contributing is even larger than the Manhattan Project that led to the creation of the atomic bomb during World War II, said Hill.
In just three months since scientists in China produced the genetic sequence of the coronavirus, researchers around the world have produced over 15,000 research articles, some of which have been published in scientific journals, while researchers have self-published others to share their findings in real time.
Working with computer scientists from different fields at BNL, Kleese van Dam is helping researchers screen through the abundant current research on COVID-19. The number of papers is “accelerating at a rate no one can read,” Hill explained.
Kleese van Dam and four of her scientists are setting up a natural language processing interface so scientists can type in what they want to find, such as a protein binding with a specific complex, and put it into a search engine. She is working on an initial service that she hopes to expand. Additionally, the computer science team is planning to start a project to look at epidemiological data to determine how various people might react to different treatment.
Kleese van Dam and her team are also working to build an archive in the United States that they hope will host at least the results of the Department of Energy funded projects in medical therapeutics. “[We are] convinced that this would provide a much better starting point for future outbreaks, as well as providing a near term clearing house of results,” she explained in an email.
As for the work at the synchrotron, Hill said that the high-energy x-rays can determine the specific atomic configuration of proteins in the virus.
The NSLS II, which was designed to study the structure of batteries, geology and plant cells, among other objects, can look at “small protein crystals better than anywhere else in the world.”
The virus relies on a docking mechanism that allows it to enter a cell and then insert its malevolent RNA to disrupt the cell’s normal function. Understanding how the pieces come together physically can allow researchers to look for small molecules or approved drugs that could interfere with the virus.
One of the many advantages of the synchrotron over protein crystallography is that the NSLS II doesn’t need as many copies of proteins to determine their atomic structure. Hill said protein crystallography needs samples that are about 100 to 200 microns in size, which is about the width of a human hair, which can take weeks to months to years to grow. This is a “bottleneck in the whole process” of solving protein structure, he said.
On the other hand, the NSLS II only requires samples of about a micron in size. This “greatly speeds up the process,” he added. Two different groups of researchers, from the pharmaceutical industry and from academia and national labs, are conducting experiments on the NSLS II.
Hill said he was receiving viral proteins scientists believe will bind with the virus from collaborators in the United Kingdom. The scientific process is as quick and collaborative as it’s ever been among researchers, he said. The proteins arrived recently.
That collaborative process would have “taken months to set up under normal circumstances,” Hill said. Instead, it only took a few days.
At the same time, BNL is constructing a cryo-electron microscope, which doesn’t have the same resolution as the NSLS II, but does not need crystals and can study individual proteins. Researchers need about 10,000 of them and can average the images together. The resolution is five to 10 times worse than x-rays.
BNL is accelerating the construction of the cryo EM and hope to have the first beam in mid-May. Commissioning will take some extra time, Hill said. The first structure of the coronavirus spike protein was determined by using an electron microscope.
For Hill and Kleese van Dam, who each have dedicated much of their time to these efforts, the opportunity to contribute to a project that could have implications for a public that is battling this disease is rewarding and offers reasons for optimism.
“To be able to help at such a scale is indeed humbling and gratifying,” said Kleese van Dam. “Science is going to solve this problem,” added Hill. “That gives me comfort.”
Until recently, many people thought COVID-19 was like the common cold or maybe like the flu. Now, most of us know somebody directly or indirectly who has been hospitalized with COVID-19.
While social distancing and handwashing are critical to prevent its spread, strengthening lung function is crucial to preventing its progression to severe disease.
Among those with highest risk for severe COVID-19 are those with chronic obstructive lung diseases such as chronic obstructive pulmonary disease (COPD) and asthma, as well as those who smoke and vape.
What can we do to strengthen our lungs? We can improve lung function with simple lifestyle modifications including exercising, eating a plant-based diet with a focus on fruits and vegetables, expanding lung capacity with an incentive spirometer, and quitting smoking and vaping, which damage the lungs (1). Not only people with compromised lungs will benefit; studies suggest “healthy” people will also benefit.
Why is this important?
This virus starts in the throat but may progress to the lungs attacking the alveoli, small air sacs that allow gas exchange to take place. When this occurs, patients get short of breath and may have to be hospitalized and placed on a ventilator. Two factors influence this: inflammation and fluid in the lungs.
Both asthma and COPD increase inflammation of the airways and the lung’s functional tissue (parenchyma) thus, potentially making these patients more susceptible to severe COVID-19.
Let’s look at the research, taking a three-pronged, or “forked,” approach: diet, incentive spirometry and exercise.
Diet Studies in Asthma
In a randomized controlled trial (gold standard of studies) of asthma patients, results show that after 14 days those who ate a low-antioxidant diet had less lung function compared to those who ate a high-antioxidant diet (2). Researchers measured lung function with one-second forced expiratory volume (FEV1) and predicted forced vital capacity (FVC). Additionally, those who were in the low-antioxidant diet group also had higher inflammation at 14 weeks, as measured using a c-reactive protein (CRP) biomarker. Those who were in the low-antioxidant group also were over two-times more likely to have an asthma exacerbation.
The good news is that the difference in behavior between the high- and low-antioxidant groups was small. The high-antioxidant group had a modest five servings of vegetables and two servings of fruit daily, while the low-antioxidant group ate no more than two servings of vegetables and one serving of fruit daily. Carotenoid supplementation, instead of antioxidant foods, made no difference in inflammation. The authors concluded that an increase in carotenoids from diet have a clinically significant impact on asthma and can be seen in a very short period.
Diet Studies in COPD
Several studies demonstrate that higher consumption of fiber from plants decreases the risk of COPD in smokers and ex-smokers. Bear with me, because the studies were done with men or women, not both at the same time. In one study of men, for example, results showed that higher fiber intake was associated with significant 48 percent reductions in COPD incidence in smokers and 38 percent incidence reductions in ex-smokers (3). The high-fiber group ate at least 36.8 grams per day, compared to the low-fiber group, which ate less than 23.7 grams per day. Fiber sources were fruits, vegetables and whole grain, essentially a whole foods plant-based diet. The high-fiber group was still below the American Dietetic Association-recommended 38 grams per day. This is within our grasp.
In another study, women had a highly significant 37 percent decreased risk of COPD among those who consumed at least 2.5 serving of fruit per day compared to those who consumed less than 0.8 servings per day (4).
The highlighted fruits shown to reduce COPD in both men and women included apples, bananas, and pears.
Incentive Spirometry
What is an incentive spirometer? It’s a device that helps expand the lungs by inhaling through a tube and causing a ball or multiple balls to rise. This opens the alveoli and may help you breathe better.
Incentive spirometry has been used for patients with pneumonia, those who have chest or abdominal surgery and those with asthma or COPD, but it has also been useful for healthy participants (5).
A small study showed that those who trained with an incentive spirometer for two weeks increased their vital capacity, right and left chest wall motion, and right diaphragm motion. This means it improved lung function and respiratory motion. Participants were 10 non-smoking healthy adults who were instructed to take five sets of five deep breaths twice a day, totaling 50 deep breaths per day. The brands used in the study are easily accessible, such as Teleflex’s Triflo II.
In another small, two-month study of 27 patients with COPD, the incentive spirometer improved blood gasses, such as partial pressure carbon dioxide and oxygen, in COPD patients with exacerbation (6). The authors concluded that it may improve quality of life for COPD patients.
Exercise Studies
Photo from METRO
Exercise can have a direct impact on lung function. In a study involving healthy women ages 65 years and older, results showed that 20 minutes of high-intensity exercise three times a day improved FEV1 and FVC, both indicators of lung function, in as little as 12 weeks (7). Participants began with a 15-minute warm-up, then 20 minutes of high-intensity exercise on a treadmill, followed by 15 minutes of cool-down with stretching.
What is impressive is that it was done in older adults, not those in their twenties and not in elite athletes. Since most of us don’t have access to a treadmill right now, note that any physical exercise will be beneficial.
We should be working to strengthen our lungs, regardless of COVID-19. However, to potentially reduce our risk of severe COVID-19, this three-pronged approach of lifestyle modifications – diet, exercise and incentive spirometer – may help without expending significant time or expense. As Yogi Berra would say, “When you come to a fork in the road, take it!” There is no time to waste.
References:
(1) Public Health Rep. 2011 Mar-Apr; 126(2): 158-159. (2) Am J Clin Nutr. 2012 Sep;96(3):534-43. (3) Epidemiology Mar 2018;29(2):254-260. (4) Int J Epidemiol Dec 1 2018;47(6);1897-1909. (5) Ann Rehabil Med. Jun 2015;39(3):360-365. (6) Respirology. Jun 2005;10(3):349-53. (7) J Phys Ther Sci. Aug 2017;29(8):1454-1457.
Dr. Dunaief is a speaker, author and local lifestyle medicine physician focusing on the integration of medicine, nutrition, fitness and stress management. For further information, visit www.medicalcompassmd.com.
We need help, and we need it fast. Not just for COVID-19, but also for diabetes, for the combination of the two is much worse than either disease alone. Type 2 diabetes can have devastating effects that can potentially result in patients dying prematurely from cardiovascular complications (1). COVID-19 symptoms can range from asymptomatic to severe or result in death.
Now combine diabetes with COVID-19 and you are at much higher risk of severe viral symptoms that require hospitalization and ICU admission. According to the CDC, about one-third ICU patients infected with COVID-19 have diabetes (2).
Keeping patients out of the hospital
We know containment is critical to control COVID-19, but it’s equally important to get ahead of the mitigation of symptoms curve; we need to control the chronic diseases that exacerbate the virus’s severity. And Type 2 diabetes is one of the largest contributors.
We can treat and reverse diabetes by empowering patients with lifestyle changes, especially diet. This is such an issue that the Mexican Deputy Minister of Health recently alluded to the fact that poor diet over at least the last 4 decades has resulted in more diabetes and obesity making people much more susceptible to COVID-19 and progressing to severe COVID-19 (3).
It is tempting while staying at home for most of the day to want reach for comfort foods. Don’t do it. In fact, take the opposite approach and improve your diet. A whole food plant-based (WFPB) diet has been shown time and time again to prevent, treat and reverse diabetes potentially resulting in patients getting off their drugs and achieving levels that are considered normoglycemic, or non-diabetic.
Let’s look at the evidence.
Treating and reversing diabetes
Drugs help treat glucose, or sugar levels, and help reduce the risk of microvascular diseases such as diabetic retinopathy (eye disease causing blindness); nephropathy (kidney disease); and peripheral neuropathy, which can result in amputation. A few medications can even reduce macrovascular risk, or cardiovascular disease. Still, diet is still the best tool we have for reversing diabetes overall, with only beneficial side effects.
With COVID-19, those whose glucose is not under control are at highest risk of severe disease that results in a progression from hospitalization to ICU and the need for a ventilator to increased mortality risk. High sugars may have negative impacts on the white blood cells, which makes patients more susceptible to infection from viruses (4).
Medications’ impact
Diabetes medication alone can help control sugars, but it can’t reverse diabetes. In fact, studies with medication alone may actually increase the risk of death from polypharmacy, or too many medications. In the ACCORD trial, patients were put on an average of four diabetes medications. Researchers stopped the trial early after 3.5 years, because of a 22 percent increased rate of mortality (5). Patients did not reach their HbA1C (a three-month sugar reading) target of under 6.0 percent, because the increased death rate occurred at around 6.5. This was a large randomized controlled clinical trial with 10,251 patients, a mean age of 62.2 years, and mean HbA1C of 8.1 at baseline.
Reversing Type 2 diabetes:plant-based dietary approach
On the other hand, studies with a WFPB diet, have shown significant reduction in sugars and potential reversal of diabetes. These include a small retrospective study and small randomized clinical trial comparing a WFPB diet to the American Diabetes’ (ADA) recommended diet.
In a small retrospective study, the results showed a reduction of HbA1C from 8.2, which was a similar baseline as with the ACCORD trial, to 5.8 (6). Remember, the goal of the ACCORD trial was to get patients below a HbA1C of 6.0. These results occurred over a mean of seven months. In addition, patients were able to stop all of their diabetes medications and reduce their total number of medications from four to one.The side effect was better health with a significant reduction in high blood pressure to normal levels, as well.
The weakness of this study was that it was retrospective (looking backward in time), only had 13 patients, and there was no control arm. However, it suggests that this type of diet is powerful to reduce and reverse type 2 diabetes. The foods used in the nutrient-dense WFPB diet included a non-starchy vegetable-rich approach, with an emphasis on dark green leafy vegetables, whole fruits, beans, and limiting grains, especially refined grains, and limiting starchy vegetables such as sweet potatoes, winter squashes, corn and pumpkin.
In a larger study, results showed that a high fiber diet in patients with type 2 diabetes and hypertension significantly reduced HbA1C, fasting glucose, systolic (top number) blood pressure, branchial-ankle pulse wave velocity, serum cholesterol and waist-to-hip ratio, ultimately reducing the risk of cardiovascular disease (7). The participants were considered to be having high fiber if they increased their consumption 20-25 percent above recommended daily allowances. The fiber came from foods, not supplements, including vegetables, fruits, beans and whole grains. There were 200 participants over a six-month duration.
A third study, which was a randomized controlled trial comparing the 2003 American Diabetes Association (ADA) diet to a low-fat vegan diet showed that a low-fat vegan diet significantly reduced the HbA1C compared to the 2003 ADA diet in a 74-week study (8). There were 99 type 2 diabetes patients in the study. A “side effect” of the low-fat vegan diet was that it also significantly reduced cholesterol.
Preventing diabetes
There have been numerous studies demonstrating that a WFPB diet reduces the risk of diabetes. One of the best was the Adventist Health Study 2 (9). The results showed that a vegan diet reduced the risk of type 2 diabetes by 49 percent. This study is interesting because the different groups were very similar and it showed that small changes could have a big impact. Semi-vegetarians, pesco-vegetarians, and lacto-ovo vegetarians all had a reduced risk of diabetes compared to plant-focused non-vegetarians, but not as much as vegans.
In a more recent study, results showed a 30 percent reduction in the risk of type 2 diabetes for those who ate a predominantly whole food plant-based diet including fruits, vegetables and whole grains (10). Participants were still eating some animal protein daily. This was over a 2-to-28 year period in a metanalysis involving nine observational trials.
In conclusion, the best way to reduce your risk of severe COVID-19 is to control and reverse chronic disease. Type 2 diabetes is one of the most common chronic diseases that may contribute to getting COVID-19 and progressing to a severe form. A nutrient-dense WFPB diet has been shown to potentially reverse type 2 diabetes. While you are mostly housebound, empower yourself by taking action to reduce your risk of getting COVID-19 and especially the severe disease. We have the tools: it starts with what you put on your plate.
References:
(1) Lancet 389(10085):2239–2251. (2) CDC.gov. (3) Reuters.com April 4, 2020. (4) Medscape.com March 18, 2020. (5) NEJM 2008;358:2545-2559. (6) OJPM 2012;2(3):364-371. (7) ACC Middle East Conference 2019 Presentation. (8) Am J Clin Nutr.2009 May; 89(5): 1588S–1596S. (9) Diabetes Care. 2009;32:791–796. (10) JAMA Int. Med. Online July 22, 2019.
Dr. Dunaief is a speaker, author and local lifestyle medicine physician focusing on the integration of medicine, nutrition, fitness and stress management. For further information, visit www.medicalcompassmd.com.
Sticking to a plant-rich diet that can reduce high blood pressure. Stock photo
Call to arms to reverse high blood pressure, once and for all
By David Dunaief, M.D.
Dr. David Dunaief
Hypertension (high blood pressure) and COVID-19 are intertwined. Those who have hypertension are more susceptible to COVID-19 and are more likely to get a severe form and experience complications from the virus. A study done in China captured the statistics: of 1099 patients infected, 15 percent had hypertension, and of those with severe cases, 23.7 percent had hypertension (1). Ultimately, those with hypertension are at higher risk, but we don’t at this point understand the specifics of why.
Even before the COVID-19 pandemic, a recent study showed that the number of deaths from hypertension had increased a whopping 26 percent overall from 2007 to 2017 (2).
What about medications to blunt the association? There is a THEORY, not a study, that angiotensin converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) may be harmful by increasing ACE2 in the lungs, which is a receptor that COVID-19 binds to; however, there is also a case for these medications having benefits (3). Do not stop or change your hypertension medications without talking to your doctor. Remember, this is just a theory, and theories are very dangerous; we don’t have research to support them, by definition (4).
I view this as a call to arms to control and, even more importantly, treat and reverse hypertension. Presently, only 54 percent of hypertension patients are controlled with medication (5).
Potential to control and reverse hypertension through diet
We have the capability to treat and reverse hypertension with lifestyle modifications, including diet, exercise, sleep and stress management. We are going to focus on diet.
A whole foods plant-based diet (WFPBD) that is dark green leafy vegetable-rich has been shown to help prevent, control and possibly reverse hypertension. I call this the LIFE diet, which stands for Low Inflammatory Foods Everyday. The most researched type of WFPBD is the DASH (dietary approach to stopping hypertension) diet, which emphasizes fruits, vegetables, grains and reductions in saturated fats and total fat. DASH was the first randomized control trial to show that a predominantly whole food plant-based approach reduces blood pressure (6).
Why does diet have an effect? There are several factors, including inflammation; electrolytes, specifically sodium and potassium; and phytochemicals (plant nutrients and fiber content).
Why is inflammation so important?
Inflammation is a culprit in most chronic diseases, including hypertension. It also plays a crucial role in the severity of COVID-19. Those who take a turn for the worse in COVID-19 have high inflammation. On the news, an ER doctor noted that while COVID-19 patients may come in stable, they need to be watched carefully; in 3-24 hours, they could show high inflammation and fluid in their lungs and need to be on a ventilator.
There are several studies that show a direct relationship between high sensitivity C-reactive protein, one of the most well-studied biomarkers for inflammation, and hypertension in both men and women (7)(8). In the Physicians Health Study, those men who had high hsCRP (>3 mg/L) and hypertension had a 40 percent increased risk of stroke compared to those without hypertension and with hsCRP <1, which is optimal. Not to leave women out, the CARDIA study found that premenopausal women with elevated hsCRP were significantly more likely to have hypertension.
How can we decrease inflammation?
Anti-inflammatory drugs, including NSAIDS like ibuprofen, may suppress the immune system and make patients more susceptible to COVID-19. They also worsen hypertension and may increase the risk for cardiovascular events, such as a heart attack. In fact, prescription NSAIDS carry an FDA black box warning about this dangerous side effect. Anti-inflammatory drugs should not be the “go-to” solution.
Fortunately, a WFPBD is associated with reduction in inflammation, specifically hsCRP. We recently published a study showing that the LIFE diet has an inverse relationship between blood levels of beta carotene, a phytonutrient, and hsCRP (9). As you increase the intake of dark green leafy vegetables, the higher the beta carotene and the lower the hsCRP. There was a 75 percent reduction in inflammation with those that increased their beta carotene over the normal level compared to those who were non-adherent. The DASH diet also emphasizes an increased intake of vegetables.
There are studies to suggest that, as we lower animal protein intake, we are able to better reduce blood pressure. In the EPIC study, those who at who reduced animal protein to none had the biggest impact on blood pressure. This study compared meat-eaters, fish-eaters, vegetarians and vegans (10).
Electrolytes – sodium and potassium
The optimal approach for these electrolytes is to have a sodium to potassium ratio that is less than one. For most, this means consuming less sodium and more potassium (11). The American Heart Association emphasizes low sodium, less than 1500 mg of sodium per day and higher potassium intake (12).
What I find in my practice is that blood levels that are south of 140 mmol/L are better and that the bottom of the range is ideal; the range is between 135-145 mmol/L. This way, whether you are sodium-sensitive or not, you can either help control blood pressure or rule it out as a factor. Potassium should be 4.5 (units) or higher. These electrolytes should come from vegetables, especially dark green leafy vegetables, which have a natural balance of potassium and sodium. Other good sources of potassium are beans and nuts.
Ultimately, the power is in your hands. By changing your diet to one that is more plant-based and vegetable-rich, you can reduce inflammation, strengthen your immune system, possibly reduce or even get off anti-hypertension medications, reverse the trend of dying from hypertension, and reduce your susceptibility to severe COVID-19.
References:
(1) N Engl J Med. Online Feb 28, 2020. (2) J Am Coll Cardiol. Online March 19, 2020). (3) Nephron. Online Mar 23, 2020.) (4) Nature. Feb 2020, 579:270–273. (5) Circulation. 2016;133:e38–e360. (6) N Engl J Med. 1997 Apr 17; 336(16):1117-24. (7) JAMA.2015 Sep:4(9):e002073 (8) Menopause. 2016 Jun; 23(6):662. (9) AJLM Online. Dec. 21, 2019. (10) Oybkuc Gektg Bytr, 2002 Oct; 5(5):645-54. (11) Circulation Online. Oct 11 2017. (12) heart.org.
Dr. Dunaief is a speaker, author and local lifestyle medicine physician focusing on the integration of medicine, nutrition, fitness and stress management. For further information, visit www.medicalcompassmd.com.
During my sophomore year of college, I was preparing to visit my family for Thanksgiving. In early November, however, I had this incredible need to come home to see my mother, my younger brother, our aged-but-still-hanging-in-there golden retriever and my dying father, who was in the hospital full time.
I asked my mother if I could come home a week before Thanksgiving, return to school and then travel back again for Thanksgiving. She acquiesced, suggesting that the family would be happy to see me twice during the month. Of course, she also gently reminded me, to the extent that she ever gently reminded me of anything, that I bring home any schoolwork.
My brother picked me up at the airport and drove me home. Initially, we avoided the subject that hung over every conversation. I didn’t ask how dad was because cancer is a horrific roller coaster ride, in which every small rise inevitably precedes a hard and fast drop towards the abyss.
Over the weekend, my mother brought me to the hospital. She warned me several times that my father was taking so many pain medications that he probably wouldn’t know I was in the room. He might not even wake up, she cautioned. Still, I needed to see him.
When I got to his room, he turned toward me and he acknowledged me, in the smallest way, with his eyes. He didn’t smile or speak, but his eyes told me that he not only knew who I was, but that he was glad to see me. He tried to sit up, which was extremely unusual in the end stage of his life. His movements through the day were extraordinarily limited and he wasn’t interacting with anyone regularly.
Protecting me from seeing my father’s emaciated body in a hospital gown that hung tenuously onto his body the way he clung to life, my mother took me to the cafeteria to get my father a grilled cheese while a nurse brought him to a chair. By the time we got back, he was mostly asleep in the chair. He didn’t eat or acknowledge me, and had already drifted away.
That was the last time I saw him alive. He died before Thanksgiving. Difficult as the memory is, I know how fortunate I am to have had the chance to see him one last time. I didn’t thank him for being a wonderful father or receive any sage advice. I got one more moment to connect with him.
With that memory in mind, my heart aches with the recognition of the hardships families are enduring through their separations caused by the coronavirus. I am confident courageous nurses and doctors are comforting those with uncontrollable coughs, fever, aches and all the other symptoms of this dreaded disease.
And yet, I also recognize how difficult it must be for people not to share the same room or, as I did, to exchange one last glance into a loved one’s eyes.
We draw inspiration from seeing each other, sharing space and time, and wrapping ourselves in the blanket of humanity that offers comfort during times of crisis. I admire those who have stood outside the windows of loved ones, with messages of hope and encouragement. I also appreciate the benefit that FaceTime provides, letting people look at a virtual image of people whose lives have defined ours.
Hopefully, our continued commitment to social distancing and working from home will prevent people from contracting COVID-19, while we await vaccines from scientists and pharmaceutical companies. These efforts will ultimately prevent more families from enduring the additional layer of pain caused by such separations.
In the crunch of reporting the latest COVID-19 news and working remotely to the extent possible last week, we failed to notice our media company’s anniversary. Last Wednesday marked the 44th year since we offered the first issue of our first newspaper, The Village Times, to the community.
For me, that is akin to forgetting my birthday; so exciting and memorable were those early days. After incredibly long hours and endless hard work, we had created something that had never before existed and both proudly and nervously had given it to the residents to judge. Would they become engaged or would they ignore our efforts? Would they find what we published to be relevant and important to their lives or would they just go on without us? Such are the thoughts and fears of entrepreneurs.
I was just asked recently why I wanted to start a newspaper. I had to stop and remember what life was like on April 8, 1976, because we were certainly a product of our times. My husband and I had come with our children to live here on the North Shore of Suffolk County largely because of the university. The State University at Stony Brook was just in its earliest years, a medical center was planned, and my husband wanted to practice his specialty, along with a research hospital affiliation, wherever we settled. That’s the way it was then: a physician hung out a shingle wherever he wanted a private practice and began to see patients.
We were utterly charmed by the picturesque village of Stony Brook, with its quality schools, rich Revolutionary War history, cultural offerings and unending recreational opportunities both on land and on the Sound. After a time, we came to learn there existed a seemingly unbridgeable town-gown split. Thousands of new university hires and students were pouring into the community every year, in some ways upending the peaceful existence of longtime residents, even as they prompted property values to soar. The 1960s were, anyway, unsettling times, with the Vietnam War, assassinations and bursts of protests in the streets. Yet the small villages offered a peaceful and fulfilling existence, it seemed to me, if only there could be better communication between the university and the residents.
I had been thinking, as I worked for Time Inc. in New York City, about what I imagined were the joys of owning a community newspaper: meeting residents, serving their needs for information, providing a “town hall” for dialogue from all points of view, offering opinion through editorials, tracking local accomplishments in the arts, sciences, sports and cultural worlds and strengthening the sense of community for protection and pride.
So when my youngest of three started first grade, I saw my opportunity. I assembled what turned out to be a brilliant and committed team of largely other housewives, sold shares to families in order to capitalize the venture, rented an office on Route 25A in Setauket, and we were off. The thrill and excitement of creating a newspaper to serve a community could fill a book, and perhaps one day it will. There are so many stories, some side-splitting funny, some tough moments, some amazingly stupid mistakes, so many honors and awards for encouragement, and the bottom line: here we are, 44 years later.
Speaking of the bottom line, like so many other small businesses, we are in an unprecedented position now, with our traditional advertisers shuttered and their customers shut-ins. Our revenues have dramatically dropped, yet we feel it is our ethical duty to keep our communities informed of the latest information concerning COVID-19 via print and daily internet, yet our expenses continue. Indeed, we have been designated as “essential,” and we are publicizing every week, at no cost to them, other such businesses that are open, including restaurants and pharmacies.
These are our papers and internet presence. They are also yours. We trust we are serving you well.
Please note last week’s column contained several errors for which I humbly apologize. Please check any information that you might use. My thanks to the readers that pointed out the errors.
Like many people who hunch down when they step into cold air, many materials shrink when exposed to the frigid temperatures.
That, however, is not the case for samarium sulfide when it has impurities such as yttrium sprinkled throughout. Indeed, the material goes through negative thermal expansion, in which cold air causes it to expand.
Daniel Mazzone, a post-doctoral fellow in Brookhaven National Laboratory’s Condensed Matter Physics and Materials Science Department who is joining the Paul Scherrer Institute in May, wanted to know how this happened.
Working with synchrotrons on three different continents, at the National Synchrotron Lightsource II at BNL, the Soleil synchrotron in France and the SPring-8 synchrotron in Japan, Mazzone and a team of scientists explored the properties of this metal.
The work that led to an understanding of the properties that made the metal expand in cold temperatures could have applications in a range of industries. Some companies use materials that balance between expansion and contraction to prevent the lower temperatures from altering their configuration.
Mazzone said the expansion properties can be fine tuned by altering the mixture of materials. With these results, he and his colleagues “bring a new material class to the focus of the community,” he wrote in a recent email.
So, what is happening with this samarium sulfide mixed with yttrium particles?
In a paper in the journal Physics Review Letters, Mazzone and his partners, including Ignace Jarrige, who is the group leader of the Soft Inelastic X-ray Scattering Beamline, described the way mobile conduction electrons screen the samarium ions, causing a fractional transfer of an electron into the outermost electronic samarium shell. Quantum mechanical rules govern the process.
Using the Pair Distribution Function beamline at NSLS-II, the researchers performed diffraction experiments. The scientists determined how the x-rays bounced off the samarium sample at different temperatures. The sample was contained in a liquid helium cooled crysotat.
“We track how the x-rays bounce off the sample to identify the locations of atoms and the distances between them,” Milinda Abeykoon, the lead scientist of the PDF beamline, said in a press release. “Our results show that, as the temperature drops, the atoms of this material move farther apart, causing the entire material to expand up to three percent in volume.”
In France and Japan, the researchers also used x-rays to explore what electrons were doing as temperatures changed.
“These ‘x-ray absorption spectroscopy’ experiments can track whether electrons are moving into or out of the outermost ‘shell’ of electrons around the samarium atoms,” Jarrige explained in a press release.
The valence electrons in samarium, which are the outermost electrons, are in a shell that is under half full. That means that they are more reactive than they would be if they the shell was full, as it is with noble gases.
The researchers observed that a fractional part of the electrons are transferred from the conduction band in the outermost samarium shell. This causes the samarium to expand, as the outermost shell needs to accommodate an extra electron. When this happens for the numerous ions in the system, this can have an important effect.
By working with Maxim Dzero, who is a theoretical physicist at Kent State University, the scientists were able to apply the Kondo effect, which was named after solid-state physicist Jun Kondo. Back in the 1960s, Kondo explained how magnetic impurities encourage electron scattering at low temperatures, which not only increases the volume of the materials, but can also increase their electrical resistance.
In the Kondo effect, electrons align their spins in the opposite direction of the larger magnetic articles to cancel its magnetism. For the samarium material, the outer shell moves around the atomic core, creating the magnetic moment of the samarium ion.
“For some elements, because of the way the outer shell fills up, it is more energetically favorable for electrons to move out of the shell,” Jarrige explained in a press release. “But for a couple of these materials, the electrons can move in, which leads to expansion.”
A phone call among several of the collaborators led them to believe the process involved with the samarium was akin to the one that causes water to expand when it freezes. As scientists build on this understanding, they will likely need to create or search for similar but alternative materials to samarium sulfide, Mazzone said.
Samarium sulfide is incredibly expensive. Materials scientist will need to find the right elements that can “do the same job,” he explained. “The next step is to find the materials that are cheaper and optimize it.”
Mazzone, who is currently living in his home country of Switzerland, is preparing for his next job, which is expected to start next month.
He and his wife Fabienne, who is an economist at the ski producer Stöckli, enjoyed living on Long Island during his two year post-doctoral research experience.
“Switzerland is landlocked and surrounded by mountains,” said Mazzone, who speaks German, French, English and some Italian. “Having a beach at the front door [when they lived on Long Island] was beautiful.”
Dedicated climbers, the Mazzones traveled to the Shawangunk and Adirondack mountains while they lived on Long Island to find an outlet for their passion for rock climbing.
As for his future work, Mazzone anticipates remaining in academia where he would like to continue his research and teach. He plans to conduct additional experiments on the Kondo effect. These materials also feature properties such as unconventional superconductivity and other quantum phases that may help with quantum computing.
When a person does their estate planning, he or she will typically prepare a Last Will and Testament. A will contains a provision that nominates an Executor. Since there is a nominated executor, typically, in probate proceedings the appointment of the fiduciary is not complicated as it is controlled by the selection made by the testator.
It is significantly different when a person dies intestate (without a will). In these situations, the Surrogate’s Court is required to appoint an Administrator. The rules on the priority of who is eligible for appointment are contained in Surrogate’s Court Procedure Act. The statute contains a detailed order of priority in the court’s granting of letters of administration. Absent a showing that the person with statutory priority is ineligible to receive letters of administration due to several grounds including: that person is an infant; incapacitated; a non-domiciliary of the United States; a felon or does not possess the qualifications required of a fiduciary by reason of substance abuse or dishonesty, letters must issue to that person.
The decedent’s surviving spouse has priority to receive letters. Unless he or she is ineligible as stated above, the spouse will be appointed. This becomes an issue in many second marriage situations where the children of the first marriage do not get along with spouse from the second marriage. Unless there are grounds to disqualify the spouse, it is likely not worth pursuing objections to his or her appointment. Filing objections will delay the matter and cost a lot of money in legal fees with little likelihood of success.
Complications in the appointment of an Administrator also arise when there are several people in one category with equal priority to serve. This happens when the decedent has no spouse and several children. This situation can also arise in families where the decedent has no spouse, children, or surviving parents but several surviving siblings. Regardless of whose consent is required in each case, letters of administration can only issue to an eligible person(s) or person nominated by all interested parties.
It is not always advisable to resolve family disputes for letters of administration by agreeing to have the two or more administrators serve together. If the level of hostility is great, it is unlikely that they will be able to work together for the smooth administration of the estate. The parties might be able to agree on a third party to serve, known as a designee.
If not, the court may appoint one of the parties or might appoint the Public Administrator. While the Public Administrator will ensure fairness in the process, its fees are typically higher than if a family member served. The Public Administrator will take statutory commissions if appointed, and the Public Administrator will also be entitled to have its attorneys’ fees and the expenses of its office paid from the estate.
The appointment of an Administrator can be as simple or as difficult as the family dynamics allow. Regardless, if you are seeking to become the administrator of an estate, you should seek the advice of an attorney experienced in estate administration to guide you through the process. Getting appointed by the court is only the first step in the process of administering an estate.
Nancy Burner, Esq. practices elder law and estate planning from her East Setauket office. Visit www.burnerlaw.com.
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