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Diet may also affect quality of life as we age

By David Dunaief, M.D.

Dr. David Dunaief

Here’s a stunning statistic: 60 percent of American adults have a chronic disease, with 40 percent of adults having more than one (1). This is likely a factor in the slowing pace of life expectancy increases in the U.S., which have plateaued in the past decade at around 78.8 years old (2).

Most chronic diseases, including common killers, such as heart disease, stroke, diabetes and some cancers, can potentially be prevented, modified and even reversed with a focus on nutrients, according to the Centers for Disease Control and Prevention (CDC). 

The truth is that many Americans are malnourished. How could that be, when so many are overweight or obese? We are not a developing country, where access to healthy food is more challenging. Still, malnourishment is common at all levels of socioeconomic class. The definition of malnourished is insufficient nutrition, which in the U.S. results from low levels of much-needed nutrients.

I regularly test patients’ carotenoid levels. Carotenoids are nutrients that are incredibly important for tissue and organ health. They are measurable and give the practitioner a sense of whether the patient may lack potentially disease-fighting nutrients. Testing is often covered if the patient is diagnosed with moderate malnutrition. Because the standard American diet is very low in nutrients, classifying a patient with moderate malnutrition can be appropriate. A high nutrient intake approach can rectify the situation and increase, among others, carotenoid levels.

High nutrient intake

A high nutrient intake is an approach that focuses on micronutrients, which literally means small nutrients, including antioxidants and phytochemicals -— plant nutrients. Micronutrients are bioactive compounds found mostly in foods and some supplements. While fiber is not considered a micronutrient, it also has significant disease modifying effects. Micronutrients interact with each other in synergistic ways, meaning the sum is greater than the parts. Diets that are plant-rich raise the levels of micronutrients considerably in patients.

In a 2017 study that included 73,700 men and women who were participants in the Nurses’ Health Study and the Health Professionals Follow-up Study, participants’ diets were rated over a 12-year period using three established dietary scores: the Alternate Healthy Eating Index–2010 score, the Alternate Mediterranean Diet score, and the Dietary Approaches to Stop Hypertension (DASH) diet score (3).

A 20 percent increase in diet scores (indicating an improved quality of diet) was significantly associated with a reduction in total mortality of 8 to 17 percent, depending on whether two or three scoring methods were used. Participants who maintained a high-quality diet over a 12-year period reduced their risk of death by 9 to 14 percent than participants with consistently low diet scores over time. By contrast, worsening diet quality over 12 years was associated with an increase in mortality of 6 to 12 percent. Not surprisingly, longer periods of healthy eating had a greater effect than shorter periods.

This study reinforces the findings of the Greek EPIC trial, a large prospective (forward-looking) cohort study, where the Mediterranean-type diet decreased mortality significantly – the better the compliance, the greater the effect (4). The most powerful dietary components were the fruits, vegetables, nuts, olive oil, legumes and moderate alcohol intake. Low consumption of meat also contributed to the beneficial effects. Dairy and cereals had a neutral or minimal effect.

Quality of life

Quality of life is also important, though. Let’s examine some studies that examine the impact of diet on diseases that may reduce our quality of life as we age.

A study showed olive oil reduces the risk of stroke by 41 percent (5). The authors attribute this effect at least partially to oleic acid, a bioactive compound found in olive oil. While olive oil is important, I recommend limiting olive oil to one tablespoon a day. There are 120 calories per tablespoon of olive oil, all of them fat. If you eat too much, even of good fat, it defeats the purpose. The authors commented that the Mediterranean-type diet had only recently been used in trials with neurologic diseases and results suggest benefits in several disorders, such as Alzheimer’s. 

In a case-control (compare those with and without disease) study, high intake of antioxidants from food is associated with a significant decrease in the risk of early Age-related Macular Degeneration (AMD), even when participants had a genetic predisposition for the disease (6). AMD is the leading cause of blindness in those 55 years or older. There were 2,167 people enrolled in the study with several different genetic variations that made them high risk for AMD. Those with a highest nutrient intake, including B-carotene, zinc, lutein, zeaxanthin, EPA and DHA- substances found in fish, had an inverse relationship with risk of early AMD. Nutrients, thus, may play a role in modifying gene expression. 

Though many Americans are malnourished, nutrients that are effective and available can alter this predicament. Hopefully, with a focus on a high nutrient intake, we can re-ignite the pace of increased life expectancy and, on an individual level, improve our quality of life.

References:

(1) cdc.gov. (2) macrotrends.net. (3) N Engl J Med 2017; 377:143-153. (4) BMJ. 2009;338:b2337. (5) Neurology June 15, 2011. (6) Arch Ophthalmol. 2011;129(6):758-766.

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.       

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By Linda Kolakowski

Linda Kolakowski

While the concept of social capital is not new, more recently it’s become a buzz phrase of sorts. Social capital is defined as the personal links, shared values and understandings in a community that enable individuals and groups to trust each other and therefore, help each other. 

People require a sense of belonging to thrive. Whether the community we belong to is our family, our work, our place of worship, where we live, or all of these places, community is where we find comfort in difficult times. In addition to providing companionship, the social capital we earn through our relationships often replaces money which people would use to buy the same help. 

We use social capital throughout our lives, from our schoolyard days to assistance with raising our children, or seeking the help from someone physically stronger.  For older adults, the value of social capital increases as there are things that we can’t or don’t wish to do for ourselves.  For this reason, it’s important to keep community ties robust. 

There’s no question that the digital age has changed the way we relate to one another and satisfy our need for connection.  Many of us have strong communities of Facebook friends and stay connected through emails, texts and other social media platforms.  Though these friends can be great when it comes to sharing everyday joys and challenges, at times there is no substitute for being in the same room with a trusted friend or group of friends. 

Significant others are the first people we turn to when we’re having a hard time. Support from a loved one helps us to cope better, reducing stress and benefitting our mental and physical health.  Depending too much upon a significant other, however, carries the risk of creating disconnection from other parts of our social life. No matter how much we love our significant others, it’s unlikely that they alone can meet all of our social needs.

Expanding our friend group by just one person has the power to introduce us to a whole new social network.  When we develop a new friendship or romantic partnership, our networks double through these new connections.  At Jefferson’s Ferry, we get to observe the benefits of new friendships on a regular basis as new residents form bonds within the community and try new activities.  New friends are energizing!

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Jefferson’s Ferry residents have been participating in a five- year Age Well Study conducted by the Mather Institute and Northwestern University that analyzes the impact of living in a Life Plan Community.  Now in its second year, the study has focused on investigating factors that may be associated with healthy behaviors and health outcomes among residents. Researchers found that:

• Residents with higher scores of the personality trait of openness to experience and extroversion reported the highest levels of healthy behaviors and more positive health outcomes.

• Residents who form strong bonds within their community tend to engage in more healthy behaviors and have better overall health.

Those living in areas with greater social capital, such as a community setting like Jefferson’s Ferry, demonstrate significantly higher physical mobility scores than those living a more isolated existence.

The results support what we do here. Living in a place where there is a built in community, where there  is trust and like-minded neighbors encourages our residents to get up, get out and socialize.  The activities that we offer through our Health and Wellness Program provide a variety of opportunities that may appeal to residents with different personalities and interests which lead to better life balance and health overall for everyone.

Another study looked at older adults without dementia at the onset of a 12-year period. Over the course of the study, the participants were measured on their social activity levels and then tested periodically on their cognitive functioning. The rate of cognitive decline was 70 percent less in people with frequent social contact than those with low social activity.

In another study, the social activity level of older people free of dementia was measured and looked at in terms of their ability to care for themselves. Findings showed that those with more frequent social activity maintained lower levels of disability in several areas, suggesting that they would be able to live independently longer than their less social counterparts.

Whatever our age or living situation, the message is clear.  We are at heart social beings who are at our very best when we make community a priority in our lives.  We’ve heard it in song, in advertising, in memes.  Reach out and touch someone today!

Linda Kolakowski is Vice President of Resident Life at Jefferson’s Ferry Life Plan Community in South Setauket. 

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By Matthew Kearns, DVM

Concerns about a human coronavirus, better known as COVID 19, is raising fears for a global outbreak. The good news is that although COVID 19 may have its origins in a coronavirus found in bats, THERE IS NO EVIDENCE AT THIS TIME that the known canine and feline coronaviruses can spread from animals to humans. The risk of spread of COVID 19 is human to human at this time.

Coronavirus in dogs typically causes enteritis, or inflammation of the bowel. Most of the cases cause a mild, self-limiting diarrhea that lasts for a few days and does not even require a trip to the veterinarian’s office. Less commonly, more severe diarrhea, loss of appetite, or vomiting occur. 

More recently, a canine coronavirus respiratory virus has been isolated in association with other respiratory viruses into a disease termed Canine Infectious Respiratory Disease Complex (CIRDC). Again, the symptoms are usually mild and self-limiting rarely causing death.

Coronavirus in cats is much more serious. Most coronavirus in cats also cause self-limiting gastrointestinal symptoms similar to dogs. However, there is a particular strain of feline coronavirus that leads to a disease process called Feline Infectious Peritonitis, or FIP for short. 

This FIP strain of the coronavirus appears to be a mutation of one of the more benign strains of the enteric (gut) coronavirus. Rather than a self-limiting diarrhea, the deadly FIP develops. FIP has two forms: a “wet form” and a “dry form.” In the wet form a high fever and effusion develops. This effusion, or protein rich fluid, usually develops in the abdomen causing a peritonitis. Less commonly the fluid develops in the chest cavity causing a pleural effusion. In either case the outcome is severe and always fatal. The symptoms develop rapidly (over a few days to, at most, a few weeks). The patient stops eating and is usually humanely euthanized if he or she does not pass away on their own. 

There is also a less common “dry form” of the disease. The dry form of FIP is a slower developing sequela of the disease. Rather than a rapid progression of disease over a few weeks, the dry form takes months to years. The dry form produces a granulomatous response and produces deposits of a specific type of scar tissue in internal organs. These internal organs then begin to dysfunction and ultimately shut down. 

My experience has shown patients usually are humanely euthanized or pass away from kidney failure secondary to the dry form of FIP. The kidneys, unlike some other organs, do not regenerate cells or repair damage. Once a certain percentage of the kidneys stops functioning the rest of the body quickly shuts down.

There are both feline and canine coronavirus vaccines but their actual efficacy is questionable. There are so many strains that the single strain in the vaccine protect against them all. It would be like having a single flu vaccine that is never modified year to year. The good news is that most cases of both feline and canine coronavirus are mild and self-limiting. Also, I have found no information at this time that states that the canine or feline coronavirus poses any threat to human health. 

If you have questions that are not answered in this article, or are concerned about the health of your individual pet please contact your regular veterinarian for an appointment.  

Dr. Kearns practices veterinary medicine from his Port Jefferson office and is pictured with his son Matthew and his dog Jasmine. Have a question for the vet? Email it to [email protected] and see his answer in an upcoming column.

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By Linda Toga, Esq.

Linda Toga

THE FACTS: Just before my husband died we adopted a puppy we named Morris. Morris is a great source of comfort and joy and I cannot imagine being without him. My concern is that something may happen to me that makes it difficult or impossible for me to care for Morris. Although my children live close by, I cannot depend on them to care for Morris because of allergies and their living arrangements. My friends told me that I should include a pet trust in my will so that Morris’s needs will be met but, I understand that the provisions in my will will have no bearing on Morris’ care until I die and my will is admitted to probate.

THE QUESTION: What can I do to make sure Morris will be cared for in the event I am disabled or simply cannot take care of him any longer? 

THE ANSWER: To insure that Morris is cared for despite your inability to take care of him yourself, you should create an intervivos pet trust. An intervivos pet trust becomes effective as soon as it is executed and funded in contrast to a pet trust that is included in your will. The latter will not address Morris’s needs during your lifetime. 

In the pet trust you need to name the pet or pets that you want to benefit from the terms of the trust. If Morris is your only pet and you do not have plans to get another pet, you can name Morris as the sole beneficiary of the trust. People who have more than one pet or who expect to have other pets during their lifetime may want to identify the beneficiaries of the trust as “any and all pets” they may have at the time the provisions of the trust are triggered. Generally, the terms of a pet trust are triggered when the pet owner’s health deteriorates to the point that the caregiver must assume responsibility for the pet’s care. Triggering events may include your illness, disability (either permanent or temporary) and your death.  

In addition to naming the pets who are to benefit from the provisions of the trust and the events that will result in Morris’s care being taken over by the caregiver, you need to name the person or persons who will be Morris’ caregiver. Be sure to name a successor caregiver in case the caregiver you name is unable to deal with Morris when the need arises. Before naming a caregiver, you should ask each potential caregiver if she is willing to take on the responsibility of caring for Morris. It is important to discuss with all potential caregivers whether their living arrangements can accommodate your pet, whether they or the people they live with have any health issues that may be adversely impacted by the presence of your pet and whether caring for Morris will be an undue burden, financially or otherwise. 

You should plan on funding the pet trust with enough money to cover Morris’s anticipated expenses for the rest of his life. Doing so will alleviate any financial burden on the caregiver However, money will not necessarily alleviate the burden created by the time and effort needed to feed and walk Morris and to get to him the vet and/or groomer as needed. Make sure the caregiver you chose understands exactly what is involved in caring for Morris. You should not assume that everyone will be willing and/or able to give Morris the care and attention he has grown accustomed to. 

Your pet trust should address what will be done in the event you are temporarily unable to care for Morris, as well as what will be done if your health deteriorates to the point that you can no longer care for him at all. Obviously, the trust should also provide guidance as to Morris’s care after your death and your wishes with respect to Morris’s burial or cremation. 

In the trust you should set forth any special needs that Morris may have in terms of diet, grooming or medication. You should also provide the names and contact information for the people who have been treating and grooming Morris. If you want Morris to be groomed monthly, state that in the trust. If you want Morris to be fed a special diet, state as much in the trust. The more information you can provide the caregiver, the more likely it is that Morris will be taken care of in accordance with your wishes. 

With respect to how much money to put into the trust for Morris’s care, you need to consider his age and current physical condition, as well as what you have historically paid for his care. Although you don’t want to set aside too much money, the trust should be funded with sufficient assets to cover routine expenses as well as expenses that will arise when Morris dies. You can indicate in the trust what will happen to the funds that may remain in the trust once Morris is gone. Many people have those assets pass to the caregiver in recognition of their service but, some people opt to have the funds pass to a charity that provides services to abandoned pets. 

There are clearly a lot that goes into the creation of a pet trust for a beloved pet like Morris. It is, therefore, important to seek the expertise of an attorney with experience in creating pet trusts since they are in the best position to insure that all of the important issues that should be addressed in the trust are, in fact, addressed. 

Linda M. Toga, Esq. provides legal services in the areas of estate planning and administration, real estate, small business services and litigation from her East Setauket office. Visit her website at www.lmtogalaw.com or call 631-444-5605 to schedule a free consultation.

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By Daniel Dunaief

Daniel Dunaief

I just celebrated an incredible birthday, thanks to the thoughtfulness of friends and family who took the time to talk with me and shop for greatly appreciated gifts.

Each year, these birthdays have the potential to be challenging, especially given that mine often comes some time around school midterms. Even though I’m no longer watching the calendar to see how many days I have left before I have to take a big test, I still ride that roller coaster vicariously with my children. This year, however, enormous and difficult tests didn’t hang over us, like the academic sword of Damocles.

For starters, before my birthday celebration kicked in, my sister-in-law and brother-in-law sent me AirPods. I knew I was supposed to open the gift on my birthday, but I’m not exactly the most patient person when it comes to opening presents. Gee, I wonder where my kids get that trait?

Anyway, the reaction from my son was almost as enjoyable as the present itself. When he saw me wearing them, he said, “How did you get those?” as if the question were an accusation. “My friends all have them.”

My daughter did a test run with me, chatting with me on FaceTime while she stared at my ears instead of at my uneven sideburns or the hairy bridge connecting my eyebrows. It’s increasingly rare these days for anything I do, say or wear to be considered “up to date,” so this wonderful gift hit the mark.

I’m enjoying using the AirPods at the gym, where I don’t have to worry about the wire bouncing around when I’m running or after I’ve exercised, when I’m panting as I lean over the water fountain.

The best part, though, is that they allow me to talk with someone while I’m walking my dog and picking up his droppings. I don’t have to worry about the wire coming lose when he suddenly pulls hard on the leash to chase a rabbit or to run away from the sudden noise a desiccated leaf makes when it blows in the wind behind us. Yes, despite his 90-pound body, he finds the unexpected noise from leaves threatening.

While I insisted to my wife that she didn’t need to buy anything for me, she purchased several items of clothing, like shorts and shirts that fit, look good and are incredibly comfortable. She also got this terrific jacket that repels the white dog hair that has rendered the rest of my outerwear ridiculous when interacting with members of the general public.

This birthday we ventured to the Big Easy, where the ubiquitous music still resonates. We took a paddleboat ride and heard about the Mississippi River and the site of the Battle of New Orleans. The oak trees lining the bank are about 250 to 300 years old, which means that the same trees stood in the same spot during the battle. 

My teenage son, who isn’t always the picture of patience with his demanding dad, played with me and allowed me to hug him in public during the weekend. That was better than any gift he could have purchased. My daughter, meanwhile, celebrated vicariously from college. A few of her friends wandered into the screen and wished me the best.

Finally, I connected by phone with college roommates, nephews, brothers and my mom, who was a critical part of that day so many years ago. Birthdays have, at times, made me feel older and displaced. This one, with the meaningful conversations, the laughter with my wife and children and the chats with friends and relatives, as well as the “cool” gifts, made me feel so young.

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Photo courtesy of Museum of the American Revolution

By Leah S. Dunaief

Leah Dunaief

In this year of celebrating a century since women were granted the right to vote with the passage of the 19th Amendment, I will tell you a true tale from the dustbin of history.

Women voted for three decades after the American Revolution. They voted from 1776-1807 alongside men in, of all places, New Jersey. How do I know? Jennifer Schuessler tells me so in the Feb. 24 edition of The New York Times.

The women were only stopped from voting after “rampant fraud and corruption.” For example it seems that some men put on dresses to vote multiple times. New Jersey passed a law then, limiting voting in 1807 to white men.

Was it an early expression of gender equality or a legal loophole that enabled women — and African Americans — to vote at the dawn of our country? Or was that a myth?

The Museum of the American Revolution in Philadelphia located new-found poll lists that show women voted in “significant numbers” before they were denied. In August of this year the museum will open an exhibit called ironically, “When Women Lost the Vote,” featuring those documents. This is a great triumph for the museum and the tale.

While other states limited the vote to “freemen” or male inhabitants, New Jersey gave the right to vote to all “inhabitants” as long as “they” could show they had property worth 50 pounds. That ruled out most married women, whose property or income went to their husbands when they married. However, the law enfranchised many women, regardless of race, in New Jersey — or so the early story went. But where was the proof?

Then, an 1801 poll list from Montgomery Township, found in the New Jersey State Archives in Trenton, was the first real modern-day evidence of numerous women voters. The state archives had acquired the lists in 2016 “from the descendants of a long-ago county clerk.”

Now there are 18 poll lists from four New Jersey townships from 1797-1807 that have been found. Nine of them include 163 unique women’s names. The women had cast about 7.7 percent of total votes. On some lists, it was as much as 14 percent.

An interesting corollary is that the women’s names almost always appear in bunches, suggesting that women came to the polls in groups. Maybe that had something to do with the polls often being located in taverns “awash with drunkenness and guns,” according to The Times.

Philip Mead, chief historian at the Museum of the American Revolution, explained that there was difficulty in determining who met the property requirements, which contributed to the end of gender and race equality in New Jersey.

Still, Mead sees a positive message in this research for the museum’s exhibit: “In early New Jersey, we have women voting and African Americans voting. This is a story both about what we might have been, and about who we’ve become.”

It is a fitting tale to mark the end of Black History Month and the beginning of Women’s History Month.

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Easy Shrimp Curry

By Barbara Beltrami

Just exactly what is curry? Good question. Originally it was a name given by western colonizers to the dishes they perceived as foreign.  But what is it really? It’s a variety of dishes using complex herbs and spices, especially cumin, coriander, ginger, turmeric, and fresh or dried chiles. 

What is its provenance? Basically it comes from the Indian subcontinent, Southeast Asia and Oceania. Although genuine curries use their spices separately, not in a combination called curry powder which westerners created, unless you are well versed in making curries, it is best to at least make your own curry powder which most recipes call for anyway. And more often than not, curry refers to the sauce in which a dish is prepared. 

I’m not very experienced with curries, but the ones I’ve done are not for those on a bland diet. They’re savory, aromatic piquant combinations that give a pleasant wakeup call to your palate.

Basic Curry Powder

Curry Powder

 

YIELD: Makes approximately 1/2 cup.

INGREDIENTS:

2 tablespoons ground coriander

2 tablespoons ground cumin

2 tablespoons ground turmeric

2 teaspoons ground ginger

1 teaspoon dry mustard

1/2 teaspoon ground pepper

1/2 teaspoon ground cinnamon

1/2 teaspoon ground cardamom

1/2 teaspoon cayenne

DIRECTIONS: 

In small bowl thoroughly combine all ingredients; transfer to jar, cover tightly and store in a cool dark place.

Easy Shrimp Curry

Easy Shrimp Curry

YIELD: Makes 4 servings.

INGREDIENTS:

1 medium white onion, coarsely chopped

3 garlic cloves, chopped

One 2” piece ginger, peeled and chopped

One 14 1/2-ounce can diced tomatoes

1/4 cup oil

1 to 2 serrano chile peppers, halved

2 teaspoons homemade curry powder (see recipe above)

Salt to taste

1 pound peeled, deveined shrimp

1/2 cup plain yogurt

1/2 cup chopped cilantro

DIRECTIONS: 

In an electric food processor, mince the onion, garlic and ginger; remove and set aside. In the same processor bowl puree tomatoes with one cup water. In a large deep skillet or Dutch oven, heat oil over medium-high heat; add onion, garlic, ginger, chiles, salt and curry powder. Stirring frequently over medium-high heat, cook until onion start to brown slightly, about 5 minutes. Add pureed tomatoes and simmer until thickened, about 10 minutes. Add shrimp and cook over medium-low heat until pink and done, about 4 to 5 minutes. Remove skillet from heat, remove and discard chiles; stir in yogurt and cilantro. Serve hot with basmati rice

Vegetable Curry

YIELD: Makes 4 servings.

INGREDIENTS:

1 pound cauliflower florets

3 tablespoons extra virgin olive oil

2 pints grape tomatoes, halved

Salt and freshly ground pepper to taste

1 large onion, diced

3 garlic cloves, minced

1 tablespoon minced peeled fresh ginger

1 1/2 tablespoons homemade curry powder(see recipe above)

1/2 teaspoon crushed dried pepper flakes

One 14 1/2-ounce can chick peas, rinsed and drained

3 cups finely chopped, rinsed Swiss chard

2 tablespoons chopped cilantro leaves

DIRECTIONS: 

Preheat oven to 375 F. Toss cauliflower with one teaspoon oil, then spread on half of a rimmed cookie sheet. Toss grape tomatoes with another teaspoon oil and spread on other half of cookie sheet. Season with salt and pepper; roast until florets start to brown a little and tomatoes turn soft, about 20 minutes. 

Meanwhile in a small-medium skillet, heat remaining oil over medium-high heat; add onion and, stirring frequently, cook onion until is starts to brown, about 8 to 10 minutes. Add garlic, ginger, curry powder and pepper flakes; cook, stirring constantly, until they release their aroma, about one minute. Add tomatoes, cauliflower, chick peas and Swiss chard and cook over medium heat until chard is tender and other vegetables are heated through, about 8 to 10 minutes. Stir in cilantro and serve hot with a cucumber and yogurt salad.

 

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Oliver

MEET OLIVER!

This week’s shelter pet is Oliver, a 2- year-old domestic short haired cat waiting patiently at Kent Animal Shelter for his furever home. Oliver is good with everything and everyone. He loves kids and other cats, but can be a little shy when he’s first getting to know you. Come on down to the shelter and spend some time with this sweet boy.  You won’t be disappointed! 

Oliver comes neutered, microchipped and is up to date on all his vaccines.

Kent Animal Shelter is located at 2259 River Road in Calverton. The adoption center is open seven days a week from 10 a.m. to 4 p.m. For more information on Oliver and other adoptable pets at Kent, call 631-727-5731 or visit www.kentanimalshelter.com.

 

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It is important to stay hydrated if you have a history of stone formation. Stock photo
High sodium and hypertension can increase probability

By David Dunaief, M.D.

Kidney stones, or nephrolithiasis, can be asymptomatic (no symptoms at all) or may present with the classic symptoms of blood in the urine and colicky pain. Pain can be intermittent or constant, ranging from dull to extremely painful, described by some as being worse than giving birth, shot or burned. The pain may radiate from the kidneys to the bladder and even to the groin in males, depending on the obstruction (1). 

Lifetime risk of kidney stones is about 19 percent in men and 9 percent in women (2). Once you form one stone, your risk of another within five to seven years is approximately 50 percent.

Stones are usually diagnosed through clinical examination and abdominal x-rays and/or non-contrast CT scans.

Unfortunately, the first line treatment for passing kidney stones – at least small ones – involves supportive care. This means that patients are given pain medications and plenty of fluids until the stone(s) pass. Usually stones that are <4mm pass spontaneously. Location is an important factor as well, with stones closest to the opening of the urethra more likely to pass (3).

The good news is there are lifestyle changes that can reduce the risk of kidney stones. First, it is very important to stay hydrated, drinking plenty of fluids, especially if you have a history of stone formation (4).

Calcium supplementation’s impact

One of the easiest methods is to significantly reduce your intake of calcium supplements, including foods fortified with calcium. There are two types of stones, with calcium oxalate being the dominant one, occurring approximately 80 percent of the time (5). Calcium supplements increase the risk of kidney stones. When physicians started treating women for osteoporosis with calcium supplements, the rate of kidney stones increased by 37 percent (6). 

According to findings from the Nurses’ Health Study, those who consumed highest amount of supplemental calcium were 20 percent more likely to have kidney stones than those who consumed the lowest amount (7). It did not matter whether participants were taking calcium citrate or calcium carbonate supplements.

Interestingly, the same study found that calcium from dietary sources has the opposite effect, decreasing risk. Those participants who consumed the highest amount of dietary calcium had a 35 percent reduction in risk, compared to those who were in the lowest group. Calcium intake should not be too low, for that also increases kidney stone risk. However, the source of calcium is a key to preventing kidney stones. 

Sodium’s effect

It’s important to reduce sodium for many reasons, but this provides one more. Again, in the Nurses’ Health Study, participants who consumed 4.5 g sodium per day had a 30 percent higher risk of kidney stones than those who consumed 1.5 g per day (7). The reason is that increased sodium causes increased urinary excretion of calcium. When there is more calcium going through the kidneys, there is a higher chance of stones.

Animal protein

Animal protein also seems to play a role. In a five-year, randomized clinical trial, men who consumed small amounts of animal protein, approximately two ounces per day, and lower sodium were 51 percent less likely to experience a kidney stone than those who consumed low amounts of calcium (8). These were men who had a history of stone formation. The reason that animal protein may increase the risk of calcium oxalate stones more than vegetable protein is that its higher sulfur content produces more acid, which is neutralized by release of calcium from the bone (9).

Hypertension

Some medical conditions may increase the likelihood of stone formation. For example, in a cross-sectional study (a certain population during a specific period) with Italian men, those with high blood pressure had a two times greater risk of kidney stones than those who had a normal blood pressure (10). Amazingly, it did not matter if the patients were treated for their high blood pressure; the risk remained. This is just one more reason to treat the underlying cause of blood pressure, not the symptoms.

The most productive way to avoid the potentially excruciating experience of kidney stones is to make these relatively simple lifestyle changes. The more changes that you implement, the lower your risk of stones.

References:

(1) emedicine January 1, 2008. (2) kidney.org. (3) J Urol. 2006;175(2):575. (4) J Urol. 1996;155(3):839. (5) N Engl J Med. 2004;350(7):684. (6) Kidney Int 2003;63:1817–23. (7) Ann Intern Med. 1997;126(7):497-504. (8) N Engl J Med. 2002 Jan 10;346(2):77-84. (9) J Clin Endocrinol Metab. 1988;66(1):140. (10) BMJ. 1990;300(6734):1234. 

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.  

 

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Members of the team at Brookhaven Lab’s Accelerator Test Facility from left, Mark Palmer, Dejan Trbojevic, Stephen Brooks, George Mahler, Steven Trabocchi, Thomas Roser, and Mikhail Fedurin. Photo from BNL

By Daniel Dunaief

Scientists at Brookhaven National Laboratory and Cornell University have tested and developed a new “green” accelerator. Capturing and reusing the energy from electrons that are decelerating, the newly designed model, called CBETA, will have uses in everything from computer chip manufacture to medicine to missile defense to basic science.

Employing permanent magnets, which require no energy to operate, and superconducting material, these researchers brought to fruition an idea first formulated in 1965 by Maury Tigner, professor emeritus at Cornell University.

“It was talked about for many years,” said Thomas Roser, who just completed his 10th year as chairman of the Collider-Accelerator Department at Brookhaven National Laboratory. “To put everything together in an energy efficient way could have a significant impact for the future.”

Indeed, the new design could lower the energy needs of a future facility like the Electron Ion Collider, which BNL plans to complete in 2030.

“We all have a responsibility to contribute to the well-being” of the planet, including in efforts to reduce the energy consumption of devices used to unlock the mysteries of the universe and produce future technology, said Roser.

Schematic of the Cornell-BNL
ERL Test Accelerator.
Image courtesy of Cornell University

One of the many advantages of the new accelerator design, which was tested in the early morning hours of Dec. 24 at Cornell, is that it captures and reuses the energy in a multi-turn particle accelerator. The idea of the accelerator was to enable beams of different energy to travel through the same magnets on slightly different paths in an oblong structure. 

The design is akin to a relay race on a running track. Each lane has runners that move at their own speeds. When it is time for one of the runners to slow down and leave the track, she shares the energy from her sprint with an intermediary, which drives the next runner forward at a rapid pace, while she decelerates in a nearby loop.

In the case of the accelerator, the intermediary is a superconducting radio frequency cavity.

A key design feature is that multiple beams recirculate in these cavities four times. This cuts down on future construction costs and reduces the size of an accelerator from about a football field to a single experimental hall, according to information from Cornell.

A fresh electron beam allows researchers to get a better quality beam than in the traditional way of operating an accelerator, in a ring that would circulate continuously. 

“The beam is always refreshed, and what gets recirculated is the energy,” Roser said.

The high quality, bright beam creates bright lasers that companies may be able to use to manufacture new chips for computer or phone technology. These accelerators could also make infrared lasers that could melt objects. This type of application could help with defense department efforts to thwart an incoming missile. While BNL is taking steps to work on applications in other areas, the Department of Energy laboratory is not involved in such missile defense applications.

In the medical arena, this kind of accelerator could enable the construction of smaller, simpler and lighter devices for proton therapy to treat cancer. The multi-energy beam transport of CBETA would allow the building of more compact and less expensive gantries that deliver beams to the patient.

Using different energies at the same time, doctors could “treat cancers at different depths inside the body,” Roser said. “That’s an application for this unique transport.” Proton therapy could become cheaper and available in more hospitals with this approach, he asserted.

For Dejan Trbojevic, the principal investigator on the CBETA project and a senior physicist from BNL, the successful test of the concept was a validation of over 20 years of work.

“You can do a lot of simulations assuming realistic errors,” but the actual experiment demonstrating the concept “makes a big difference,” he explained in an email.

The BNL scientist was at Cornell in late December, where he and his colleagues celebrated the results with champagne.

Trbojevic, who had developed the concept of using a single beamline instead of multiple beamlines, hopes to use the new design to create a less expensive design to proton therapy treatment for cancer

“I’m trying to make this cheaper so more hospitals can have it,” Trbojevic said. He has already made contact with companies and a professor in Europe who hopes to use the design concept. He has also requested funding from the Department of Energy.

Beyond the excitement of the recent collaboration with Cornell on the new accelerator design, Roser reflected on his first decade as chairman of the Collider-Accelerator Department.

The BNL department is leading the world in many accelerator technologies and is collaborating closely with CERN, which was founded in Europe seven years after BNL.

Indeed, this year marks numerous celebrations for the department. The Relativistic Heavy Ion Collider, or RHIC, has been operating for 20 years and will become a part of the new Electron Ion Collider. At the same time, the Alternating Gradient Synchrotron, where research for three Nobel Prizes was conducted, marks its 60th year of generating scientific results.

And, to top off the historical trifecta, Ernest Courant, a former BNL Scientist who teamed up with Stanley Livingston and Hartland Snyder to create the strong focusing principle, turns 100 in March. Courant, who worked with Trbojevic on a paper describing the single beamline concept in 1999, helped provide a critical step for modern particle accelerators.

As it did 10 years ago, the department is rolling these three celebrations into one in June.

Courant can’t attend the event because he lives in a retirement home in Ann Arbor, Michigan near his son. BNL will likely show photos and video from Ernest’s birthday at the celebration.

As for the recently completed collaboration with Cornell, Roser believes the work is an important step.

“It’s a new concept and a new type” of accelerator, Roser said. “That doesn’t come around very often. There are cyclotrons and there are linear accelerators. This is a combination of a circular and linear accelerator put together in a new way.”

 

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