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Tobias Janowitz with research technician Ya Gao at Cold Spring Harbor Lab Photo by ©Gina Motisi, 2019/CSHL

By Daniel Dunaief

It’s a low-tech setting with high stakes. Scientists present their findings, often without slides and pictures, to future colleagues and collaborators in a chalk talk, hoping faculty at other institutions see the potential benefit of offering them an employment opportunity.

For Tobias Janowitz, this discussion convinced him that Cold Spring Harbor Laboratory was worth uprooting his wife and three young children from across the Atlantic Ocean to join.

Chalk talks in most places encourage people to “defend their thinking. Here, it was completely different. They moved on from my chalk talk quickly,” said Janowitz in a recent interview.

Research technician Ya Gao and Tobias Janowitz at Cold Spring Harbor Lab. Photo by ©Gina Motisi, 2019/CSHL

Janowitz recalled how CSHL CEO Bruce Stillman asked him “what else will you do that’s important and high risk. He moved me on from that discussion within five minutes and essentially skipped a step I’d usually spend at another institution. It’s a very special place.”

Janowitz, who earned a medical degree and a doctorate from the University of Cambridge, came to the lab to work in a field where he’s distinguished himself with cancer research that points to the role of a glycoprotein called interleukin 6, or IL-6, in a specific step in the progression of the disease, and as a medical oncologist. He will work as a clinician scientist, dedicated to research and discovery and advancing clinical care, rather than delivering standard care.

As CSHL continues to develop its ongoing relationship with Northwell Health, Janowitz said he expects to be “one of the intellectual bridges between the two institutions.”

In his research, the scientist specializes in understanding the reciprocal interaction between a tumor and the body. Rather than focusing on one type of cancer, he explores the insidious steps that affect an organ or system and then wants to understand the progression of signals and interactions that lead to conditions like cachexia, in which a person with cancer loses weight and his or her appetite declines, depriving the body of necessary nutrition.

CSHL Cancer Center Director David Tuveson appreciates Janowitz’s approach to cancer.

“Few scientists are ready to embrace the macro scale of cancer, the multiple organ systems and body functions which are impaired,” Tuveson said. Janowitz is “trying to understand the essential details [of cachexia and other cancer conditions] so he can interrupt parts of it and give patients a better chance to go on clinical trials that would fight their cancer cells.”

A successful and driven scientist and medical doctor, Janowitz “is very talented and could be anywhere,” Tuveson said, and was pleased his new colleague decided to join CSHL.

Janowitz suggested that the combination of weight loss and loss of appetite in advancing cancer is “paradoxical. Why would you not be ravenously hungry if you’re losing weight? What is going on that drives this biologically seemingly paradoxical phenomenon? Is it reversible or modifiable?”

At this point, his research has shown that tumors can reprogram the host metabolism in a way that it “profoundly affects immunity and can affect therapy.” Reversing cachexia may require an anti-IL-6 treatment, with nutritional support.

As he looks for clinical cases that could reveal the role of this protein in cachexia, Janowitz has seen that patients with IL-6-producing tumors may have a worse outcome, a finding he is now seeking to validate.

At this point, treatment for other conditions with anti-IL-6 drugs has produced few side effects, although patients with advanced cancer haven’t received such treatment. Researchers know how to dose antibodies to IL-6 in the human body and treatment intervals would last for a few weeks.

Scientists have long thought of cancer as being like a wound that doesn’t heal. IL-6 is important in infections and inflammation.

Ultimately, Janowitz hopes to extend his research findings to other diseases and conditions. To do that, he would need to take small steps with one disease before expanding an effective approach to other conditions. “Are disease processes enacting parts of the biological response that are interchangeable?” he asked. “I think that’s the case.”

Eventually, Janowitz hopes to engage in patient care, but he first needs to obtain a license to practice medicine in the United States. He hopes to take the steps to achieve certification in the next year.

He plans to gather samples from patients on Long Island to study cancer and its metabolic consequences, including cachexia.

Several years down the road, the scientist hopes the collaborations he has with neuroscientists can reveal basic properties of cancer.

Tuveson believes Janowitz has “the potential of having a big impact individually as well as on everyone around him,” at Cold Spring Harbor Laboratory. “We are lucky to recruit him and want him to succeed and solve vexing problems so patients get better.”

Janowitz lives in Cold Spring Harbor Laboratory housing with his wife Clary and their three children, Viola, 6, Arthur, 4, and Albert, 2.

Clary is a radiation oncologist who hopes to start working soon at Northwell Health.

The Janowitz family has found Long Island “very welcoming” and appreciates the area’s “openness and willingness to support people who have come here,” he said. The family enjoys exploring nature.

The couple met at a production of “A Midsummer Night’s Dream,” which was performed by a traveling cast of the Globe in Emmanuel College Gardens in Cambridge, England.

As with many others, Janowitz has had family members who are living with cancer, including both of his parents. His mother has had cancer for more than a decade and struggles with loss of appetite and weight. He has met many patients and their relatives over the years who struggle with these phenomena, which is part of the motivation for his dedication to this work.

Most cancer patients, Janowitz said, are “remarkable individuals. They adjust the way that they interact with the world and themselves when they get life changing diagnoses.” Patients have a “very reflected and engaged attitude” with the disease, which makes looking after them “incredibly rewarding.”

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Felix Hoppe-Seyler

By Elof Axel Carlson

Elof Axel Carlson

I enjoy doing history of science because I learn so much when delving into the past. If I am reading about cell theory and the types of tissues there are, I remember the course in microscopic techniques I took as an undergraduate at NYU.

I did not know then that the microtome to cut slices of tissue for making slides was first introduced by Johannes Purkinje. I did not know that growing bacteria on agar plates or slants in test tubes to obtain pure cultures was first done by Robert Koch. I did not know that the word “mutation,” as a change in heredity, was first introduced by Hugo de Vries. Similarly, I did not know that Bernhard Tollens first showed carbohydrates were composed of sugars.

It was William Cheselden who first demonstrated that the role of saliva was to break down food for digestion. I did not know the chemical notation for representing molecules, like CO2 being carbon dioxide was invented by Jöns Berzelius. I did not know the first person to show that oxygen binds to hemoglobin was Felix Hoppe-Seyler. But I did know that Albrecht Kossel was the first to isolate and name the nitrogenous biases of nucleic acid and he called them adenine, guanine, thymine, cytosine and uracil. 

I did not know ringworm was shown to be a fungal parasite by Johann Schönlein. He also changed the name “consumption” to “tuberculosis” and made a third contribution: He was the first science professor to teach in his native tongue, German, instead of Latin to his students. It was Rudolf Leuckart who worked out the nematode parasite causing trichinosis in pork, and his work led to compulsory meat inspection in most industrial countries. The first phylogenetic tree for evolutionary history of plants or animals was constructed by Ernst Haeckel (that I did know).

Even the nouns I use as a scientist have known origins: Tissue was first introduced by Marie François Xavier Bichat at the time of the French Revolution (his 20 different tissues became the four basic tissues I learned as an undergraduate).

The cell theory was first promoted by Matthias Schleiden and Theodor Schwann in 1838. It was changed to a cell doctrine (all cells arise from preceding cells) by Robert Remak and Rudolf Virchow. Most of the names I have mentioned lived in the 1700s and 1800s. We remember the names of 20th century scientists partly because they are published in textbooks. But if one studies a field and looks at old textbooks of about 100 years ago or more, lots of terms used in those past generations have disappeared. Also, the names of then recent scientists are abundant.

It is a curious honor to be a discoverer of something important and then 100 years after your death your role in it is no longer present in texts or scientific articles. Who remembers that Karl Gegenbaur first introduced the idea of homology into comparative anatomy (your hands, a bat’s wings and a horse’s forefeet are homologous because they have an embryonic common formation from an initial limb bud)?   

Scientists do science because they enjoy the opportunity to make discoveries. Very few will be remembered for centuries like Galileo, Newton or Darwin. All who have published will be dug up centuries from now by historians curious about the origins of ideas and processes of our own generation.

Elof Axel Carlson is a distinguished teaching professor emeritus in the Department of Biochemistry and Cell Biology at Stony Brook University.

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Early voting will take place in New York State before the Nov. 5 general election. Stock photo

By Lisa Scott

Voting is about to get easier for New Yorkers. New York has long been behind most of the country when it comes to voting. Our election laws were archaic, making it difficult for people to vote and resulting in low voter turnout. However, both the NYS Assembly and Senate passed several bills on election law, most of which have been signed into law by Gov. Andrew Cuomo (D).

Not all are effective immediately and some will require additional money to be added in the state budget. Other reforms such as no-excuse absentee ballots and same-day voter registration must go through the NYS Constitution amendment process, which will delay their implementation for at least three years.

Early voting will take place for the first time in New York for the Nov. 5, 2019 general election. (Thirty-eight states and District of Columbia have already instituted in-person early voting.) Voters will be able to vote at designated poll sites 10 days prior to Election Day. Each county board of elections will follow the law designating the number of and placement of the early voting poll sites and notify voters of the days, hours and locations of the early polling sites. But all NYS county boards of elections (especially those like Suffolk County, which have large populations and geographic areas) face a myriad of challenges to meet the early voting law requirements.

The League of Women Voters of New York (LWVNY) estimates the cost of statewide early voting to be $9.3 million for implementation in the 2019 general election. The law requires one site per 50,000 registered voters over a period of 9 days with 8 hours of weekday early voting and 5 hours of weekend early voting.

The projected cost areas include poll sites (rental fees for 83 additional sites throughout NYS), staffing and training (training session costs and staffing compensation), voting equipment (some counties may need to purchase new equipment including electronic poll books), security (voting machines and ballots must be secure 24/7 throughout the period of early voting) and education (statewide mailings advising all registered voters — this would be a one-time cost).

In particular, electronic poll books (utilizing secure tablets or laptops with data downloaded in advance eliminating Wi-Fi/hacking concerns) are essential for Suffolk and similar multisite early voting counties in NYS. They allow greater ease and accuracy during the early voting period and will have long-term cost savings after their initial investment. They provide a fast check-in process, reducing the propensity for long lines. They reduce the need for provisional ballots because voters’ records can be searched for in multiple ways. And if a voter is in the wrong place, she can quickly be directed to the correct precinct in order to cast a regular ballot.

Additionally they can be updated right before the election, reducing the rush to enter registration and updates in time to print and distribute paper poll books; and they make postelection updates much faster and accurate. Three NYS counties conducted successful pilot projects utilizing electronic poll books last year.

As of mid-March 2019, Cuomo had not included funding for early voting in his January 2019 Executive Budget (and his February amendment proposals). LWVNY and other good-government groups have been lobbying NYS Senate and Assembly members to include early voting funding in their budget amendments in March. NYS law requires a budget by April 1 each year, so there will be substantial negotiations for the governor and the NYS Senate president and Assembly speaker in late March.

The governor contends that significant savings from a consolidated single state primary will be adequate to cover early voting costs. But there is only one primary date in 2019, so that money will only become available in 2020. Absent funding for early voting in the 2019 NYS budget, each county will have to find its own funding for early voting this year. Suffolk County will thus face a substantial unfunded mandate from NYS in a time of decreasing revenues and substantial borrowing.

Contact your NYS Senate and Assembly leadership and representatives and Cuomo now to ensure appropriate funding for a successful early voting rollout in November!

Lisa Scott is president of the League of Women Voters of Suffolk County, a nonprofit, nonpartisan organization that encourages the informed and active participation of citizens in government and influences public policy through education and advocacy. For more information, visit https://www.lwv-suffolkcounty.org, email [email protected] or call 631-862-6860.

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Irish Cream

By Barbara Beltrami

‘Tis a challenge to write about St. Patrick’s Day without resorting to the clichéd corned beef and cabbage. Sure and there are other Irish dishes that can also celebrate the wearin’ o’ the green.

There’s colcannon — boiled potatoes and cabbage mashed together with butter and salt and pepper. Then there’s shepherd’s pie, a dish as hearty as they come, made with ground meat and veggies and topped with a mashed potato crust. I’d never made colcannon before, but after looking up a few recipes, it was easy to come up with my own version. I dug up shepherd’s pie from deep in my recipe files where I’d forgotten all about it and have happily restored it to my current repertoire. But I think my favorite is Irish cream, a whiskey blend with cream and an alcohol by volume content of 15 to 20 percent that will put green beer to shame.

Colcannon

 

Colcannon

YIELD: Makes 4 servings

INGREDIENTS:

2 pounds potatoes, preferably Yukon Gold, peeled and quartered

¼ pound unsalted butter

2 leeks (white and light green parts only) washed and thinly sliced

¼ large head cabbage, shredded

1¾ cups half-and-half

Salt and freshly ground black pepper to taste

DIRECTIONS:

In a large saucepan over medium heat boil the potatoes in salted water until fork tender. Meanwhile in another large saucepan melt half the butter over medium heat, add leeks and cook, stirring frequently, until very soft, about 8 to 10 minutes. Add cabbage and cook, stirring frequently, until soft; add half-and-half, stir and bring to simmer. Add potatoes, two tablespoons of the remaining butter and salt and pepper; stir and coarsely mash whole mixture. Transfer to serving bowl; melt final two tablespoons butter and drizzle over top.  Serve hot with fish, meat or poultry.

Shepherd’s Pie

Shepherd’s Pie

YIELD: Makes 4 servings

INGREDIENTS:

3 to 4 medium potatoes, peeled and boiled in salted water until very tender

¼ pound unsalted butter

1 large onion, chopped

1 cup diced carrots

1½ pounds ground beef

½ cup vegetable or beef broth

1 cup frozen peas, thawed

Salt and freshly ground black pepper to taste

DIRECTIONS:

Preheat oven to 400 F. While potatoes are boiling, melt half the butter in a large skillet over medium heat. Add the onions and carrots and cook, stirring frequently, until tender, about 8 minutes. Add the ground beef to the skillet and cook, stirring frequently, until no longer pink. Add the broth and continue to cook, covered, over medium heat until liquid is absorbed, about 10 minutes. Stir in thawed peas and season with salt and pepper. Mash potatoes with remaining butter. Spread meat and vegetable mixture in an 8×13-inch greased baking dish; spread potatoes on top to form a crust; bake until mashed potatoes turn slightly golden, about 30 minutes. Serve hot with a crisp green salad.

Irish Cream

Irish Cream

YIELD: Makes approximately 6 cups

INGREDIENTS:

1 cup heavy cream

One 14-ounce can sweetened condensed milk

1¾ cups Irish whiskey

½ cup coffee liqueur

¼ cup chocolate liqueur

1 teaspoon vanilla extract

DIRECTIONS:

Combine all ingredients in a blender and blend 20 to 30 seconds. Transfer to a tightly sealed container and refrigerate. Serve at room temperature with hot coffee, over ice or with crispy cookies such as biscotti or wafers. Top with whipped cream if desired.

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Charles Gallagher cuts the ribbon during the grand opening celebration with wife Judith and daughter Megan.
The produce section of the new Shoprite in Port Jefferson Station
An in-store registered dietitian will be available
Charles Gallagher presents a check to Long Island Cares
Veterans of Foreign Wars Post 6249 receives a check from Charles Gallagher
The exterior of the new store

ShopRite held a grand opening celebration for its newest store, a state-of-the-art, full-service supermarket in Port Jefferson Station, on Friday, March 8. Located at 5145 Nesconset Highway in Port Jefferson Station, the 68,000-square-foot supermarket will be operated by the Gallagher family.

During the ribbon cutting, the Gallagher family presented a check for $10,000 to Long Island Cares food bank, as well as $1,000 to the Veterans of Foreign Wars Post 6249, Rocky Point.

The existing retail space was completely renovated to make way for a new ShopRite with a convenient shopping format. The store was outfitted with the latest energy-saving and sustainable technologies, including LED lighting and environmentally friendly, energy-efficient refrigerant systems. The parking lot was refreshed with new landscaping and lighting. The store will employ approximately 250 people, many of them local residents.

An in-store, registered dietitian will provide free nutrition and wellness counseling to customers, associates and the community, and the new store will also offer a large selection of organic, local and gluten-free foods and fresh produce. Expanded gluten-free options are available in grocery, bakery and the frozen aisle, and the store also offers a refrigerated dairy-free section.

“We are very excited to bring ShopRite to Port Jefferson with the opening of this state-of-the-art shopping destination. This new supermarket is committed to providing low prices, outstanding service and health and wellness options to the local community,” said Charles Gallagher, president of Gallagher Family Markets.

Charles and his wife, Judith, who also own and operate the ShopRites in Selden and Lake Ronkonkoma, will be joined by other members of the family in running the new store, which is now open daily from 7 a.m. to 11 p.m. For more information, call 631-476-5717.

See more photos from the grand opening event at www.tbrnewsmedia.com/arts-lifestyles/.

All photos courtesy of BML Public Relations

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Daniel Dunaief

By Daniel Dunaief

What better day than today, March 14, to celebrate numbers? In case you haven’t heard, math teachers around the country have been getting in on the calendar action for 31 years, designating the day before Caesar’s dreaded Ides of March as pi day, because the first three numbers of this month and day — 3, 1, 4 — are the same as pi, the Greek letter that is a mathematical constant and makes calculations like the area and circumference of a circle possible.

We can become numb to numbers, but they are everywhere and help define and shape even the non-perfectly circular parts of our lives.

We have a social security number, a birth date, a birth order, height and weight, and a street address, with a latitude and longitude, if we’re especially numerically inclined.

Numbers save us, as computer codes using numbers keep planes from flying at the same altitude. Numbers tell us what to wear, as the temperature, especially around this time of year, dictates whether we take a sweatshirt, jacket or heavy coat.

We use them when we’re ordering food, paying for a meal in a restaurant and counting calories. They are a part of music as they dictate rhythms and tempos, and of history, allowing us to keep the order of events straight.

We use numbers to keep track of landmarks, like the year of our graduation from high school or college, the year we met or married our partners, or the years our children were born.

Numbers help us track the time of year. Even a warm day in February doesn’t make it July, just as a cold day in June doesn’t turn the calendar to November.

People complain regularly that they aren’t good at math or science, and yet they can calculate the time it takes to get to school to pick up their kids, get them home to do their homework, cook dinner and manage a budget, all of which requires an awareness of the numbers that populate our lives.

We know when to get up because of the numbers flashing on the phone or alarm clock near the side of our bed, which are unfortunately an hour, 60 minutes or 3,600 seconds ahead thanks to daylight savings time. Many of our numbers are in base 10, but not all, as our 24-hour clocks, 24-hour days, 12-month years and seven-day weeks celebrate other calculations.

Numbers start early in our lives, as parents share their children’s height and weight and, if they’re preparing themselves for a lifetime of monitoring their children’s achievements, their Apgar scores.

Children read Dr. Seuss’ “One Fish, Two Fish, Red Fish, Blue Fish.” We use numbers to connect the dots in a game, drawing lines that form an image of Dumbo or a giraffe.

Numbers progress through our elementary education — “I’m 10 and I’m in fifth grade” — and they follow us in all of our activities: “I got a 94 on my social studies test.”

Imagine life without numbers, just for 60 seconds or so. Would everything be relative? How would we track winners and losers in anything, from the biggest house to the best basketball team? Would we understand how warm or cold the day had become by developing a sliding scale system? Would we have enough ways to capture the difference between 58 degrees Fahrenheit and 71 degrees?

Objects that appear uncountable cause confusion or awe. Look in the sky and try to count the stars, or study a jar of M&Ms and try to calculate the number of candies.

A picture may be worth a thousand words, but a number tells its own tale — it was a six-alarm fire, I had 37 friends at my birthday party or I walked a mile in a circle, which means the diameter of that circle was about 1,680 feet — thanks to pi.

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Leah Dunaief

By Leah S. Dunaief

So, how are those New Year’s resolutions going? Do you even remember what they were? If you are sticking to them, heartfelt congratulations. You are one of few with the discipline and tenacity to hang on. But if you are in the majority for having slipped or temporarily abandoned your resolves, here is some help. It’s called habits.

Habits can be a valuable tool to change your life, both for the better and not. By that I mean, we can slip into some unwelcome behaviors and they become habits almost before we realize it. Or we can consciously take control and set out to break or redefine or make new ones, and as they become part of a routine, they become easier to follow.

This is all far simpler than it sounds, of course. There is a whole branch of science dealing with habits, the unconscious behavioral patterns formed to deal with actions. “We do not so much direct our own actions as become shaped by them,” wrote Jeffrey Kluger in his introductory chapter for a special edition from Time Inc. called “The Power of Habits.”

He points out, by quoting Léon Dumont — the 19th century French psychologist and philosopher — that “a garment, after having been worn a certain amount of time, clings to the shape of the body better than when it was new. There has been a change in the tissue, and this change is a new habit of cohesion.” That is certainly true of the old, comfy pair of slippers that, despite their age, you hate to replace them, and the old pair of pants that have come to fit you like a glove.

Accordingly, the manner of our actions “fashion for themselves in the nervous system more and more appropriate paths.” Kluger here is again quoting Dumont, who studied the science of laughter, of gratitude, of empathy and, for our purposes here, the science of habits.

William James, the American philosopher greatly influenced by Dumont, suggested that people were little more than “bundles of habits.” The point of all this is to build on the idea that if we can shape our brains and the rest of our nervous systems the way we shape a pair of pants, we can control and redirect our lives to follow the actions we wish to take, namely our resolutions to be better.

Think about how many of our daily moves are just programmed in. We get up in the morning and automatically brush our teeth, take a shower, dress, put up the coffee, get our keys, slide behind the wheel of the car, place the coffee cup in the holder, drive to work, all probably while thinking of something else. Occasionally we are surprised to find we have arrived at our destination without consciously paying attention to the route. Almost all of that execution was the result of habit.

Well, suppose you built another step in there, like running 20 minutes on that treadmill or stationary bike collecting dust in your basement before you got into the shower. You like to watch the morning TV shows? Jog along with them as you watch. If you repeat that action for awhile, it could become a habit and presto! You are doing the recommended minutes of exercise a week without the ironclad discipline seemingly required each day.

It just becomes as much a habit as brushing your teeth. If you are forever locked into dipping into the candy jar in the evenings, and you find you are gaining weight, substitute chilled blueberries or red grapes from a cut-glass bowl within reach of your fingers. Of course you have to remember to buy the blueberries or grapes beforehand, wash them and keep them in the refrigerator at the ready.

Complex habits, like procrastination or chronic lateness or smoking are harder to unlearn — but not impossible. We can rewire ourselves, using substitutions or rewards, splinting a bad habit onto a good one for support or hanging out with those whose actions we would like to emulate.

Here’s the bottom line: We can do it. It will just take time for a new behavior to feel part of our routine, an average of two weeks or so. To become a habit will average 66 days.

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The phrase has become oxymoronic. It’s like a bad riddle: What is something everyone needs, but fewer people on Long Island can have?

They call it affordable housing. The real question is, affordable to whom?

Smithtown just recently hosted its second housing lotto in a year for affordable housing developments March 11. Another lotto is coming up to bat March 26 for three one-bedroom units with a total monthly gross rent of $2,300; and one two-bedroom unit with a total monthly gross rent of $3,200.

The Suffolk County Legislature’s Welfare to Work Commission, which advises the Legislature on issues related to poverty in the county, released a report in 2018 that detailed the holes in affordable housing and government programs.

Country Pointe Woods in Smithtown

The report describes that if a family wants to rent, only 18 percent of available housing is rental, compared to the national average of 37 percent. Market rate for monthly apartment rentals in Suffolk was $1,589 in 2017, according to census data, meaning families in that market would have to earn $57,204 — 52 percent of the area median income — a year if they spent 30 percent of their income on the apartment costs. In Smithtown, average rental costs are upward of $2,500 for a one-bedroom apartment, according to online rent tracker RENTCafé.

It’s hard to call such options such as the lottos in Smithtown truly “cheap,” mostly because each is only cheap by comparison.

The Town of Huntington hosted a lotto for Harborfields Estates March 5 with 608 first-time home-buyer applicants entered in that drawing. It’s a staggering number of people all bidding on the hope of owning a four-bedroom home valued $350,125. Real estate taxes on the unit are estimated to be $9,700 annually and estimated HOA fees will be approximately $460 annually.

The county report noted the 2017 Suffolk yearly median income was $110,800, while the median price of a home in 2017 was $376,000, according to census data. If an individual or family spent 30 percent of income on housing costs, the national and suggested average, they would have to earn $125,000 a year to afford the median home price.

These lotteries are an opportunity for the average person looking for a home on Long Island to have the chance to start a life here, but there’s also something dystopian about the entire idea of gambling a chance to be able to afford something as basic as a residence, whether that means renting or owning. Not to mention, anybody who is making less than the area median income knows just how tough it is to find truly affordable living anywhere along the North Shore.

It’s not to say these lotteries aren’t helping those whose names are drawn, but one wonders at the state of some of the hundreds of people who apply for these lottos who then walk away empty handed. While certainly a few of those applying may already own homes or rent apartments and are just looking for a cheaper option, the very nature of a lottery draws upon the desperate.

Municipalities at every end of the Island are complaining about brain drain, of Long Islanders fleeing to seek cheaper housing options elsewhere. Their governments need to look at the issue holistically and take an approach that affects communities as a whole, rather than give it to select individuals.

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Too much milk may be bad for your health. Stock photo
Does dairy really build strong bones?

By David Dunaief, M.D.

Dr. David Dunaief

The prevalence of osteoporosis is increasing, especially as the population ages. Why is this important? Osteoporosis may lead to increased risk of fracture due to a decrease in bone strength (1). That is what we do know. But what about what we think we know?

For decades we have been told that if we want strong bones, we need to drink milk. This has been drilled into our brains since we were toddlers. Milk has calcium and is fortified with vitamin D, so milk could only be helpful, right? Not necessarily.

The data is mixed, but studies indicate that milk may not be as beneficial as we have been led to believe. Even worse, it may be harmful. The operative word here is “may.” We will investigate this further. Vitamin D and calcium are good for us. But do supplements help prevent osteoporosis and subsequent fractures? Again the data are mixed, but supplements may not be the answer for those who are not deficient.

Milk – it’s not what you think

The results of a large, observational study involving men and women in Sweden showed that milk may be harmful (2). When comparing those who consumed three or more cups of milk daily to those who consumed less than one, there was a 93 percent increased risk of mortality in women between the ages of 39 and 74. There was also an indication of increased mortality based on dosage.

For every one glass of milk consumed there was a 15 percent increased risk of death in these women. There was a much smaller, but significant, 3 percent per glass increased risk of death in men. Women experienced a small, but significant, increased risk of hip fracture, but no increased risk in overall fracture risk. There was no increased risk of fracture in men, but there was no benefit either. There were higher levels of biomarkers that indicate oxidative stress and inflammation found in the urine.

This study was 20 years in duration and is eye-opening. We cannot make any decisive conclusions, only associations, since it is not a randomized controlled trial. But it does get you thinking. The researchers surmise that milk has high levels of D-galactose, a simple sugar that may increase inflammation and ultimately contribute to this potentially negative effect, whereas other foods have many-fold lower levels of this substance.

Ironically, the USDA recommends that, from 9 years of age through adulthood, we consume three cups of dairy per day (3). This is interesting, since the results from the previous study showed the negative effects at this recommended level of milk consumption. The USDA may want to rethink these guidelines.

Prior studies show milk may not be beneficial for preventing osteoporotic fractures. Specifically, in a meta-analysis that used data from the Nurses’ Health Study for women and the Health Professionals Follow-up Study for men, neither men nor women saw any benefit from milk consumption in preventing hip fractures (4).

Calcium disappointments

Unfortunately, it is not only milk that may not be beneficial. In a meta-analysis involving a group of observational studies, there was no statistically significant improvement in hip fracture risk in those men or women ingesting at least 300 mg of calcium from supplements and/or food on a daily basis (5).

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

Vitamin D benefit

Finally, though the data is not always consistent for vitamin D, when it comes to fracture prevention, it appears it may be valuable. In a meta-analysis (involving 11 randomized controlled trials), vitamin D supplementation resulted in a reduction in fractures (6). When patients were given a median dose of 800 IUs (ranging from 792 to 2,000 IUs) of vitamin D daily, there was a significant 14 percent reduction in nonvertebral fractures and an even greater 30 percent reduction in hip fractures in those 65 years and over. However, vitamin D in lower levels showed no significant ability to reduce fracture risk.

Just because something in medicine is a paradigm does not mean it’s correct. Milk may be an example of this. No definitive statement can be made about calcium, although even in randomized controlled trials with supplements, there seemed to be no significant benefit. Of course, the patients in these trials were not necessarily deficient in calcium or vitamin D.

In order to get benefit from vitamin D supplementation to prevent fracture, patients may need at least 800 IUs per day, which is the Institute of Medicine’s recommended amount for a relatively similar population as in the study.

Remember that studies, though imperfect, are better than tradition alone. Prevention and treatment therefore should be individualized, and deficiency in vitamin D or calcium should usually be treated, of course. Please, talk to your doctor before adding or changing any supplements.

References:

(1) JAMA. 2001;285:785-795. (2) BMJ 2014;349:g6015. (3) health.gov. (4) JAMA Pediatr. 2014;168(1):54-60. (5) Am J Clin Nutr. 2007 Dec;86(6):1780-1790. (6) N Engl J Med. 2012 Aug. 2;367(5):481.

Dr. Dunaief is a speaker, author and local lifestyle medicine physician focusing on the integration of medicine, nutrition, fitness and stress management. For further information, visit www.medicalcompassmd.com or consult your personal physician.      

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