Accountings are part of the administration of an estate, regardless of whether the decedent died with a will or intestate.
By Nancy Burner, ESQ.
Nancy Burner, Esq.
There are many steps and layers associated with the administration of an estate. Ultimately, for most estates, the goal is to distribute the assets to the respective beneficiaries named in the decedent’s will or are intestate heirs pursuant to the laws of intestacy. As part of this administration process, and prior to making any final distributions, the beneficiaries of the estate are entitled to receive and review an accounting prepared and provided by the fiduciary for the estate.
One of the fiduciary duties the executor or administrator is tasked with is to marshal the assets of the estate. The administrator reports to the beneficiary the assets of the estate; the income collected during the pendency of the administration; the expenses, debts and claims that were paid on behalf of the estate; and the amount and value of funds that ultimately remain on hand to be distributed to the beneficiaries.
The function of the accounting is to provide a clear and concise review, in proper reportable form, of all of the estate receipts and expenditures of the estate so that the beneficiary fully understands exactly why he or she is receiving a certain sum of money. As discussed above, once the accounting is approved, the ultimate distribution is made in accordance with the terms of the probated will or as provided by the laws of intestacy.
Once provided with the accounting from the fiduciary, the beneficiaries of the estate generally have questions regarding the transactions of the fiduciary. It is important that the fiduciary respond and address any concerns the beneficiary may have regarding the administration of the estate.
After explanation and substantive discussions, most accountings are approved by the beneficiaries and the estate fiduciary can proceed to the next and likely final step of making final distributions.
Conversely, beneficiaries also have the legal right to object to the accounting provided by the fiduciary. Once this occurs, there are provisions in the Surrogate’s Court Procedure Act (SCPA) and other statutes that provide a means by which the beneficiaries can investigate any questions they have about the administration of the estate.
Specifically, SCPA 2211 entitled, “Voluntary account; proceedings thereupon” allows a party to take oral testimony of a fiduciary to examine all of the papers relating to the accounting. These papers include, but are not limited to, bank statements, brokerage statements, deeds, tax returns, financial records, bills and receipts. Following the completion of the SCPA 2211 examination, a decision can then be made by the beneficiaries as to whether to file formal objections to the accounting.
The Surrogate’s Court in New York generally encourages interested parties to resolve their disputes, including any accounting contests, without extensive court intervention, proceedings or a trial as these proceedings can be costly and time consuming.
Accountings are part of the administration of an estate, regardless of whether the decedent died with a will or intestate. Accordingly, whether you are the fiduciary or a beneficiary, it is important to consult with an experienced estate administration attorney to assist and guide you through the accounting process.
Nancy Burner, Esq. practices elder law and estate planning from her East Setauket office.
Different types of exercise have different impacts
By David Dunaief, M.D.
Dr. David Dunaief
Mild cognitive impairment (MCI) is one of the more common disorders that occurs as we age. But age is not the only determinant. There are a number of modifiable risk factors. MCI is feared, not only for its own challenges but also because it may lead to dementia, with Alzheimer’s disease and vascular dementia being the more common forms. Prevalence of MCI may be as high as one-in-five in those over age 70 (1). It is thought that those with MCI may have a 10 percent chance of developing Alzheimer’s disease (2).
Since there are very few medications presently that help prevent cognitive decline, the most compelling questions are: What increases risk and what can we do to minimize the risk of developing cognitive impairment? These are the important questions.
Many chronic diseases and disorders contribute to MCI risk. These include diabetes, heart disease, Parkinson’s disease and strokes. If we can control these maladies, we may reduce the risk of cognitive decline. This involves making lifestyle modifications such as exercise and diet. We know that we can’t stop aging, but we can age gracefully.
Heart disease’s impact
Although we have made great strides, heart disease continues to be prevalent in America. In an observational study, results demonstrated that those suffering from years of heart disease are at a substantial risk of developing MCI (3). The study involved 1,450 participants who were between the ages of 70 and 89 and were not afflicted by cognitive decline at the beginning of the study. Patients with a history of cardiac disease had an almost two times greater risk of developing nonamnestic MCI, compared to those individuals without cardiac disease. Women with cardiac disease were affected even more, with a three times increased risk of cognitive impairment.
Nonamnestic MCI affects executive functioning — decision-making abilities, spatial relations, problem-solving capabilities, judgments and language. It is a more subtle form of impairment that may be more frustrating because of its subtlety. It may lead to vascular dementia and may be a result of clots. This gives us yet another reason to treat and prevent cardiac disease.
Stroke location vs. frequency
Not surprisingly, stroke may have a role in cognitive impairment. Stroke is also referred to as a type of vascular brain injury. But what is surprising is that in a study, results showed that the location of the stroke was more relevant than the frequency or the multitude of strokes (4). If strokes occurred in the cortical and subcortical gray matter regions of the brain, executive functioning and memory were affected, respectively. Thus, the locations of strokes may be better predictors of subsequent cognitive decline than the number of strokes. Clinically silent strokes that were found incidentally by MRI scans had no direct effect on cognition, according to the authors.
Exercise’s effects
Studies have shown that aerobic exercise improves brain function. Stock photo
Exercise may play a significant role in potentially preventing cognitive decline and possibly even improving MCI in patients who have the disorder. Interestingly, different types of exercise have different effects on the brain. Aerobic exercise may stimulate one type of neuronal development, while resistance training or weight lifting another.
In an animal study involving rats, researchers compared aerobic exercise to weight lifting (5). Weight lifting was simulated by attaching weights to the tails of rats while they climbed ladders. Both groups showed improvements in memory tests, however, there was an interesting divergence.
With aerobic exercise, the level of the protein BDNF (brain-derived neurotrophic factor) increased significantly. This is important, because BDNF is involved in neurons and the connections among them, called synapses, related mostly to the hippocampus, or memory center. The rats that “lifted weights” had an increase in another protein, IGF (insulin growth factor), that promotes the development of neurons in a different area of the brain. The authors stressed the most important thing is to exercise, regardless of the type.
In another study that complements the previous study, women were found to have improved spatial memory when they exercised — either aerobic or weight lifting (6). Interestingly, verbal memory was improved more by aerobic exercise than by weight lifting. Spatial memory is the ability to recall where items were arranged, and verbal memory is the ability to recall words. The authors suggest that aerobic exercise and weight lifting affect different parts of the brain, which corroborates the animal study findings above.
This was a randomized controlled trial that was six months in duration and involved women, ages 70 to 80, who had MCI at the trial’s start. There were three groups in the study: aerobic, weight lifting and stretching and toning. Those who did stretches or toning alone experienced deterioration in memory skills over the same period.
Here is the catch with exercise: We know exercise is valuable in preventing disorders like cardiovascular disease and cognitive decline, but are Americans doing enough? A Centers for Disease Control and Prevention report claims the majority of the adult population is woefully deficient in exercise: Only about 1 in 5 Americans exercise regularly, both using weights and doing aerobic exercise (7).
Diet’s effects
Several studies show that the Mediterranean diet helps prevent MCI and possibly prevents conversion from MCI to Alzheimer’s (8, 9). In addition, a study showed that high levels of carbohydrates and sugars, when compared to lower levels, increased the risk of cognitive decline by more than three times (5). The authors surmise that carbohydrates have a negative impact on insulin and glucose utilization in the brain.
Cognitive decline is a disorder that should be taken very seriously, and everything that can be done to prevent it should be utilized. Though the number of Americans exercising regularly is woefully deficient, the silver lining is that there is substantial room for improvement. Exercise has potentially positive effects on neuron growth and development. We need more campaigns like the NFL’s Play 60, which entices children to be active at least 60 minutes every day, but we also need to target adults of all ages. Let’s not squander the opportunity to reduce the risk of MCI, a potentially life-altering disorder.
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.
How old were you when you kissed your first partner, had your first alcoholic drink, met the person of your dreams, had your first child, dealt with your first serious loss, got your first big job or made your first million?
We can use age to motivate us, give us a sense of time and place, and allow us to hear the alarm bells, or to hit the snooze button for the next phase of our lives.
We compare ourselves to those around us to see if we’re approaching the landmarks at the right pace. We take pride in our accomplishments, or in the accomplishments of our children, as in, “My son started walking when he was 7 months old.”
The comparisons often start with our parents, even though we come from a different generation. I wasn’t anywhere close to getting married at the same age as my parents were when they wed. I thought about that when I passed that landmark age. Was I moving too slowly? Was I missing something or someone? Was I falling behind?
I took comfort in knowing that I lived at a different time. Then again, I also passed the age at which my brother got married. Did I need to do a hard target search of every outhouse, henhouse and farmhouse to find my fugitive wife?
Fortunately, the answer had nothing to do with age. I could have married other women, but I hadn’t met the right person.
Before my wife and I got married, we were in sync about when we wanted to try to make that wonderfully challenging transition toward parenthood.
Now, as the years have passed and our children have learned to drive the car — and us crazy — we have reached other milestone ages.
They have celebrated academic landmarks, graduating from elementary and middle schools while working their way through high school.
Our milestone birthday numbers don’t come as frequently as 16, 18, 21, and 25 do for our kids.
But, every so often, we hit a number that has significance either on its own, ending in a zero or a five, or because of some family connection.
I am approaching just such a challenging milestone. My father was this old when he died. I know there are people like Mickey Mantle, who expected to live a relatively short life. Mantle’s grandfather died at 60 and his father passed away at 40, both from Hodgkin disease. In the event, the baseball legend lived until he was nearly 64.
At every annual physical, my doctor and I review my family history. We are aware of the diseases that may be lurking somewhere in my genes. It makes sense to monitor my health and to catch anything early, particularly something that may run in the family.
Still, I don’t share Mantle’s sense of predestination, just as I didn’t feel an overwhelming urge to grab the nearest woman I found relatively unobjectionable because I had to get married at the same age as my parents or my brother.
My life doesn’t come with a playbook or a chapter outline. Maybe I would have made more money by now, reached more personal milestones, or run a few more marathons — OK, one — if I’d recognized all the age-related alarm bells.
Then again, if I had, I would have missed out on knowing my wife and our children, three people whose lives enrich and define my own.
So, yes, while I keep an eye on the genetic footprints in the sand ahead of me, I also hope to follow my own compass as I imagine the days ahead when I become older than my father.
The recent frigid weather was good training to harden us for our trip north this past weekend. We went high up in the Green Mountains of Vermont to ski. Now before you wonder at my sanity, I hasten to repeat what my clever neighbor told me when he heard we were going. “Skiing? Just hang out at the bar for a couple of days, then come back and tell us you went skiing. We’ll never know.”
So with proper full disclosure, I confess that I did not ski. I stretched out before a roaring fire in the lodge with a good book that was interrupted only occasionally for some good food and a good nap here and there. But my children and grandchildren skied and dutifully reported back at the end of each day in such vivid detail that I felt like I had swooshed down from the summit but without the cold and the half-hour wait on the lift lines to get there. Now don’t get me wrong. I always loved to ski. Why else would I have put up with the long drives, the absurd boots, the itchy hats and the running nose except for those few exhilarating moments when the view of the valley below from above the snow line is spectacular, the air is sharp and clear, the snow sparkles with sunlight in an unbroken trail before me and the deep silence assures me that the splendor is mine alone.
That said, age has its advantages, and I stayed warm and dry, letting subsequent generations enjoy the marvel of skiing.
We were there to celebrate my middle son’s 50th birthday. It became a tradition in our family, when my oldest son turned 50, that we would gather at the location of his choosing to properly mark the occasion together. This trip was not without its dangers but not from skiing. It was the drive up to the slopes on Friday that kept us on the edge of our seats in the car, peering into the darkness. If you remember, the day began uncharacteristically warm, but as the hours went by, a deep freeze descended from the north and pushed into the warmer air, creating dense fog.
We crossed the Sound on the ferry, unable to see the shores, and actually missed the turnoff to the Merritt Parkway and thence Interstate 91 from Route 8 on the Connecticut side because the fog shrouded the signs above our heads on the roadway. That wasn’t of any great consequence as we continued on Route 8 to Interstate 84 East, a slightly longer stretch, but it did serve to warn us of what lay ahead.
We drove for the next couple of hours and the fog only seemed to intensify, but we were in good spirits anticipating the coming weekend’s festivities. We even stopped for a nice German dinner in Springfield, Massachusetts. What difference would a couple of extra hours make, we rationalized, since it was going to be dark anyway by the time we left the highway?
Initially driving wasn’t so difficult on Route 103, the first of the back-country roads, because there were other cars snaking along, marking the contours of the road with the glow of red taillights. At one point a bus joined the parade in front of us, and that was dandy. The real problems started when we turned onto Route 100 and left the bus behind. So dense was the fog that we missed the turn and had to circle back for a second try.
We were all alone from that point on, sometimes inching our way forward, straining to follow the yellow midline. Snowbanks lined the road, with only an occasional reflective marker to indicate a precipice off to the side. In that fashion, our hazard lights blinking noisily in the car to avoid anyone colliding with us, we traveled the next 24 miles. We knew we were climbing because our ears popped periodically, but we could see nothing of the mountains. We finally arrived at our lodging, a couple of hours later, in a glazed-eye stupor.
After that, simply skiing was a piece of cake. Birthday cake, that is.
Yali Xu and Christopher Vakoc at the 2013 Don Monti Memorial Research Foundation’s Anniversary Ball. Photo from Yali Xu
By Daniel Dunaief
It’s like a top scorer for another team that the greatest minds can’t seem to stop. Whatever they throw at it, it seems to slip by, collecting the kinds of points that can eventually lead to a life-threatening loss. The scorer is a transcription factor called MYB, and the points it collects can, and often do, lead to breast and colon cancer and leukemia.
Researchers have known for over 30 years that stopping MYB could help with cancer treatment. Unlike other possible targets, however, MYB didn’t seem to have the kind of structural weakness that pharmaceutical companies seek, where developing a small molecule could prevent the cancer signals MYB delivered. Some researchers have decided that drugs won’t stop this high-profile cancer target.
Cold Spring Harbor Laboratory Associate Professor Christopher Vakoc and his graduate research assistant Yali Xu, however, have figured out a way around this seemingly intractable problem. The CSHL scientists recently published their results in the journal Cancer Cell.
MYB binds at a small nub to a large and important coactivation protein called TFIID (which is pronounced TF-two-D). This protein is involved in numerous life functions and, without it, organisms couldn’t survive. Vakoc and Xu found that they could use a small peptide decoy to trick MYB into believing it had attached to this protein when, it reality, it hit the equivalent of a molecular dead end.
In a mouse model of acute myeloid leukemia, this peptide caused leukemias to shrink in size by about 80 percent. “What we’ve discovered is head and shoulders above anything we’ve come across before,” Vakoc said.
As with many scientific discoveries, researchers have to clear numerous hurdles between this conceptual discovery and any potential new cancer therapy. “This is not a medicine a person can take,” Vakoc said.
Indeed, scientists and pharmaceutical companies would need to study what leukemia cells escaped this type of treatment to understand how a cancer might rebound or become resistant after an initial treatment. “Our goal is to develop something with longer lasting effects” that doesn’t become ineffective after three to six months, Vakov said. He described understanding the way a disease reacts to a treatment as an “arms race.” Nature inevitably “finds a way to outsmart our decoy. We’d like to know how [it] does it. We’re always trying to study both sides and trying to anticipate” the next steps.
Down the road, Vakoc could foresee researchers and, ultimately, physicians using this kind of approach in combination with other drugs or therapies, the way doctors now provide patients who have the HIV infection with a cocktail of drugs. Conceptually, however, Vakoc is thrilled that this work “highlights what’s possible.”
One of the most encouraging elements of this approach, Vakoc said, is that it combats MYB without harming organ systems. When the researchers gave the treatment to rodents, the mice were “running around, eating and gaining weight.” Their body tissues appeared normal, and they didn’t demonstrate the same sensitivity that is a common byproduct of chemotherapy treatment, such as losing any hair or having problems in their gut.
An important step in this study, Vakoc said, was to understand the basics of how MYB and TFIID found each other. That, Xu said, was one of the first steps in her graduate work, which took about five years to complete.
In Vakoc’s lab, which includes 13 other researchers, he described how scientists make thousands of perturbations to cancer and normal cells, while they are hunting for cancer-specific targets. By using this screening technique, Vakoc and his team can stress test how cancer cells and normal cells react when they are deprived of certain proteins or genes.
“This began as a screen,” he said. “We took leukemia and normal blood cells and did a precise comparison of the perturbation.” They searched for what had the most specific toxicity and, to their surprise, found that interfering with the binding between MYB and TFIID had the strongest effect. “Once we understood what this nub was doing, we applied all kinds of biochemical assay experiments,” Vakov added.
Ultimately, the peptide they found was a fragment of a larger protein that’s active in the cell. Vakoc credits Xu for her consistent and hard work. “When we started on this hunt, we had no idea where this was headed,” he said. Xu was “relentless” in trying to find the answers. “She pieced it all together. It took a great amount of imagination and intellect to solve this puzzle.”
Vakoc suggested that Xu, who plans to defend her thesis this spring and graduate this summer, has set a great example for the other members of his lab. “I now have 13 other people inspired to outdo her work,” he said. “We know we have a new standard.”
Xu is grateful for the support she has received from Vakoc and appreciates the journey from her arrival as a graduate student from China to the verge of her graduation. “It’s very satisfying when you look back and think how things evolved from the beginning to the end” of her graduate work, said Xu, who lives near Huntington Village and enjoys the chance to visit local restaurants and sample coffee and ice cream when she isn’t conducting research toward her doctorate.
The scientific effort, which was published recently, has attracted the attention of others, particularly those who are studying MYB. Vakoc recently received an email from members of a foundation that is funding research on a solid tumor in which scientists believe MYB plays a role. He is writing grants to get more financial support to pursue this concept. Vakoc is encouraged by the opportunity to make progress with a protein that has been “staring [scientists] in the face for three decades.”
Chokeberry can be planted in most soil conditions including sandy soil. Stock photo
By Kyrnan Harvey
Single-digit overnight temperatures and daytime highs of 16 degrees with howling winds are as bad as it gets in winter on Long Island, unless your property is at sea level, in which case flooding makes the gardener yet more miserable. Port Jefferson locals were reminded by the Jan. 4 storm that their village was called Drowned Meadow. Elsewhere, “from swerve of shore to bend of bay,” and to varying degrees the blast of blizzard was dramatically exacerbated by saltwater flooding.
I had, for many years, such a garden on Manhasset Bay. Nor’easters and hurricanes coinciding with full moons were likely to inundate the garden, and it sure got ugly if it was a blizzard at that time of the month. The salinity of the water was resented most by rhododendrons and other broad-leaved evergreens that had no business growing there, but for the rest — the tulips and daffodils, the roses and forget-me-nots, the hydrangeas and crape myrtles and garden phlox — come May and June and hot summer, they were as happy as Larry, naturalized in their waterfront setting.
Of perhaps greater deleterious effect than the salt water from the coastal flooding was, on the one hand, the enormous deposits left in the garden — a thick layer of Phragmites seasoned with driftwood and plastic detritus, some of which I would add to my collection of ready-mades — and, on the other hand, the stripping of humus and mulch by the receding tide, leaving feeder roots exposed and begging for amelioration. In that case the gardener has no choice but to have a truckload of mulch — or better yet, compost — delivered as soon as possible. Inflate the tire of your wheelbarrow or call in a professional landscaper.
My garden on Manhasset Bay was not only right at sea level but it was entirely flat. There were many storms in which the salt water and flotsam reached into the garden some 20 or 30 feet, but there were also three or four times in 20 years that the entire acre of garden was inundated.
Of course, you could certainly leave such a plot to open lawn and the random privet and black locust. However, what if you want to garden on it, where coastal flooding is not an infrequent occurrence? What planting strategies are there?
Go with the flow and select a few native plants that are adapted to Long Island coastal and establish them in mass plantings. Use these to create a less exposed ecosystem, a cozier environment, a more distinctive sense of place and to minimize erosion. Of course, as always, there are the deer to consider, which unfortunately eliminates sumac (Rhus), eastern red cedar (Juniperus virginiana), winterberry (Ilex verticillata) and bayberry (Myrica), all of which fit the bill of desirable LI coastal natives. These can be tried in future years.
However, in order to establish a durable and dependable infrastructure impervious to saline and cervine, let’s select chokeberry (Aronia), arrowwood (Viburnum dentatum) and grasses, like switchgrass and panic grass (Panicum).
There is a superb source for all these and many more in Eastport (between Moriches and Westhampton), a grower and nursery called Long Island Natives. They may have suggestions unknown to me and firsthand experience that contradicts my own.
Very rarely is there coastal flooding in spring. September through December are the months when the coincidence of heavy storm and full moon will inundate the shorelines. Thus spring is the time to plant in gardens where there is coastal flooding. Let plants have a long season to establish in the soil. If you have established beds and plants that are not known to be adapted to this condition, and they were flooded in the storm of Jan. 4, you must immediately spread at least an inch of compost or mulch.
Email your horticultural questions to [email protected] for possible inclusion in this column.
Kyrnan Harvey is a horticulturist and garden designer residing in East Setauket. For more information, visit www.boskygarden.com.
MEET SAMMY! This is Sammy, a 4-year-old foxhound currently waiting at Kent Animal Shelter for his forever home. Sammy is a happy guy and would make an awesome family dog. Weighing in at 87 pounds, he used to be a hunting dog. He wouldn’t stay with the pack during the hunt so he was turned in for adoption. He is neutered, microchipped, up to date on all his vaccines and ready to be a part of your family.
Kent Animal Shelter, located at 2259 River Road in Calverton, is open from 10 a.m. to 4 p.m. seven days a week. For more information on Sammy and other adoptable pets at Kent, visit www.kentanimalshelter.com or call 631-727-5731.
Last week’s column was devoted to tummy warmers and so is this week’s. What kind of a food columnist would I be if I didn’t devote at least one winter column and maybe more to hearty winter soups? Especially in this weather!
Ah, soup, glorious soup. Anyone who’s ever shivered, had numb toes and fingers and chattering teeth knows how wonderful a mug or bowl of hot soup is. There are so many to choose from, and I love them all. That’s because not only are they comforting, nourishing and savory but also because they’re one pot meals full of nutrition and appetite satisfaction.
Moreover, they just keep giving and giving if you make big vats of them and then divide them into containers for freezing. And they are oh so easy! You pretty much just throw the ingredients into a pot, cover it and simmer till done. And here’s an idea you might like. How about using one of the thicker soups as a pasta sauce? You can puree it or leave it chunky and reduce the liquid. Whatever kind of soup you make, be sure to serve it with lots of crusty bread, a mixed salad and a light red wine such as Beaujolais.
Carrot, Squash and Ginger Soup
Carrot, Squash and Ginger Soup
YIELD: Makes 4 servings
INGREDIENTS:
1 small butternut squash, peeled, seeded and cut into 2-inch chunks
1 pound carrots, peeled and cut into 1-inch chunks
3 tablespoons extra virgin olive oil
1 medium onion, diced
4 cups water or chicken broth
One 2-inch piece fresh ginger, peeled and grated
Salt and freshly ground white pepper, to taste
¼ cup toasted sesame seeds
DIRECTIONS: Steam the squash and carrots until very tender. In a large pot heat the oil over medium heat; add onion and cook until translucent, about 5 minutes. Remove from heat. When slightly cooled, being careful of spattering oil, add water or chicken broth, steamed squash and carrots, ginger, salt and pepper. Simmer until heated through, about 15 minutes; remove from heat; let cool to lukewarm. In 2 or 3 batches, puree in food processor or with immersion blender until smooth. Reheat, stirring frequently, and add more liquid if too thick; sprinkle with sesame seeds and serve immediately with stir-fried veggies and brown rice or refrigerate for later use.
Escarole and Bean Soup
Escarole and Bean Soup
YIELD: Makes 4 servings
INGREDIENTS:
1/4 cup extra virgin olive oil
1 medium onion chopped
6 cups water or chicken broth
1 head escarole, washed and chopped
1 can cannellini beans, rinsed and drained
2 garlic cloves, minced
Salt to taste, if using water
1/4 teaspoon crushed dried red pepper flakes
1/2 cup freshly grated Parmesan cheese
DIRECTIONS: In a large pot, heat oil, add onion and over medium-high heat, cook until slightly golden; remove from heat. When slightly cooled, being careful of spattering oil, add water or chicken broth, escarole, beans, garlic, salt and red pepper flakes. Stir, return to heat and bring to a boil. Reduce heat, cover partially and simmer until escarole is completely wilted, about 15 to 20 minutes. Sprinkle with grated cheese and serve immediately with crusty bread dipped in extra virgin olive oil or refrigerate for later use.
Mushroom and Barley Soup
Mushroom and Barley Soup
YIELD: Makes 4 servings
INGREDIENTS:
6 cups beef broth or stock
2 carrots, cut into 1/2-inch slices
2 celery ribs, thinly sliced
1 small onion, finely chopped
1 pound thinly sliced white or baby portobello mushrooms
1/3 cup barley
1/2 cup chopped Italian flat-leaf parsley
Salt and freshly ground black pepper, to taste
DIRECTIONS: In a large pot, combine all ingredients and stir. Bring to a boil, then cook over medium-low heat, partially covered, until veggies and barley are tender. Note: For an even heartier soup, if desired, add approximately 1 to 2 cups small chunks of cooked beef at the beginning.
FROM OLD FIELD TO STRONG’S NECK TO SUNSET Brian Cohen of Stony Brook captured this image in the parking lot of the Old Field Lighthouse at dusk on Dec. 17 using his Canon EOS Rebel T6. He writes, ‘Long Island history abounds from each geographical point in this photo. I took this imagining that our original settlers may have experienced the same view and wondered what it would be like to step back in time.’
EAT YOUR FRUITS AND VEGGIES: Studies have shown that eating five servings or more of fruits and vegetables daily can reduce your risk of cardiovascular disease. Stock photo
Cardiovascular disease is pervasive but preventable
By David Dunaief, M.D.
Dr. David Dunaief
Heart disease is so pervasive that men who are 40 years old have a lifetime risk of 49 percent. In other words, about half of men will be affected by heart disease. The statistics are better for women, but they still have a staggering 32 percent lifetime risk at age 40 (1).
The good news is that heart disease is on the decline due to a number of factors, including better awareness in lay and medical communities, improved medicines, earlier treatment of risk factors and lifestyle modifications. We are headed in the right direction, but we can do better. Heart disease is something that is eminently preventable.
Heart disease risk factors
Risk factors include obesity, high cholesterol, high blood pressure, smoking and diabetes. Unfortunately, both obesity and diabetes are on the rise. For patients with type 2 diabetes, 70 percent die of cardiovascular causes (2). However, high blood pressure, high cholesterol and smoking have declined (3).
Of course, family history also contributes to the risk of heart disease, especially with parents who experienced heart attacks before age 60, according to the Women’s Health Study and the Physician’s Health Study (4). Inactivity and the standard American diet, rich in saturated fat and calories, also contribute to heart disease risk (5). The underlying culprit is atherosclerosis (fatty streaks in the arteries).
The newest potential risk factor is a resting heart rate greater than 80 beats per minute (bpm). In one study, healthy men and women had 18 and 10 percent increased risks of dying from a heart attack, respectively, for every increase of 10 bpm over 80 (6). A normal resting heart rate is usually between 60 and 100 bpm. Thus, you don’t have to have a racing heart rate, just one that is high-normal. All of these risk factors can be overcome, even family history.
The role of medication
Cholesterol and blood pressure medications have been credited to some extent with reducing the risk of heart disease. The compliance with blood pressure medications has increased over the last 10 years from 33 to 50 percent, according to the American Society of Hypertension.
In terms of lipids, statins have played a key role in primary prevention. Statins are effective at not only lowering lipid levels, including total cholesterol and LDL — the “bad” cholesterol — but also inflammation levels that contribute to the risk of cardiovascular disease. The Jupiter trial showed a 55 percent combined reduction in heart disease, stroke and mortality from cardiovascular disease in healthy patients — those with a slightly elevated level of inflammation and normal cholesterol profile — with statins.
The downside of statins is their side effects. Statins have been shown to increase the risk of diabetes in intensive dosing, compared to moderate dosing (7).
Unfortunately, many on statins also suffer from myopathy (muscle pain). I have a number of patients who have complained of muscle pain and cramps. Their goal when they come to see me is to reduce and ultimately discontinue their statins by following a lifestyle modification plan involving diet and exercise. Now I will address the role of lifestyle modification as a powerful ally in this endeavor. There is an abundance of studies showing exciting effects.
Lifestyle effects
There was significant reduction in mortality from cardiovascular disease with participants who were followed for a very long mean duration of 18 years. The Baltimore Longitudinal Study of Aging, a prospective (forward-looking) study, investigated 501 healthy men and their risk of dying from cardiovascular disease. The authors concluded that those who consumed five servings or more of fruits and vegetables daily with <12 percent saturated fat had a 76 percent reduction in their risk of dying from heart disease compared to those who did not (8). The authors theorized that eating more fruits and vegetables helped to displace saturated fats from the diet. These results are impressive and, most importantly, to achieve them it only required a modest change in diet.
The Nurses’ Health Study shows that these results are also seen in women, with lifestyle modification reducing the risk of sudden cardiac death (SCD). Many times, this is the first manifestation of heart disease in women. The authors looked at four parameters of lifestyle modification, including a Mediterranean-type diet, exercise, smoking and body mass index. There was a decrease in SCD that was dose dependent, meaning the more factors incorporated, the greater the risk reduction. There was as much as a 92 percent decrease in SCD risk when all four parameters were followed (9). Thus, it is possible to almost eliminate the risk of SCD for women with lifestyle modifications.
Heart risk and decreased sexual function in men
A meta-analysis (group of studies) showed that with lifestyle modifications and medication therapies, the risk of cardiovascular disease was reduced significantly, which appeared to result in improvements in erectile dysfunction (10). The lifestyle modifications included dietary changes and increased physical activity. When statin medications were not included, the risk reduction remained relatively constant, demonstrating the strength of lifestyle changes. This research is important, since those with chronic erectile dysfunction are likely to have heart disease within two to five years, according to the authors.
How do you know that you are reducing your risk of heart disease and how long does it take?
These are good questions that I have been asked by a number of patients. We use cardiac biomarkers, including inflammatory markers like C-reactive protein, blood pressure, cholesterol and body mass index. A cohort (a certain group of people) study helped answer these questions. It studied both high-risk participants and patients with heart disease. The results showed an improvement in biomarkers, as well as in cognitive function and overall quality of life.
Participants followed extensive lifestyle modification: a plant-based, whole foods diet accompanied by exercise and stress management. The results were statistically significant with all parameters measured. The best part is the results occurred over a very short period to time — three months from the start of the trial (11). Many patients I have seen have had similar results.
Ideally, if patient needs to use medications to treat risk factors for heart disease, it is for the short term. For some patients, it may be appropriate to use medication and lifestyle changes together; for others, lifestyle modifications may be sufficient, as long as patients are willing to take an active role.
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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