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By Yusuf A. Hannun, M.D. 

Dr. Yusuf Hannun

Because of major advances in cancer prevention, early detection and treatment, many patients with cancer are enjoying longer lives and maintaining their quality of life, as the number of cancer survivors grows.

National Cancer Survivors Day®, an annual worldwide celebration of life, is held each year on the first Sunday in June. Anyone living with a history of cancer — from the moment of diagnosis through the remainder of life — is a cancer survivor, according to the National Cancer Survivors Day Foundation. In the United States alone, there are more than 14.5 million people living with a history of cancer.

Stony Brook University Cancer Center will host its 13th Annual Cancer Survivors Day this  Sunday, June 4, from 11 a.m. to 3 p.m. at the Cancer Center, located on the Stony Brook Medicine campus.

The event is a celebration for those who have survived cancer and serves as an inspiration for those who have been recently diagnosed. In addition, this event is a gathering of support for families and friends. Attendees will also have the opportunity to meet and mingle with Stony Brook Medicine physicians, nurses and support staff.

The day features inspirational speaker Jennifer Arnold, MD, MSc, FAPP, who will share her story of perseverance, resilience and strength to bring hope to others facing obstacles and difficulties. Dr. Arnold, a three-year cancer survivor, stars in TLC’s docu-drama “The Little Couple” along with her husband, Bill, and their children, Will and Zoey.

All cancer survivors are invited, whether they were treated at Stony Brook or not. In addition to Dr. Arnold’s talk, attendees can enjoy a variety of outdoor activities, such as dunk-a-doc, bedpan golf, chemo bag toss and face painting, as well as musical entertainment and light refreshments. They can also participate in the very moving Parade of Survivors. This event is free but registration is required. To register, visit cancer.stonybrookmedicine.edu/survivors2017 or call 631-444-4000.

National Cancer Survivors Day is just one of many ways Stony Brook reaches out to the community. The Cancer Center has created several initiatives and programs to help make life easier for patients with cancer, including support groups, cancer prevention screenings and the School Intervention and Re-Entry Program for pediatric patients.

As a leading provider of cancer services in Suffolk County, the Cancer Center is on the forefront of research, discovery and cancer care. In the new Kavita and Lalit Bahl Center for Metabolomics and Imaging, for instance, we are receiving international recognition for our pioneering studies in metabolism and cancer. It’s changing what is known about the role metabolism plays in cancer and brings us closer than ever before to understanding how to prevent and treat it.

And next year, Stony Brook Cancer Center will relocate to a state-of-the-art Medical and Research Translation (MART) building that will focus on cancer research and care. This 240,000-square-foot facility will allow scientists and physicians to work side by side to advance clinical cancer research and improve treatment options.

Propelled by these advances, we continue to bring comprehensive cancer resources to you in your community. Our ambitious drive to transform cancer care and research is just one more reason for hope and celebration.

Dr. Yusuf A. Hannun is the Director of Stony Brook University’s Cancer Center, 
Vice Dean for Cancer Medicine and 
Joel Strum Kenny Professor in Cancer Research

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Quiche Lorraine

By Barbara Beltrami

Of all my memories from my travels, one of the clearest and most poignant is a picnic lunch on a riverbank in the Dordogne area of France. After a long walk through meadows and the cobblestoned streets of tiny villages, across bridges and down rutted roads, what our guide had told us would be a modest lunch prepared by his fiancée turned out to be an incredibly sumptuous feast of everything one fantasizes about in such a setting.

I still remember the platters of freshly cut melon with delicate slices of ham, local farm fresh cheeses and butter, pates with cornichons, thick slices of juicy homegrown tomatoes and fresh picked delicate greens with just a touch of vinaigrette, long crusty baguettes still warm from the oven, ruby red cherries and the piece de resistance — not one but three different quiches made, of course, with vegetables from their garden, eggs from their chickens and cream from their cow.

I’ve made many a fancy lunch and many a quiche in my day, but none will ever come close to those. I have neither the quality of ingredients nor that setting with its perfect ambiance. But I have often tried to imitate if not duplicate those quiches. The recipes that follow for Quiche Lorraine, Zucchini Quiche and Spinach and Mushroom Quiche are the closest I’ve gotten. Bon appétit!

Quiche Lorraine

Quiche Lorraine

 

YIELD: Makes 6 to 8 servings

INGREDIENTS:

Pastry for one 9-inch pie

1 tablespoon unsalted butter

1 medium onion, thinly sliced

4 strips crispy cooked bacon, lightly crumbled

1 cup shredded Gruyere or Emmenthaler (Swiss) cheese

¼ cup grated Parmesan cheese

4 eggs, lightly beaten

2 cups half-and-half

¼ teaspoon freshly grated nutmeg

Salt and freshly ground white pepper, to taste

DIRECTIONS: Preheat oven to 450 F. Line bottom and sides of a 9-inch quiche pan or pie plate with pastry and bake 5 minutes. In a small skillet, sauté onion in butter until softened and opaque. Sprinkle bacon, onion and cheeses over bottom of baked pastry. With a wire whisk thoroughly combine eggs, half-and-half, nutmeg and salt and pepper. Pour mixture onto pie crust. Bake the quiche 15 minutes at 450 F, then reduce oven temperature to 350 F and bake until a knife inserted in center comes out clean, about 10 to 15 minutes longer. Serve hot or warm with onion soup, arugula salad and a French baguette.

Zucchini Quiche

Zucchini Quiche

YIELD: Makes 6 to 8 servings.

INGREDIENTS:

One 9-inch pie crust

1 tablespoon unsalted butter

1 tablespoon olive oil

2/3–¾ lb zucchini, washed, halved lengthwise then very thinly sliced crosswise

1 medium onion, finely chopped

1½ cups half-and-half

3 large eggs

Salt and freshly ground black pepper, to taste

3 ounces Emmenthaler (Swiss), Jarlsberg or Gruyere cheese, shredded

DIRECTIONS: Preheat oven to 450 F. Line bottom and sides of 9-inch quiche pan or pie dish with pie crust and bake 5 minutes. In large skillet melt butter; add oil. Add zucchini and onion and sauté until tender and just starting to turn golden brown, about 5 to 7 minutes. In medium bowl, vigorously whisk together the half-and-half, eggs and salt and pepper. Sprinkle cheese, zucchini and onions evenly over bottom of crust. Pour in egg mixture. Bake at 450 F for 10 minutes, then reduce heat to 350 F and bake another 10 to 15 minutes until knife inserted in center comes out clean. Serve with garlic bread and sliced tomatoes with olive oil, basil and vinegar.

Spinach and Mushroom Quiche

Spinach and Mushroom Quiche

YIELD: Makes 6 to 8 servings

INGREDIENTS:

One 9-inch pie crust

2 tablespoons unsalted butter

1 cup cleaned fresh mushrooms, thinly sliced

1 cup cooked, drained and chopped fresh or frozen spinach

2/3 cup grated Emmenthaler (Swiss) cheese

1/3 cup crumbled blue or Roquefort cheese

1 3/4 cups half-and-half

3 eggs

Salt and freshly ground black pepper, to taste

DIRECTIONS: Preheat oven to 450 F. Line bottom and sides of a 9-inch quiche pan or pie plate with crust and bake 5 minutes. In small skillet, melt butter, add mushrooms and sauté 5 minutes over medium heat. Remove from heat; add prepared spinach and toss with mushrooms and remaining melted butter to coat. Sprinkle evenly in pie dish, then sprinkle the two cheeses on top. In medium bowl, whisk together the half-and-half, eggs and salt and pepper. Pour into pie plate. Bake at 450 F for 10 minutes, then lower heat to 350 F and bake for another 10 to 15 minutes, until knife inserted in center comes out clean. Serve with a salad of fennel, endive, radicchio, fresh or dried fruits, chopped walnuts and a French baguette.

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By Fr. Francis Pizzarelli

On a Friday in May, a very distraught man in his mid-40s barricaded himself in a Catholic Church in Center Moriches. He threatened police to use incendiary devices. After the police retreated, he set the church on fire and killed himself.

The first responders and Suffolk County police were extraordinary; hundreds of people reached out to the young pastor to offer help in the midst of this horrific tragedy.

Located directly next to the church was a regional Catholic school, grades K through eight. A few hundred children were locked in for most of the afternoon. They were petrified. By late afternoon, they were released to their parents.

On the Monday after this horrific tragedy, the pastor designated the 8 o’clock morning Mass as a Mass for healing and peace for the parish and school community. The entire student body assembled in the gym along with countless parishioners and community members. This gymnasium turned worship space was alive with faith and renewed hope.

The pastor began the Mass with inspiring words of welcome. After the Gospel reading, he gave an extraordinary homily that was beyond words. The students were mesmerized by his words of compassion, unconditional love, profound gratitude and renewed hope.

He asked the students that morning how many had been afraid on Friday. More than half of the student body raised their hands. The young priest did too. He said he had been really scared but had drawn on his faith and he knew he would be okay. He went on to say to this very attentive audience that it was okay to be scared but that they would be okay too; that we just need to draw on our faith! All who participated that morning left with a renewed sense of hope and a real belief that everything would be okay!

There was a young social work intern at this peace and healing service. He was a social work intern from one of New York City’s graduate schools of social work. I have known him since he was a teenager; he is an extraordinary young man but like many of his generation not without some real-life challenges.

His graduate school graduation was on the Sunday before that Monday morning Mass. I asked him how was graduation. He told me he had been really excited to get hooded since he had missed his undergraduate graduation. However, because of the tragedy in his field placement, he made the difficult decision to pass on commencement. He said, “my students need me; I think it’s more important for me to be present among them. I want them to know that they will be okay!” I was profoundly touched by the decision he made.

That same graduation weekend two young men who have battled addiction since high school are powerful examples that transformation does take place and recovery can and does lead to new life.

One young man graduated cum laude from a local liberal arts college and will begin his professional career as a quality control scientist for a pharmaceutical company. The other young man, a philosophy major as an undergraduate, graduated at the top of his class with a law degree. Both men continue to give back and express gratitude every day for the lives they have reclaimed.

The drug epidemic is a national health crisis. Those in government pay lip service to this infectious affliction; despite their inaction, people do recover, reclaim their lives and become life-giving members of our society.

These are just a few stories of hope. I am fortunate to see these kinds of miracles every day across a landscape of unnecessary human carnage!

Fr. Pizzarelli, SMM, LCSW-R, ACSW, DCSW, is the director of Hope House Ministries in Port Jefferson.

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By Matthew Kearns, DVM

“My dog ate three grapes (or raisins). Should I be worried?” We get a phone call like this at least once every week to every other week. That’s a good question because we, as a veterinary community, are still looking for the exact answer. Let’s take a closer look at grape and raisin toxicity to see if we can shed some light on what we do know about this nebulous topic.

What portion of the grape or raisin is toxic? Unfortunately, the exact toxic substance to dogs in grapes and raisins is still unknown. Neither the color of the grape, nor seeded versus seedless makes a difference. As a matter of fact, the one portion of the grape that has been ruled out as a cause of kidney damage is the seed or grape seed extract.

Theories arise as to which component of the grape is toxic. Some experts feel that high concentration of a type of sugar component called monosaccharides, whereas others blame a compound called tannins.

Additional theories do not implicate anything in the grape itself, but rather the growth of certain fungi on the grape and toxins produced called aflatoxins, or pesticides sprayed on grapes. More recent evidence points toward something in the meaty portion of the grape or raisin because veterinary toxicologists found that raisins that have been cooked (in cookies, breads, cakes, etc.) are less toxic than grapes or uncooked raisins.

How much is too much? This answer is also unclear. There does seem to be a genetic component associated with which individual dogs are more sensitive to grapes or raisins.

An article published in 2009 reviewed the charts of almost 200 dogs over a 13-year period. The study found some dogs ate over two pounds of raisins without developing any signs of poisoning, whereas others developed irreversible kidney failure with as little as 3 grams of grapes or raisins.

Just to give you some perspective as to how much 3 grams is: Your average grape weighs 5 grams, and a raisin weighs about 0.5 gram. As little as one grape or six raisins could be toxic to your dog. However, some dogs will not get sick or require large amounts of grapes/raisins before any damage is done.

Is there an antidote to this type of poisoning? The short answer is no. This is truly an example of “an ounce of prevention is worth a pound of cure.”

The patients that did better in the same 2009 study were those in which the owners witnessed the ingestion and brought them to a veterinary clinic immediately. The veterinarians were able to induce emesis (force vomiting) and give activated charcoal ASAP. Patients that were already showing symptoms of toxicity such as lethargy, loss of appetite, vomiting and increase in thirst/urination were less likely to make a full recovery.

In conclusion, veterinarians are still not sure as to what portion of the grape/raisin is poisonous, nor which dogs are more sensitive to grapes/raisins. Therefore, keep grapes and raisins away from your dog when possible and, if you witness your dog eating grapes or raisins, bring him or her immediately to your veterinarian’s office or an emergency clinic for treatment.

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

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By Linda Toga

THE FACTS: My house and most of my liquid assets are held in an irrevocable trust that I funded over five years ago. I am fortunate in that my income is sufficient to for me to live comfortably without using my savings.

THE QUESTION: If I do need to move into a nursing home down the road, how will Medicaid deal with my income when it comes to determining if I am eligible for benefits?

THE ANSWER: Since Medicaid is a needs-based program, your eligibility will be based on the value of your available assets, meaning assets that are not in your trust, and your income. Even if your assets are very limited, if your income is sufficient to cover the cost of a nursing home, you will not be eligible for assistance.

However, because there are some sources of income that are exempt under the Medicaid rules, determining eligibility is more involved than simply applying the same monthly income level across the board.

Medicaid looks at all of the income you receive, at the source of that income and at your medical expenses to determine your Net Available Monthly Income or NAMI. If your monthly medical expenses equal or exceed your NAMI, Medicaid will deem you “income eligible.”

In general, Medicaid will consider income from stocks and bonds, IRAs and other qualified plans, pensions and trusts when making a determination as to whether you are eligible to receive benefits.

Medicaid will not, however, include in your NAMI income from German and Austrian reparation plans, Nazi persecution funds, state crime victims’ assistance funds, Seneca Nation Settlement Act Funds, special payments to American Indians or payments from federal volunteer programs.

Medicaid also exempts funds received from a reverse mortgage as long as you use the funds during the month you receive them.

If you are single, you will be allowed to keep all the exempt income you may receive plus an additional $50/month in nonexempt income and funds to cover the cost of your supplemental medical insurance premiums.

If you are a veteran, you get to keep $90/month plus exempt income and the cost of supplemental medical insurance. NAMI in excess of $50 (or $90 for veterans) plus the cost of insurance premiums must be paid to the nursing home.

If you are married and your spouse is well and continues to live in the community (the “community spouse”), the amount of income you may keep is the same as for an unmarried individual. However, your spouse, as the community spouse, is allowed a monthly income of close to $3,000 to help cover living expenses. If your spouse’s income is too large, Medicaid will apply a percentage of his or her excess income to the cost of your care in the nursing home.

Linda M. Toga, Esq. provides legal services in the areas of estate planning, probate, estate administration, litigation, wills, trusts, small business services and real estate from her East Setauket office.

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Fan Ye. Photo from SBU

By Daniel Dunaief

Fan Ye has a vision for the future filled with high service and efficiency that doesn’t involve butlers or personal attendants. The assistant professor of electrical and computer engineering in the College of Engineering and Applied Sciences at Stony Brook University is focused on creating smart environments in which window blinds open as people pull into their driveways, lights turn off in unoccupied rooms and the building guides a new student turn by turn through complex floors and hallways from entrance to the registrar’s office.

“The physical environment would be like a caring mother,” said Ye. It would sense and figure out people’s needs and “take care of the occupants inside the building.”

In Ye’s vision, which he estimates is about one year to decades away from a reality, objects that rely on people to turn them on or off, reposition them or alter their settings would have chips embedded in them, working together to create an environment that anticipates and learns in response to the need around it.

“With sensors, [a smart environment] can sense both physical conditions and human activities and adjust the environment in manners that create/improve comfort, safety, convenience” and the productivity of the occupant, he explained in an email.

Ye recently received a $450,000 award over the next five years from the National Science Foundation for early-career faculty for his study of smart environments. The prestigious award is the highest honor given by the government to scientists and engineers beginning their independent careers.

Initially, Ye is developing and testing a security system with the Stony Brook University Police Department and the Center of Excellence in Wireless and Information Technology that grants specific access to buildings or facilities depending on the specifications of an administrator.

Many of the buildings on campus have electric locks, which someone can open with a badge where there’s a badge reader. A badge, however “isn’t that flexible,” Ye said. If an administrator would like to grant someone one-time access to open a door that doesn’t provide ongoing access, that is difficult to do with a badge system.

“What’s lacking in this closed proprietary system is flexible access control, which can determine who has what access based on context factors,” he said. Ye, his team, the police department and the CEWIT are building a system that can enable greater flexibility that allows someone to open an office door for five minutes during a specific hour. “If any of these context factors is not satisfied, they don’t have access,” he said.

Ultimately, he would like to construct a system using modern mobile technology, like smartphones, instead of physical badges. The system would include embedded security that employs modern cryptography so a hacker or attacker can’t trick the system.

By using software and hardware security, Ye is hoping to develop a system that prevents the most common attacks at a reasonable cost, which he hopes would prevent someone from gaining access.

Ye is building real systems and testing them. The cost-benefit of these systems depends on the object. A motor to open and close a window would cost money to manufacture, install and operate. As with any technological innovation, he said, “the question comes down to, How do you invest versus how much do you get in return?”

Looking at the historical trend for computation resources, Ye said computing and storage costs are falling at an exponential rate, while the price for radio and sensing is also falling rapidly, although not at the same pace.

“I believe this trend will continue, especially for a lot of these objects that need small embedded systems” that can be manufactured at a scale with low cost, he continued. The process of turning the environment into an efficient, high-service system isn’t an all-or-nothing proposition. Consumers might decide to focus on the air-conditioning or heat use in their homes.

Other researchers are developing ways to harness the vibrational energy of movement or sound, which, conceivably, could power some of these electronics without requiring the delivery and consumption of more energy.

Ye recognizes that these parts can and will break down and require repair, just as dishwashers sometimes stop working and iPhones can lose a list of contacts. So many small electronic parts in a smart environment could seem like an invitation to malfunctions.

He likens the repair process to cloud computing, which allows small to medium-sized companies to rent computing resources from larger companies. “A smart environment, especially for public buildings like a university or office, could potentially run in a similar model,” he said. Individuals might rely on IT support from dedicated personnel who, like a superintendent in a building, could be responsible for a host of smart products.

A native of Hubei Province in China, Ye, who now lives in Setauket, loves to hike in national parks. His favorite is Canyonlands in Utah. Ye had worked at IBM for about 10 years before joining Stony Brook almost three years ago. While he was there, Ye worked on numerous projects, including distributed stream processing, cloud-based queueing and wide-area dependable messaging. “I learned tremendously at IBM,” he said.

Ye is “”well known and respected in the mobile and wireless computing research community,” Hui Lei, an IBM distinguished engineer, wrote in an email. “He conducted pioneering work on scalable message delivery, robust coverage and security in wireless sensor networks, which are well received and highly cited and closely related to the smart environment work he is doing now.”

Lei suggested that Ye’s experience and accomplishments provide him with a solid track record and he is “confident that [Ye] will be able to come up with innovative solutions in this area.”

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‘Super Elfin Cha Cha Mix’ impatiens wait to be purchased at Bloomin’ Haus in Holtsville. Photo by Heidi Sutton
Shade plant makes comeback after downy mildew blight

By Ellen Barcel

Impatiens come in many different colors including shades of red, pink, white, orange and purple.

Impatiens are beautiful plants for the shade garden. They are colorful and bloom virtually the entire growing season as the plants spread. And yes, impatiens are finally coming back to the nurseries after several years of doing battle with downy mildew.

All variety of impatiens, with the exception of New Guinea, are susceptible, including plants that have impatiens in their lineage as well as wild impatiens. Although first reported in 2004, it was in 2011 when there were widespread outbreaks and impatiens disappeared from nurseries.

Look for fluffy white spots on the underside of the impatiens leaf, a sure sign of downy mildew.

Downy mildew is a fungal-type infection that causes the plants to basically shrivel up and die. Once the plants show signs of disease, they can’t be cured. But now, wholesale nursery growers know about the problem and use a fungicide before any signs of disease appear.

Since the pathogen (spores) can remain active in the soil for many years, there are several things you as a gardener can do to make sure that your new impatiens remain healthy:

◆ Check out the new plants you are buying to make sure they appear to be disease-free (no yellow, wilting, brown curling leaves or fluffy white spots on the underside).

◆ Don’t plant your new impatiens in the same spot in the garden where you planted them in previous years. That way, if there are any spores left in the soil from previous years, you will have planted your new impatiens in a safer spot.

◆ If concerned, you could also plant your new impatiens in pots that have been thoroughly cleaned rather than in the ground.

◆ Use good-quality potting soil for containers.

◆ If you are still concerned that the new impatiens may be affected by downy mildew, plant New Guinea impatiens instead since they are highly resistant to the pathogen.

There are many different types of impatiens available.

◆ To provide color in the shade, consider planting coleus, caladium or begonias instead of impatiens.

◆ To help avoid fungal diseases in general, water the ground, not the leaves of plants. For example, use a drip irrigation system that waters the soil/roots rather than the leaves.

◆ If you use a sprinkler system, have it set to come on early in the morning. That way, the water has time to soak into the soil and the daylight sun will quickly dry the plant’s leaves.

◆ If, despite all precautions, you find that your impatiens develop downy mildew, remove the entire plant (yes, that includes the roots and any fallen leaves and flowers), bag it and dispose of in the garbage. Do not compost it — or any plant showing signs of disease. If you compost it you are just saving the pathogen for next year. No current fungicide cures already infected plants.

Other common plant diseases

Many of the above recommendations apply to all sorts of plants that are prone to fungal diseases, such as the tomato/potato blight. In that case, look for disease-resistant plants. Damping off is a bacterial disease that can appear in seedlings in damp, cool soil. Always use fresh potting soil for seedlings. Blossom end rot of tomatoes seem to appear when tomato plants have not been grown in evenly moist soil. So, while you don’t want the soil soggy, you don’t want it to repeatedly dry out either. A calcium deficiency may also play a role. Black spot is common on roses, especially older varieties. Use an appropriate spray following manufacturer’s directions. To prevent the problem in new plantings, look for disease-resistant varieties.

Ellen Barcel is a freelance writer and master gardener. To reach Cornell Cooperative Extension and its Master Gardener program, call 631-727-7850.

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A recent study showed that men who ate greater amounts of fish — more than one serving per week — had lower resting heart rates than those who ate fish rarely.
Resting heart rate is a predictor of disease

By David Dunaief, M.D.

Dr. David Dunaief

Everyone has a heart rate, so everyone needs to pay attention. But what does that heart rate, or pulse, tell us beyond the obvious fact that we are alive?

Our “normal” resting heart rate is between 60 to 100 beats per minute (bpm). We know that a resting heart rate (RHR) above 100 bpm is abnormal. It is referred to as tachycardia, or a racing heartbeat, and it has potentially serious consequences. However, even normal RHRs can be stratified to identify risks for diseases. What I mean is that, even in the normal range, as your resting heart rate increases, so do your potential risks. Actually, resting heart rate below approximately 70 bpm may be ideal.

The importance of the resting heart rate should not be underestimated. In fact, it may play a role in longevity, heart disease — including heart failure, arrhythmias, heart attacks and sudden cardiac death — and even chronic kidney disease. The good news is that RHR is modifiable. Methods that may reduce your rate include medications for high blood pressure, such as beta blockers, and lifestyle modifications, including meditation, dietary changes and exercise.

Impact on life span

We all want to live longer and healthier lives. Reducing the RHR may be an important component in achieving this goal. In the Copenhagen Male Study, a prospective (forward-looking) study that followed 2,798 participants for 16 years, results showed that those with higher resting heart rates had a greater risk of death (1). There was a linear relationship between the risk of death and increasing RHR. Those who had a resting heart rate above 90 bpm were at a threefold greater risk of death, compared to those who had a RHR at or below 50 bpm. RHR was inversely related to the amount of physical activity.

Thus, the authors concluded that a “healthy” person with higher RHR may still have a shorter life span, with all other factors being equal, such as physical activity and blood pressure.

In contrast with the previous study, the following one took a “glass is half-full” approach to longevity. The Jerusalem Longitudinal Cohort Study showed that elderly women and men who had a lower RHR lived the longest (2). There were more than 2,000 study participants, ranging from 70 to 90 years old.

Heart disease mortality

In the Nord-Trondelag Health Study, a prospective observational study, those who had a higher RHR at the end of the study than they did at the beginning of the study 10 years prior were more likely to die from heart disease (3). In other words, as the RHR increased from less than 70 bpm to over 85 bpm, there was a 90 percent greater risk of heart disease, compared to those who maintained a RHR of less than 70 throughout the two measurements. This study involved 30,000 participants. However, unlike some other studies, many of us can relate to the population: They were at least 20 years old and were healthy volunteers.

Heart attacks

It is more common for women to have heart attacks with atypical symptoms than men. Therefore, it is very important for women to reduce their heart attack risks. In the Women’s Health Initiative, results showed a 26 percent decrease in the risk of cardiovascular events in those postmenopausal women who had a RHR below 62 bpm, compared to those who had a RHR above 76 bpm (4). Interestingly, these results were even more substantial in the subgroup of women who were newly postmenopausal, ranging in age from 50 to 64.

 Effect on kidney function

I have written many times about chronic kidney disease. I thought an interesting follow-up might be resting heart rate and its impact on kidney function. In the Atherosclerosis Risk in Communities Study, results showed that the most severe form of chronic kidney disease, end-stage renal disease, was 98 percent more likely to occur in those with the highest RHR, compared to those with the lowest (5). There were approximately 13,000 participants in the study, with a 16-year follow-up. The authors hypothesized that this negative effect on the kidney may be due to a loss of homeostasis in the autonomic (involuntary) nervous system, resulting in blood vessel dysfunction, such as increased inflammation and vasoconstriction (narrowing).

Eating fish

What can be done to reduce the resting heart rate with minimal side effects? Fish consumption has recently been shown to have a positive effect. In a study, European men who ate greater amounts of fish — more than one serving per week — had lower resting heart rates than those who ate fish rarely (6). There was also a direct relationship between the amount of fish consumed and the RHR: the more fish consumed per week, the greater the reduction in RHR. This was a prospective observational study involving about 5,000 men. Some beneficial side effects of eating fish included decreased triglycerides and diastolic (lower number) blood pressure, as well as increased HDL (“good cholesterol”).

Even after controlling for these beneficial side effects, there still was a significant improvement in RHR with fish consumption. Is there a resting heart rate that is too low? Well, it depends on the context. If you are a marathoner or an athlete, then a RHR in the 40s may not be abnormal. For a healthy, physically active individual, it is not uncommon to have a resting heart rate in the 50s. However, if you are on medications that reduce your RHR and/or have a chronic disease, such as heart failure, it is probably not advisable to go much below 60 bpm. Always ask your doctor about the appropriate resting heart rate for your particular situation.

Thus, resting heart rate is an easy and inexpensive biomarker to potentially determine risk stratification for disease manifestation and to increase longevity, even for those in the normal range. We can utilize RHR as a tool for primary prevention of disease. The fact that it is modifiable means it is something that we need to monitor, so that we can achieve the ideal RHR, rather than just the normal.

References: (1) Heart Journal 2013 Jun;99(12):882-887. (2) J Am Geriatr Soc. 2013;61(1):40-45. (3) JAMA 2011; 306:2579-2587. (4) BMJ. 2009 Feb 3;338:b219. (5) J Am Soc Nephrol. 2010 Sept;21(9):1560-1570. (6) Circulation. 2003;108:820-825.

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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Spinach-Strawberry Salad

By Barbara Beltrami

I think that, after reminding ourselves what Memorial Day is really all about, most of us think of it as the official beginning of summer and the kickoff for the many backyard barbecues, beach parties and picnics that will follow. Amid the flags and parades and sales, there are the hot dogs and hamburgers, barbecued chicken, ribs and steaks, potato salads, macaroni salads and cole slaw. And never would I presume to give recipes for those three side dishes because there are as many “world’s best” as there are people who make them. Instead I’d like to offer you a few recipes for other salads that are a little different and real crowd pleasers. Enjoy the following recipes for a healthy rice salad and spinach-strawberry salad.

Spinach-Strawberry Salad

Spinach-Strawberry Salad

 

YIELD: Makes 10 to 12 servings

INGREDIENTS:

Two 10-ounce bags prewashed spinach, trimmed

1 quart fresh strawberries, washed, trimmed and quartered

½ cup extra virgin olive oil

¼ cup red wine vinegar

2 tablespoons raspberry vinegar

2 tablespoons honey

2 tablespoons orange juice

Coarse salt and freshly ground pepper, to taste

½ cup toasted pignoli nuts

DIRECTIONS: In a large salad bowl toss together the spinach and strawberries. In a small bowl whisk together the oil, vinegars, honey, orange juice and salt and pepper until well emulsified. When ready to serve, whisk again and pour over spinach and strawberries; toss to coat thoroughly and sprinkle with pignoli nuts. Serve at room temperature with meat, fish, fowl or casseroles.

Rice Salad

Rice Salad

YIELD: Makes 8 to 10 servings

INGREDIENTS:

2 cups long grain white or brown rice

1/3 cup freshly squeezed lemon juice

½ cup extra virgin olive oil

2 cups chopped fresh tomatoes

1 cup thinly sliced scallions

One medium cucumber, peeled, seeded and finely chopped

1/3 cup chopped fresh flat-leaf parsley

2 teaspoons minced fresh oregano

1 teaspoon minced fresh mint

Salt and freshly ground black pepper, to taste

DIRECTIONS: Prepare the rice according to package directions; let cool to room temperature or lukewarm. Then toss with the olive oil and lemon juice. Let sit, covered, for 30 minutes. Add tomatoes, scallions, cucumber, parsley, oregano, mint, salt and pepper. Toss thoroughly. Serve at room temperature with lamb, beef, chicken or fish.

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From left, Christopher Gobler with his research team Andrew Griffith, Theresa Hattenrath-Lehmann and Yoonja Kang. Photo from SBU

By Daniel Dunaief

Christopher Gobler searches the waters around Long Island for signs of trouble, which can appear starting in April. This year, he found it, in Shinnecock Bay. Monitoring for a toxin carried by algae called Alexandrium, Gobler recently discovered levels that were three times the allowable limit from the Food and Drug Administration. His finding, along with measurements from the New York State Department of Environmental Conservation of toxins in shellfish in the bay, have caused the recent closure of shellfishing in the bay for the fourth time in seven years.

While Gobler, a marine science professor at the School of Marine and Atmospheric Sciences at Stony Brook University, watches carefully for the appearance of red tides from these algae locally, he recently completed a much broader study on the spread of these toxins.

Gobler led a team that explored the effect of ocean warming on two types of algae, Alexandrium and Dinophysis. Since 1982, as the oceans have heated up, these algae have become increasingly common, particularly in the northern Atlantic and Pacific oceans, according to a study Gobler and his colleagues recently published in the Proceedings of the National Academy of Sciences. When they become concentrated in shellfish, these algae can lead to diarrhea, paralysis and even death if people consume enough of them.

Over the course of the study, algae have begun to form “denser populations that are making shellfish toxic,” Gobler said. Temperature is one of many factors that can affect the survival, growth and range of organisms like the algae that can accumulate toxins and create human illness. “As temperatures get higher, they are becoming closer to the ideal for some species and out of the ideal for other species,” Gobler said.

The strongest effect of changing temperatures are at higher latitudes, which were, up until recently, prohibitively cold for these types of algae. The biggest changes over the course of the study came in the Bay of Fundy in Canada, in Scotland, Ireland, Scandinavia, Iceland, Greenland and Alaska. The toxic algal blooms increased in frequency between 40 and 60 degrees north latitude, according to the study. These are places where toxic algae lived but weren’t as prevalent, but the warming trend has created a more hospitable environment, Gobler said.

Raphael Kudela, a professor of ocean sciences at the University of California, Santa Cruz who wasn’t involved in this research, explained that other papers have suggested a similar link between temperature and the movement of these algae. “We’ve seen the expansion of ciguatera fish poisoning, as the temperature range has moved poleward for those algae,” Kudela wrote in an email. NOAA biological oceanographer Stephanie Moore has documented an expanded window of opportunity for paralytic shellfish poisoning linked to changes in temperature, Kudela said. “While we can point to specific events, and it makes intuitive sense, the Gobler paper actually documented these trends using a long time series, which hasn’t been done before,” Kudela continued.

R. Wayne Litaker, a supervisory ecologist at NOAA’s National Ocean Service, collaborated with Gobler on the project. He said small differences in temperature are significant for the growth rate of these toxic algae. Extending this to other organisms, Litaker explained that fish are also extending their ranges amid a rise in global temperatures. “There’s been a general movement of temperate species toward the poles,” Litaker said. He’s seen tropical fish, such as butterfly fish, off the docks of North Carolina that he hadn’t seen that far north before.

Gobler and his colleagues estimate that the need to close shellfish beds, the increase in fish kills, and the health care damage to people has exceeded a billion dollars since 1982. The largest problem for people in areas like Alaska is their lack of experience with red tides.

“Communities are being exposed to these blooms where they had not been in the past,” Gobler said. “[The blooms] can be most dangerous when they take a community by surprise.” Gobler said this happened in Alaska during the study. In the last decade, shellfish toxins that are 1,000 times more potent than cyanide caused illnesses and were suspected in two deaths in Haines, Alaska.

Litaker said he gave a talk several years ago at a conference. Gobler approached him and asked if they could work together. “One of the wonderful things about these meetings is that you see things that trigger possibilities and whole new projects are born,” Litaker said.

Litaker described Gobler as a “major player in the field” who has done “fantastic work over the years.” Litaker said he was “quite impressed with what he’s done.” Litaker explained that the climate is changing and urged fisheries and shellfish experts to prepare to respond throughout the country. “As we get warmer and more run off of nutrients, toxic cyanobacteria [algal blooms] are causing problems in all 50 states,” Litaker said.

Kudela suggested that the “new records every year for the last several years … will undoubtedly continue to impact the range, duration and toxicity of blooms.”

Locally, Gobler continues to monitor dozens of sites on Long Island, where he suggested that Alexandrium could become less prevalent with warming, while Dinophysis could become more common. Temperature and other factors favorable for algae growth have led to red tides in the past.

In oceans across the world, Kudela said the next logical step would be to explore the interaction of temperature and nutrients. “We know both are changing, and they are likely to have additive or synergistic effects, but we haven’t done the same careful study as the Gobler paper looking at how the trends are interacting,” he explained.

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