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By David Dunaief, M.D.

Autoimmune diseases are becoming increasingly common, affecting approximately 23.5 million Americans, with 78 percent of them women. These numbers are expected to continue rising. There are more than 80 conditions with autoimmunity implications (1). These diseases include rheumatoid arthritis (RA), lupus, thyroid (hypo and hyper), psoriasis, multiple sclerosis and inflammatory bowel disease, to mention just a few.

Dr. David Dunaief

Autoimmune diseases are defined by the immune system inappropriately attacking organs, cells and tissues of the body, causing chronic inflammation. Thus, inflammation is the main consequence of immune system dysfunction, and it is the underlying theme tying these diseases together. Unfortunately, autoimmune diseases tend to cluster (2). In other words, once you have one, you are much more likely to acquire others.

Drug treatments

The mainstay of treatment is immunosuppressives. For example, in RA where there is swelling of joints bilaterally, the typical drug regimen includes methotrexate and TNF (tumor necrosis factor) alpha inhibitors, like Remicade (infliximab). These therapies are thought to help reduce the underlying inflammation by suppressing the immune system and interfering with inflammatory factors, such as TNF-alpha. The disease-modifying antirheumatic drugs (DMARDs) may slow or stop the progression of joint destruction and increase physical functioning. Remicade reduces C-reactive protein (CRP), a biomarker of inflammation.

However, there are several concerning factors with these drugs. First, the side effect profile is substantial. It includes the risk of cancers, opportunistic infections and even death, according to black box warnings (the strongest warning by the FDA) (3). Opportunistic infections include diseases like tuberculosis and invasive fungal infections. It is no surprise that suppressing the immune system would result in increased infection rates. Nor is it surprising that cancer rates would increase, since the immune system helps to fend off malignancies. In fact, a study showed that after 10 years of therapy, the risk of cancer increased by approximately fourfold with the use of immunosuppressives (4).

Second, these drugs were tested and approved using short-term randomized clinical trials, but many patients are put on these therapies for 20 or more years. Remicade’s package insert was approved with approximately two years of data.

So what other methods are available to treat autoimmune diseases? These include medical nutrition therapy using bioactive compounds, which have immunomodulatory (regulation of the immune system) effects on inflammatory factors and on gene expression, and supplementation.

Nutrition and inflammation

Raising the level of beta-cryptoxanthin, a carotenoid bioactive food component, by a modest amount has a substantial impact in preventing RA. In one study, participants drank the equivalent of about one glass of freshly squeezed orange juice a day with a resultant 49 percent risk reduction in the development of RA (5).

While I have not found studies that specifically tested diet in RA treatment, there are dietary studies that have shown anti-inflammatory effects in other diseases, using biomarkers such as CRP and TNF-alpha. In a study that looked at the Mediterranean-type diet in 112 older patients, there was a significant decrease in inflammatory markers, including CRP (6).

In another study, participants showed a substantial reduction in CRP with increased flavonoid levels, an antioxidant, from vegetables and apples. Astaxanthin, a carotenoid found in fish, was shown to significantly reduce a host of inflammatory factors in mice, including TNF-alpha (7).

Vitamin D

Vitamin D is ubiquitous in helping to treat and prevent many chronic diseases — autoimmune diseases are no exception. Vitamin D affects over 200 genes, according to Wellcome Trust Centre for Human Genetics at University of Oxford. In the absence of vitamin D, T-cell response, part of the immune system, becomes dysfunctional and uncontrollable, resulting in an increase in multiple sclerosis (MS) and inflammatory bowel disease — Crohn’s and ulcerative colitis. However, when normal levels of vitamin D are conveyed to the vitamin D receptors, proper T-cell functioning is restored with no subsequent autoimmune disease, at least in animal studies (8).

Interestingly, multiple sclerosis patients are notoriously very low in vitamin D, and it is difficult to raise the levels. There was a small study proclaiming that MS patients may need as much as 50,000 IUs of vitamin D2 weekly, and that it was safe (9). I would check with a neurologist specializing in MS before taking such a high dose.

Fish oil

Fish oil helps your immune system by reducing inflammation and improving your blood chemistry.

If you think vitamin D is impressive, fish oil affects as many as 1,040 genes (10). In a randomized clinical study, 1.8 grams of eicosapentaenoic acid (EPA) plus docosahexaenoic acid (DHA) supplementation had anti-inflammatory affects, suppressing cell signals and transcription factors (proteins involved with gene expression) that are pro-inflammatory, such as NFkB.

In RA patients, fish oil helps suppress cartilage degradative enzymes, while also having an anti-inflammatory effect (11). When treating patients with autoimmune disease, I typically suggest about 2 grams of EPA plus DHA to help regulate their immune systems. Don’t take these high doses of fish oil without consulting your doctor, since fish oil may have blood thinning effects.

Probiotic supplements

The gut contains approximately 70 percent of your immune system. Probiotics, by populating the gut with live beneficial microorganisms, have immune-modulating effects that decrease inflammation and thus are appropriate for autoimmune diseases. Lactobacillus salvirus and Bifidobacterium longum infantis are two strains that were shown to have positive effects (12, 13).

In a study with Crohn’s disease patients, Lactobacillus casei and L. bulgaricus reduced the inflammatory factor, TNF-alpha (14). To provide balance, I recommend probiotics with Lactobacillus to my patients, especially with autoimmune diseases that affect the intestines, like Crohn’s and ulcerative colitis.

Fiber

Fiber has been shown to modulate inflammation by reducing biomarkers, such as CRP. In two separate clinical trials, fiber either reduced or prevented high CRP in patients. In one, a randomized clinical trial, 30 grams, or about 1 ounce, of fiber daily from either dietary sources or supplements reduced CRP significantly compared to placebo (15).

In the second trial, which was observational, participants who consumed the highest amount of dietary fiber (greater than 19.5 grams) had reductions in a vast number of inflammatory factors, including CRP, interleukin-1 (IL-1), interleukin-6 (IL-6) and TNF-alpha. (16).

Immune system regulation is complex and involves over a 1,000 genes, as well as many biomarkers. Dysfunction results in inflammation, and potentially autoimmune disease. We know the immune system is highly influenced by bioactive compounds found in high nutrient foods and supplements. Therefore, bioactive compounds may work in tandem with medications and/or may provide the ability to reset the immune system through immunomodulatory effects and thus treat and prevent autoimmune diseases.

References: (1) niaid.nih.gov. (2) J Autoimmun. 2007;29(1):1. (3) epocrates.com. (4) J Rheumatol 1999;26(8):1705-1714. (5) Am J Clin Nutr. 2005 Aug; 82(2):451-455. (6) Am J Clin Nutr. 2009 Jan;89(1):248-256. (7) Chem Biol Interact. 2011 May 20. (8) Prog Biophys Mol Biol. 2006 Sept;92(1):60-64. (9) Am J Clin Nutr. 2007 Sep;86(3):645-651. (10) Am J Clin Nutr. 2009 Aug;90(2):415-424. (11) Drugs. 2003;63(9):845-853. (12) Gut. 2003 Jul;52(7):975-980. (13) Antonie Van Leeuwenhoek 1999 Jul-Nov;76(1-4):279-292. (14) Gut. 2002;51(5):659. (15) Arch Intern Med. 2007;167(5):502-506. (16) Nutr Metab (Lond). 2010 May 13;7:42.

Dr. Dunaief is a speaker, author and local lifestyle medicine physician focusing on the integration of medicine, nutrition, fitness and stress management.

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By Elof Axel Carlson

Elof Axel Carlson

There are millions of species of living things. Until the 1860s biologists divided them into two kingdoms, animals and plants.

Louis Pasteur revealed a third group of microscopic bacteria that caused disease, fermented foods (like cheeses), rotted food and decomposed dead organisms. In the mid-20th century this third group, known as prokaryotes, was shown to consist of eubacteria and archaea, differing mostly in how they used energy to carry out their living activities.

Bacteria mostly use oxygen, sunlight and carbon dioxide as fuels and an energy source. Some bacteria are like green plants and use chlorophyll to convert carbon molecules to food and release oxygen. Most of Earth’s atmosphere arose from that early growth of photosynthetic bacteria. Archaea mostly use sulfur, superheated water and more extreme environmental conditions (like deep sea vents) for their energy.

Biologists today identify cellular life as having three domains — archaea, bacteria and eukaryotes. We belong to the eukaryotes whose cells have nuclei with chromosomes. The eukaryotes include multicellular animals, multicellular plants, unicellular protozoa (protists), unicellular algae and fungi.

The two prokaryotic domains and the five eukaryotic groups are designated as kingdoms. A rough time table of early life on Earth would put prokaryotic life about 3.5 to 3.8 billion years ago, the first free oxygen in our atmosphere about 3.5 billion years ago, the first eukaryotic cells about 2.5 billion years ago and the first multicellular organisms about 1.5 billion years ago.

The branches of the tree of life biologists construct have an earliest ancestor called LUCA (for the last universal common ancestor of a particular branch). There may have been a biochemical evolution preceding the formation of the first cellular LUCA with RNA and protein associations, RNA and DNA associations and virus-like sequences of nucleic acids.

The three domains have produced six million different genes. Molecular biologists have identified 355 genes that all cellular organisms share in common. This is possibly the genome of the LUCA of all living cellular organisms. Whether such a synthetic DNA chromosome could be inserted into a bacterial or archaeal cell or even a eukaryotic cell whose own DNA has been removed has not yet been attempted. It may not work because we know little about the non-DNA components of bacterial or archaeal cells.

Biologists have known for some time that a nucleus of a distant species (e.g., a frog) placed in a mouse egg whose nucleus has been removed will not divide or produce a living organism. But two closely related species (like algae of the genus Acetabularia) can develop after swapping nuclei. In such cases the growing organism with the donated nucleus resembles the features of the nuclear donor.

There is a LUCA for the first primate branch with the genus Homo. We are described as Homo sapiens. Anthropologists and paleontologists studying fossil human remains have worked out the twigs of the branch we identify as the genus Homo. Neanderthals and Denisovans (about 500,000 years ago) are the two most recent branches that preceded the origins of H. sapiens (about 160,000 years ago). Most humans have a small percentage of Neanderthal or Denisovan genes. Fossils of Homo erectus (about 1.8 million years ago) or Homo habilis (about 2.8 million years ago) are much older than the recent three species of Homo. Those fossils do not have DNA that can be extracted from teeth.

A second objective of studying LUCA’s 355 genes will be the identification of each gene’s function. That will tell biologists what it is that makes these genes essential in all cellular organisms.

I can think of a third important consequence of studying LUCA. There are millions of different viruses on Earth, especially in the oceans. If cellularity arose from clusters of viruses, the genes of the mother of all LUCAs may be scattered among some of those viruses and give biologists insights into the step-by-step formation of that first LUCA cell.

In Gilbert and Sullivan’s operetta, “The Mikado,” one character boasts of tracing his ancestors to a primordial bit of protoplasm. The genome of LUCA might become an unexpected example where science imitates art.

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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Liliana Davalos, right in blue and white shirt, in La Victoria, Colombia with the paleo team from Grand Valley State University during a fossil dig last year. Photo courtesy of Siobhán Cooke

By Daniel Dunaief 

It’s like that old bus riddle. The bus starts out with 20 people. Six people get off, then eight get on, two more get off, 12 enter, eight exit, and so on until, lo and behold, the bus has either the same number of people or someone asks the identity of the driver.

In this case, though, the bus is a collection of Caribbean islands called the Greater Antilles, which includes the Dominican Republic, Cuba, Hispaniola, Haiti, Puerto Rico, the Cayman Islands and Jamaica. The passengers are not people; they are species of bats.

Working with Luis Valente, a postdoctoral researcher at the Natural History Museum of Berlin, Liliana Davalos, an associate professor of conservation biology/ecology and evolution at Stony Brook University, recently determined that the number of species of bats, like the people entering and leaving the bus, remained in relative equilibrium for millions of years over many generations.

Liliana Davalos at La Venta site in Colombia with a rainbow in the background.Photo courtesy of Siobhán Cooke

While several species of bats will colonize the islands and new species will also form over that long time scale, the rate of natural extinction in that time balances out the islands’ diversity gains, leaving the metaphorical bus with about the same number of species.

Famous biologists Edward O. Wilson and Robert MacArthur came up with the theory of island biogeography in 1967, which might help explain how the number of species of bats remained in equilibrium for millions of years. The theory proposes an equilibrium between colonization and extinction.

For bats, however, that balance changed. About 20,000 years ago, fossils of extinct species made their final appearance, while other species died off about 3,000 to 4,000 years ago. So, what happened to the bat bus?

The last ice age accounts for some of the declines about 20,000 years ago. More recently, the arrival of people altered conditions on the islands. At least two other waves of colonization occurred before the arrival of Europeans, with people changing the landscape through agriculture. While hunting of other mammals is evident from the archeological record, it is less certain how changes on the land affected bats. It’s difficult to pinpoint the exact time when each species went extinct, although many of those events happened after people arrived on the islands, changing the region’s equilibrium.

Davalos’ previous work had found that the number of species lost was as predicted if the losses occurred because of the rising sea levels at the end of the last glaciation. If that were the case, many of those species would have disappeared around that time. Some of her colleagues, however, dated the remains of bats and found that these species became extinct more recently, over the last few thousand years.

“While we cannot be certain that all bat extinctions were caused by humans, evidence increasingly seems to suggest so,” explained Valente in an email. “All over the world, colonization of islands by humans has led to many extinctions of local species, because islands have very unique species that are very prone to any disturbances.”

The researchers used computer simulations to calculate that it would take nature eight million years to restore bat biodiversity. “Some people argue that if we leave nature alone it will quickly return to its original state,” Valente explained. “However, the finding that it would take eight million years to recover lost diversity suggests that is clearly not the case.” Valente, who described Davalos as a “wonderful collaborator” who was “actively involved in the project at all stages,” wrote that this study “raises awareness for conservation of the unique bat species of the Caribbean.”

While there is still work ahead, the “nations of the Greater Antilles have amazing natural parks to protect their biodiversity,” Davalos explained. In the tropics of the Western Hemisphere, Puerto Rico is the “number one example of a forest growing back,” Davalos said. “Puerto Rico is one of the places in the world that has had more of a resurgence of the forest.”

The preservation of biodiversity remains threatened even now as at least three bat populations on the Greater Antilles are threatened with extinction and two might already be extinct. Still, the effort is not “hopeless,” she said, as there are some large populations of bats thriving on these islands. Davalos and her colleagues were able to make these discoveries by examining the bat in detail.

A resident of Setauket, Davalos has been at Stony Brook University for eight years. She enjoys kayaking on Long Island and visiting local and state parks. Over the last few years, she has spent her free time on staycations, where she sees a protected area of Long Island each day.

From a young age, Davalos recalls being interested in science. Indeed, when she was only 4, she saw a documentary where Louis and Mary Leakey showed the results of their expeditions where they collected human fossils in Kenya. “From that moment on,” Davalos recalled, “I thought, ‘Some day, this is what I’m going to study.’” Her family and their acquaintances suggested that pursuing such a career path would be challenging.

She tells her current SBU students that she’s “the luckiest person in the world, living out my childhood dream.” Last year, she went on her first fossil dig in Colombia, where she joined a team from Grand Valley State University in Allendale, Michigan, and Johns Hopkins. She found fossils from bats that were 12 million years old.

While Davalos has never met the Leakey family, she wants to tell them that, “Children are watching and [their work] can have a huge effect” on their dreams. Some day, Davalos hopes a future scientist may say the same thing about her research.

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By Matthew Kearns, DVM

February is National Pet Dental Health Month; so I wanted to write an article on swellings of the oral cavity in dogs and cats. Swellings of the oral cavity are relatively common in dogs and cats. Some are tumors, some are not. Some are malignant, some are not. A fair number of cases of oral swellings are actually related to inflammation and not a tumor at all. Unfortunately, if these swellings are tumors, the majority of these tumors are malignant. This is why early diagnosis and treatment is so important.

How do we keep an eye on these things? Most veterinary oral surgeons recommend brushing your pet’s teeth daily, but I have not always found this approach feasible, even with my own pets. I think checking our pet’s mouths once weekly or as often as one can remember is more reasonable. Please bring any new swellings or masses in your pet’s mouth to your veterinarian’s attention right away. The “wait and see” approach is not recommended.

If I or any of my colleagues suspect a tumor, surgical excision and biopsy are recommended; however, certain pre-surgical testing is very important. Chest X-rays are recommended in all cases even though the rate of metastasis, or spread to other organ systems, in oral tumors is low. Chest X-rays can usually be performed without any sedation or anesthesia and, if evidence of metastasis is present, I recommend a discussion with the pet owner before proceeding with surgery/biopsy.

Wouldn’t it be great if our pets brushed their own teeth?

Also, if lymph nodes are enlarged, they should either be tested before surgery or removed and biopsied at the time of surgery to differentiate between secondary inflammation or metastasis. Preoperative blood work rules out other concurrent disease such as organ dysfunction to determine a patient’s risk of anesthesia more than it evaluates the tumor.

Oral swellings of the maxilla (upper portion of the jaw connected to the sinuses) suspected to be tumors should have either a CT (CAT-SCAN) or skull X-rays to see if there is invasion of the tumor into the bone of the skull. CT and skull X-rays require anesthesia so these are scheduled the same day as surgery.

Depending on the location of the tumor, surgical excision can be curative. The down side is that a “wide excision” is necessary. This means a large amount of tissue (both the tumor itself and a fair amount of healthy tissue around it) is necessary to ensure complete removal.

If a wide resection is not possible due to location, follow-up radiation therapy can be used after surgery to kill any remaining cancer cells. Radiation alone is only potentially curative in benign, or noncancerous, oral tumors. Chemotherapy is also sometimes used after surgery for cancerous oral tumors with either confirmed metastasis before surgery or a high metastatic potential based on biopsy.

Much of what we veterinarians recommend is not only based on location and suspicion of metastasis but also age and pre-existing disease. Whether or not to pursue testing and treatment is always up to you (as the owner) but diligent monitoring and prompt intervention should be discussed earlier rather than later.

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 Daniel Dunaief

First responders, soldiers or those exposed to any kind of chemical weapons attack need a way to remove the gas from the air. While masks with activated carbon have been effective, the latest technological breakthrough involving a metal organic framework may not only remove the gas, but it could also disarm and decompose it.

That’s the recent finding from research led by Anatoly Frenkel in a study on a substance that simulates the action of sarin nerve gas.

Frenkel, who is a senior chemist at Brookhaven National Laboratory and a professor in the Department of Materials Science and Chemical Engineering at Stony Brook University, worked with metal organic frameworks, which contain zirconium cluster nodes that are connected through a lattice of organic linkages.

Anatoly Frenkel with his son, Yoni, at Lake Hopatcong in New Jersey. Photo by Mikhail Loutsenko.

These structures would “do the job even without any catalytic activity,” Frenkel said, because they are porous and capture gases as they pass through them. “It’s like a sponge that can take in moisture. Its high porosity was already an asset.”

Frenkel and his colleagues, which include John Morris and Diego Troya from Virginia Tech, Wesley Gordon from Edgewood Chemical Biological Center and Craig Hill from Emory University, among other contributors, suspected that these frameworks might also decompose the gas.

Theoretically, researchers had predicted this might be the case, although they had no proof. Frenkel and his team used a differential method to see what was left in the structure after the gas passed through. Their studies demonstrated a high density of electrons near the zirconium atoms. “These were like bread crumbs congregated around a place where the zirconium nodes with the connecting linkers were,” Frenkel said.

While this work, which the scientists published in the Journal of the American Chemical Society, has implications for protecting soldiers or civilians in the event of a chemical weapons attack, Frenkel and his colleagues, who received funding from the Defense Threat Reduction Agency, can share their results with the public and scientific community because they are not working on classified materials and they used a substance that’s similar to a nerve gas and not sarin or any other potentially lethal gas.

“This knowledge can be transferred to classified research,” Frenkel said. “This is a stepping stone.” Indeed, Frenkel can envision the creation of a mask that includes a metal organic framework that removes deadly nerve gases from the air and, at the same time, disarms the gas, providing a defense for first responders or the military after a chemical weapons attack. Even though he doesn’t work in this arena, Frenkel also described how manufacturers might use these frameworks in treating the fabric that is used to make clothing that can prevent gases that can be harmful to the skin from making contact.

A physicist by training, Frenkel’s work, which includes collaborations on five other grants, has a common theme: He explores the relationship between structure and function, particularly in the world of nanomaterials, where smaller materials with large surface areas have applications in a range of industries, from storing and transmitting energy to delivering drugs or pharmaceuticals to a targeted site.

Eric Stach, a group leader in electron microscopy at BNL, has collaborated with Frenkel and suggested that his colleague has helped “develop all these approaches for characterizing these materials.” Stach said that Frenkel has “an outstanding reputation internationally” as an expert in X-ray absorption spectroscopy, and, in particular, a subarea that allows scientists to learn about extremely subtle changes in the distance between atoms when they are subjected to reactive environments.

Frenkel said some of the next steps in the work with metal organic frameworks include understanding how these materials might become saturated with decomposed gas after they perform their catalytic function. “It’s not clear what can affect saturation,” he said, and that is something that “needs to be systematically investigated.” After the catalyst reaches saturation, it would also be helpful to know whether it’s possible to remove the remaining compound and reuse the catalyst.

“The next question is whether to discard” the framework after it’s trapped and deactivated the chemicals or regenerate it, Frenkel said. He is also exploring how temperature ranges might affect the performance of the framework. Ideally, it would function as well in an arctic environment as it would in a desert under extreme heat. A commercial application might require the synthesis of a material with different physical characteristics for a range of temperature conditions.

Frenkel has been working on this project for about one and a half years. A colleague approached him to become a part of this new collaboration. “My role was to bring this work to a national lab setting,” where the scientists could use the advanced tools at BNL to study the material as it was working, he said.

A resident of Great Neck, Frenkel, who grew up in St. Petersburg, Russia, lives with his wife Hope Chafiian, a teacher at the Spence School in Manhattan for almost 30 years. He has three children: Yoni lives in Manhattan and works at JP Morgan Chase, Ariela is a student at Binghampton and Sophie is in middle school in Great Neck.

Frenkel appreciates the opportunity to explore the broader world of nanomaterials, which, he said, are not constrained by crystal structures and can be synthesized by design. “They show a lot of mysteries that are not understood fully,” he said. Indeed, Frenkel explained that there are numerous commercial processes that might benefit from design studies conducted by scientists. As for his work with metal organic frameworks, he said “there’s no way to overestimate how important [it is] to do work that has a practical application that improves technology, saves costs, protects the environment” and/or has the potential to save lives.

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Learn how to transform your yard into a wildlife-friendly habitat at one of 12 free workshops offered. Photo courtesy of Jay Gammill

By Ellen Barcel

The Maritime Explorium, a nonprofit organization based in Port Jefferson and dedicated to science-themed exhibits and activities, will be holding a very special series of workshops dedicated to helping gardeners “transform 100 square feet of your yard into a butterfly, bee and bird friendly habitat that keeps our waterways clean and clear …”

Lauren Hubbard, founding president and former executive director of The Maritime Explorium is the program director. She noted that there are a number of reasons for transforming part of your yard into a wildlife-friendly habitat, and there are many ecological benefits to using native plants.

“They provide food for pollinators as well as food for birds,” she said. It is these very pollinators that guarantee the seeds for the next generation of plants and that farmers rely on to produce our food. She noted that native plants don’t required fertilizers. This reduces the runoff of nitrogen [from chemical fertilizers] into the surrounding waters. Excess nitrogen leads to poor water quality, which for one thing affects eel grass which is a fish nursery. Excess nitrogen also increases algae in the Sound.

Hubbard added that native plants have roots that go very deep, that is, many have taproots. They need less supplemental water from the gardener and they catch runoff of excess rain. Butterfly weed (Asclepias tuberosa) and other varieties of milkweed, for example, have a taproot. And, many, like the New England aster, are deer resistant. Native plants also feed native birds, who also eat many of the garden pests, insects, for example, that damage our gardens.

Each project participant registers for only one workshop, but to make the workshops and project convenient, they are spread over the next six months and are held at two locations. Those at the Flax Pond Marine Laboratory in Old Field are held on Saturdays (Jan. 28, Feb. 18, March 25, April 29, May 27 and June 24). Those at The Barn at Avalon Park and Preserve in Stony Brook (off Shep Jones Lane) will be held on Sundays (Jan. 29, Feb. 19, March 26, April 30, May 28 and June 25), all from 9 to 11:30 a.m.

Not only are the workshops free, but each project participant is reimbursed up to $50 for plants they buy to create their own butterfly, bee and bird-friendly garden if they complete the project. The workshops are open to all who are interested, but there are several requirements to participate in the project and receive the reimbursement. The piece of property you wish to transform (100 square feet, i.e., roughly 10 by 10 feet) must be within the Long Island Sound watershed (water on your street drains to the Sound as opposed to the Great South Bay and ocean). If you have a question as to whether your area is within the watershed, email [email protected] for details.

The property must then be planted with appropriate plants — a list will be provided at the workshop you attend. You are then asked share a before and after photo of the 100 square feet you have transformed.

This project is funded by a grant from the Long Island Sound Future Fund from the Environmental Protection Agency and the National Fish and Wildlife Foundation. To register, go to www.eventbrite.com/e/my-yard-our-sound-nature-friendly-landscaping-workshops-tickets-31275703471.

For more details on native plants, visit The Long Island Native Plant Initiative website at www.linpi.org, which holds an annual sale of native plants.

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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Risotto with Clams

By Barbara Beltrami

When I first met my husband who is Italian and whose parents emigrated from northern Italy, I had never heard of risotto. I grew up in a town with a lot of Italian families, but they were mostly from the southern part of Italy where risotto is uncommon and pasta is king. In the north, risotto may well be the go-to comfort food. Made from either arborio or carnaroli, short-grained varieties of rice that are available in most specialty supermarkets or Italian grocery stores, a good risotto is creamy and porridge-like, and oh, so buono.

There are probably as many risotti as there are pasta shapes and sauces; the basic ingredients marry well with nearly all veggies and even some fruits, cheeses, meat, fowl or fish, although the latter are much more rare. Using the Basic Risotto recipe and cooking tips below, you can create a risotto with pretty much anything you want.

Basic Risotto Recipe

YIELD: 4 to 6 servings

INGREDIENTS:

3 to 4 cups broth

3 to 4 tablespoons extra virgin olive oil

One medium onion, finely chopped

One celery rib, washed, trimmed and finely chopped

1 cup arborio or carnaroli rice

1 cup dry white wine

Salt and pepper, to taste

DIRECTIONS: (1) In a medium saucepan, bring broth to a boil; reduce heat and keep at a simmer. (2) Heat oil in heavy saucepan for 30 seconds to one minute over medium heat. Add onion and celery and cook, stirring frequently, until softened, about two minutes. (3) Add rice, stirring constantly, for one minute over low-medium heat. (4) Add wine and half a cup of the broth, stirring constantly, until all the liquid is absorbed. (5) Continue adding broth, half a cup at a time, stirring frequently, until each addition is absorbed before adding more broth. The risotto will be ready in 15 to 20 minutes when the rice is tender and the mixture is creamy. You may not need all the broth or you may need more liquid, in which case just add a little hot water, half a cup at a time.

Risotto with Spinach and Gorgonzola Cheese

Risotto with Spinach and Gorgonzola Cheese

INGREDIENTS:

One 10-ounce package frozen chopped spinach

One recipe for Basic Risotto (above)

3 ounces Gorgonzola cheese, crumbled

DIRECTIONS: Cook spinach according to package directions; cover and set aside with its cooking liquid. Make Basic Risotto recipe with the following changes: Add spinach and its liquid between steps 4 and 5 in basic recipe. Reduce heat to low and add cheese, stirring vigorously until cheese is melted. Serve with salad or baked winter squash.

Risotto with Clams

Risotto with Clams

INGREDIENTS:

3 pounds littleneck clams

¼ cup extra virgin olive oil

4 garlic cloves thinly sliced

½ teaspoon crushed red pepper flakes

One recipe Basic Risotto (above)

1½ cups finely diced tomatoes (optional)

1/3 cup chopped fresh flat leaf parsley

DIRECTIONS: Scrub the clams well in a generous amount of cold water, then soak them in cold water for 30 minutes. Drain them and put them in a large pot with the olive oil, garlic and red pepper flakes. Cover and steam open the clams, about 5 minutes. Drain them and reserve the liquid. Strain liquid through damp cheesecloth or coffee filter to catch any sand. Set clams aside. Measure liquid and substitute for equal amount of broth to be used in Basic Recipe (left). Make Basic Risotto; when risotto is about 3 minutes from being done, add the tomatoes, clams and parsley. Stir well and finish cooking. Do not add cheese. Serve with crusty bread and a salad.

Risotto with Zucchini

INGREDIENTS:

2 medium zucchini, trimmed, cut in half lengthwise and sliced thin

One small onion, sliced very thin, rings separated

2 large garlic cloves, peeled and finely chopped

One recipe for Basic Risotto (above)

Freshly grated Parmesan cheese

DIRECTIONS: Heat the oil in a large skillet; add zucchini and onions. Saute until they start to turn golden, about 5 minutes; add the garlic and saute for another minute. Don’t let the garlic burn. Remove and set aside. Season with salt and pepper. Make the risotto. About two minutes before it is ready, add the zucchini and onion and stir well for another two minutes. Pass the grated cheese at the table. Serve with a tomato and mozzarella salad.

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By David Dunaif, M.D.

Dr. David Dunaief

Eczema is a common problem in both children and adults. Therefore, you would think there would be a plethora of research, right? Well, that’s only partly true. While there is a significant amount of research in primarily neonates and some on pediatric patients, there is not a lot of research on adults with eczema. But in my practice, I see a good number of adult patients who present with, among other disorders, eczema.

The prevalence of this disease rivals the prevalence of diabetes. In the United States, more than 10 percent of the adult population is afflicted (1). Twice as many females as males are affected, according to one study (2). Thus, we need more research.

Eczema is also referred to more broadly as atopic dermatitis. The cause is unknown, but it is thought that nature and nurture are both at play (3). Eczema is a chronic inflammatory process that involves symptoms of pruritus (itching) pain, rashes and erythema (redness) (4). There are three different severities: mild, moderate and severe. Adults tend to have eczema closer to the moderate-to-severe range.

Factors that can trigger eczema flare-ups include emotional stress, excessive bathing, dry skin, dry environment and detergent exposure (5). Treatments for eczema run the gamut from over-the-counter creams and lotions to prescription steroid creams to systemic (oral) steroids. Some use phototherapy for severe cases, but the research on phototherapy is scant. Antihistamines are sometimes used to treat the itchiness. Also, lifestyle modifications may play an important role, specifically diet. Two separate studies have shown an association between eczema and fracture, which we will investigate further. Let’s look at the evidence.

Eczema doesn’t just scratch the surface

Eczema causes cracked and irritated skin, but it may also be related to broken bones. In a newly published observational study, results showed that those with eczema had a 44 percent increased risk of injury causing limitation and an even more disturbing 67 percent risk of bone fracture and bone or joint injury for those 30 years and older (6). And if you have both fatigue or insomnia and eczema, you are at higher risk for bone or joint injury than having one or the other alone. Antihistamines may cause more fatigue. One reason for increased fracture risk, the researchers postulate, is the use of corticosteroids in treatment.

Steroids may weaken bone, ligaments and tendons and may cause osteoporosis by decreasing bone mineral density. Chronic inflammation may also contribute to the risk of bone loss. There were 34,500 patients involved in the study ranging in age from 18 to 85.

Another study corroborates these results that eczema increases the risk for sustained injury (7). There was a 48 percent increased risk of fracture at any location in the body and an even greater 87 percent increased risk of fracture in the hip and spine when compared to those who did not have eczema.

Not suprisingly, researchers’ hypotheses for the causes of increased fracture risk were similar to those of the above study: systemic steroid use and chronic inflammation of the disease, itself. The researchers analyzed the database from NHANES 2005-2006, with almost 5,000 patients involved in this study. When oral steroid was given for at least a month, there was a 44 percent increased risk of osteoporosis. For those who have eczema and have been treated with steroids, it may be wise to have a DEXA (bone) scan.

Are supplements the answer?

The thought of supplements somehow seems more appealing for some than medicine. There are two well-known supplements for helping to reduce inflammation, evening primrose oil and borage oil. Are these supplements a good replacement for medications or at least a beneficial addition? The research is really mixed, leaning toward ineffective.

In a recent meta-analysis (involving seven randomized controlled trials, the gold standard of studies), evening primrose oil was no better than placebo in treating eczema (8). The researchers also looked at eight studies of borage oil and found there was no difference from placebo in terms of symptom relief. One positive is that these supplements only had minor side effects. But don’t look to supplements for help.

Where are we on the drug front?

The FDA has given fast track processing to a biologic monoclonal antibody known as dupilumab (9). In trials, the drug has shown promise for treating moderate to severe eczema when topical steroids are not effective. An FDA decision is due by late March (10). We will have to wait for the verdict on this drug in development.

Do probiotics have a place?

When we think of probiotics, we think of taking a pill. However, there are also potentially topical probiotics with atopic dermatitis. In preliminary in-vitro (in a test tube) studies, the results look intriguing and show that topical probiotics from the human microbiome (gut) could potentially work as well as steroids (11). This may be part of the road to treatments of the future. However, this is in very early stage of development.

What about lifestyle modifications?

Cruciferous vegetables including broccoli, celery, kale, cauliflower, bok choy, watercress, cabbage, and arugula may help eczema sufferers.

Wouldn’t it be nice if what we ate could make a difference in eczema? Well, in a study involving pregnant women and their offspring, results showed that when these women ate either a diet high in green and yellow vegetables, beta carotene or citrus fruit there was a significant reduction in the risk of the child having eczema of 59 percent, 48 percent and 47 percent, respectively, when comparing highest to lowest consumption quartiles (12). This was a Japanese study involving over 700 mother-child pairings.

Elimination diets may also play a role. One study’s results showed when eggs were removed from the diet in those who were allergic, according to IgE testing, eczema improved significantly (13).

From an anecdotal perspective, I have seen very good results when treating patients who have eczema with dietary changes. My patient population includes about 15 to 20 percent of patients who suffer some level of eczema. For example, a young adult had eczema mostly on the extremities. When I first met the patient, these were angry, excoriated, erythematous and scratched lesions. However, after several months of a vegetable-rich diet, the patient’s skin had all but cleared.

I also have a personal interest in eczema. I suffered from hand eczema, where my hands would become painful and blotchy and then crack and bleed. This all stopped for me when I altered my diet over 10 years ago.

Eczema exists on a spectrum from annoying to significantly affecting a patient’s quality of life (14). Supplements may not be the solution, at least not borage oil or evening primrose oil. However, there may be promising topical probiotics ahead and medications for the hard to treat. It might be best to avoid long-term systemic steroid use; it could not only impact the skin but also may impact the bone. But don’t wait to treat the disease. Lifestyle modifications appear to be very effective, at least at the anecdotal level.

References: (1) J Allergy Clin Immunol. 2013;132(5):1132-1138. (2) BMC Dermatol. 2013;13(14). (3) Acta Derm Venereol (Stockh) 1985;117 (Suppl.):1-59. (4) uptodate.com. (5) Br J Dermatol. 2006; 1553:504. (6) JAMA Dermatol. 2015;151(1):33-41. (7) J Allergy Clin Immunol. Online Dec. 13, 2014. (8) Cochrane Database Syst Rev. 2013;4:CD004416. (9) Medscape.com. (10) www.medpagetoday.com (11) ACAAI 2014: Abstracts P328 and P329. (12) Allergy. 2010 Jun 1;65(6):758-765. (13) J Am Acad Dermatol. 2004;50(3):391-404. (14) Contact Dermatitis 2008; 59:43-47.

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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From left, Alan Inkles, Lee Wilkof, Director, ‘No Pay, No Nudity’; Ryan Lacen and Anthony Baldino, co-directors of ‘The Dust Storm’; and actor Ralph Macchio at last year’s Stony Brook Film Festival. Photo courtesy of Staller Center for the Arts

By Rita J. Egan

When Alan Inkles, director of the Staller Center for the Arts, moved from Brooklyn to Port Jefferson Station at the age of 11, the stage was being set for him to one day play an integral part in creating an impressive cultural and arts community right here on Long Island.

After graduating from Comsewogue High School, he headed out to Los Angeles to play soccer and study acting. After discovering he wasn’t cut out for college sports, he seized the opportunity to concentrate on the craft of acting and honed his talents working on commercials and pilots. Fortunately, for Long Islanders, he soon returned to New York and enrolled at Stony Brook University, earning his bachelor’s and master’s degrees in theater arts.

The founder of the Stony Brook Film Festival, his loyalty to the university has paid off for local residents who can attend high-quality shows just minutes away from their own homes. His success is a combination of meeting the needs of performers, being open to the opinions of audience members and appreciating his hard-working team, generous sponsors and the university’s supportive administration.

Recently, while nursing the flu and screening movies for the upcoming annual film festival, the director, who has brought the likes of Ray Charles, Harry Belafonte, Patti LuPone and more to the center, took time to answer a few questions about his stellar career.

Alan Inkles with Broadway star Kelli O’Hara who performed at the Staller Center on Dec. 10 of last year. Photo courtesy of the Staller Center

How long have you been the director of the Staller Center, and how did you get the job there?

I injured my knee while performing in 1983, and I had just graduated from Stony Brook and had worked as a student for the Fine Arts Center [the original name of Staller Center] during my years. And, as I couldn’t perform with my injury for a while, I asked the director of the center, Terry Netter, if he could use a theater manager — which I had done as a student. He hired me and at least seven titles later and an International Theatre Festival that I created — what really kept me interested in the early years — and  beginning to do all the programming in 1992, I took over as director upon Terry’s retirement in 1995. So, I guess officially I’ve been the director for 21 years.

You have a long history with Stony Brook University. What do you love about it?

What don’t I love about Stony Brook University? I did my undergraduate and graduate studies here. Two of my three kids and my son-in-law graduated from here, and I’ve been here as an employee and student for almost 37 years. I’ve enjoyed working for three presidents and almost a dozen provosts — permanent and acting ones, have made numerous friends with faculty, staff over the years, and have the greatest staff anyone could dream of having — some of which have been with me for my entire time as director. I love the energy of the students, the challenges that a public university continues to throw my way and the amazing ambiance of a continually growing and improving university. Stony Brook is about its amazing people, and I’ve been fortunate to be a member of this great collegial community for so long.

You’ve been credited with making the center what it is today. How did you go about that?

I guess longevity allows that to work. My predecessor Terry Netter opened the Staller Center back in 1976, 1977. It was a different time. You know back in those days the center was really more for the university, supporting the music department, the theater department, which we still do, and they did a couple of ballets and orchestras.

Early on when I started getting the itch, Terry asked to me to start programming. It was growing pains because I wanted to do more jazz and pop and children’s programs, because that’s what I saw we needed to do, because it was a different era. The arts centers of the 1960s and ’70s doing orchestras and ballets were great, and we continued to do them, but we needed to diversify. We needed to get broader. So, he really gave me a lot of leeway to go out and try to find these programs, and I liked the challenge.

What does it take to coordinate all the events the Staller Center presents during a year?

A great team. I can go to a conference, and I come back, and yesterday while being home laying in a bed (recovering from the flu), call my team up and say we’re booking Peter Cincotti. And, within 24 hours, we got a press release, the website, an email, the machine ready on social media, my production team going through the rider knowing exactly what we need so that I was able to approve it because there’s certain needs we have to get for the show. All this happens in 24 hours. I’m not so sure Live Nation could even pull it off in 24 hours!

So it starts with a great team, the confidence that I have the support of my provost (we have a new one this year, Michael Bernstein, who is really great) and a president who basically said to me, the third one I have worked for, “You raise the money, you bring in the audience, you got carte blanche.”

In addition to the performances at the center, you also coordinate the Stony Brook Film Festival. What does preparing for that entail?

Fortunately, over the years my contract administrator, my associate, Kent Marks, has taken on a good chunk of that. He’s great, and my staff have also helped pre-screen a lot of the movies. In the early days, I admit I watched everything. In the first 15, 16 years of the festival I was watching all 400 to 600 films coming in and picking 40. In the last five years we have had over 3,000 films coming in each year.

What have been your favorite personal accomplishments since being director of the center?

That’s an interesting question as I don’t think I’ve really given much thought to personal accomplishments. I’ve really always tried to focus on bringing quality programs in the arts to our faculty, staff, students and community over the years and always have tried to secure excellence and try to both entertain and enlighten our audiences and occasionally challenge them. Personally, I felt a great accomplishment in pulling off a 10-year run of a major International Theatre Festival early on in my career, and when I think back to my first trip to Sundance in 1999, and thinking about how little I knew about film festivals, I certainly am very proud of the fact that we have created a significant and lasting annual festival that grows every year in importance, quality and attendance. I’ve watched dozens of branded festivals in recent years dissolve as we gain strength.

I would also be remiss if I didn’t beam about the Outreach & Education program my staff and I have built. With just an idea over a decade ago to significantly reach out to communities and young people on Long Island, we now provide hundreds of programs at Staller and in our communities and serve several thousands of individuals who may not have had the opportunity to partake in the arts with workshops, school/library performances and complimentary Staller tickets. This is, of course, important for the future of the arts, and I am very proud of this growing and important part of our operation.

What are your plans for the Staller Center’s future?

I spent a great deal of time last weekend at the annual arts center/producer/ talent booking conference discussing with agents and artists and colleagues that we need to be creative, daring and also listen to our audience going forward. This digital era provides so much entertainment for people where they never need to leave their homes or their phones. We have to find ways through unique, different and exciting programs in the arts — theater, music, art and film — to take people away from their own arts centers —their 70-inch screen TVs.

It means continuing to be relevant so that corporate and private individuals will support us so we can bring these exciting programs to our campus and community, continue to keep the prices reasonable and make them available to all. I can promise you, I will continue to search far and wide for these live programs and films and continue to ask before I book something, “Is this something my audience needs to see?” That line has replaced the line that used to be, “What do they want to see?” And, when I stop asking that question and feel I can’t lift that proverbial rock any higher to find that program, I’ll know it’s time to pass on the baton. Fortunately, I don’t see that time coming too soon, and I’m also so grateful that my staff seems to want to keep me around a bit longer as well!

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Monarch butterfly caterpillar

By Ellen Barcel

Often when I’ve gone out to pick some parsley, I’ve found some parsley caterpillars on the stems. The question always becomes: When finding a caterpillar, to remove or not to remove it from the plant? As a kid, I liked playing with the little brown fuzzy ones. As a kid, I also remember my father removing tomato hornworms. So, the question is: Which, to gardeners are beneficial and which should we remove?

The two caterpillars that look the closest to me are the monarch butterfly caterpillar and the parsley caterpillar. Both feed on local plants and both turn into beautiful butterflies, a definite plus in my garden. The monarch obviously becomes the beautiful black and orange butterfly. Plant lots of butterfly weed (Asclepias tuberosa) for its food, a native plant with beautiful orange flowers. Cultivars include white, purple and bicolor flowers in addition to the native orange.

The parsley caterpillar turns into the beautiful blue and black eastern swallowtail. Since I grow a large pot of parsley each year, I’m more than willing to share a bit with this caterpillar. But, it can be a nuisance to professional parsley farmers.

Wooly bear caterpillar

The black and brown wooly bear caterpillars (Pyrrharctia isabella) are funny. Picked up they roll up it a ball. It emerges from of its egg in the fall, freezes over winter and turns into a light brown and black-spotted tiger moth in spring. It feeds on a whole variety of foliage. According to old lore, it’s a predictor of a harsh winter if the brown strip (not all have a pronounced strip) is wide, mild if it is narrow. I’ve read that there are even wooly bear festivals with weather prognostication (move over Holtsville Hal), crafts and races.

Tomato hornworms are green with small black and white spots. Their heads are larger and they are attracted to tomatoes — a plant that they can devastate. They also like related plants like peppers, potatoes and eggplants, which are members of the nightshade family, Solanaceae.

Tomato hornworm caterpillar

The tomato hornworm moth emerges in late spring, just in time for the nice tender shoots of its host plants. Handpicking is the easiest way to get rid of them for the home gardener. When my father removed one, it was covered in white eggs — wasp eggs. He didn’t realize that the wasps would become a natural control to this pest (as it was its dinner) and quickly removed the hornworm with its eggs. For those into companion plantings, it is said that dill, basil or marigolds can be planted among your tomatoes to control these hornworms.

Outside of the gypsy moth caterpillars (a real pest), you mainly see caterpillars alone or in groups of just a few. Make sure you identify each one before removing it from your plants.

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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