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Statin users tend to neglect dietary guidance.

By David Dunaief, M.D.

High cholesterol affects a great number of Americans and cuts across many demographics, affecting young and old and those in between. When we think of hyperlipidemia (high cholesterol), what do you think is the mainstay of medical treatment? If you said “statins” you would be correct.

Do statins deserve this central role in treatment? They have been convincingly shown in studies to significantly lower cholesterol, and they play an important role for those who have cardiovascular disease. However, should we be using statins as liberally as we have? Well, guidelines for the treatment of high cholesterol, released in November 2013, suggest that we should. In fact, if followed, these guidelines would increase the use of this medication, especially in those over the age of 60. Some in the medical community have even joked that statins might as well be put in the drinking water.

This is a medication that patients may be on for life. I don’t know about you, but that thought sends chills down my spine. We know all medications have pros and cons. Statins are no exception; they have been mired in controversy. For one thing, they have side effects. These include possibly increasing the risks of diabetes, myalgias (muscle pain), hepatic (liver) toxicity, kidney disorders and negatively affecting memory.

Statins also may reduce the benefits of exercise, and they may not be as effective in women as they are in men. Because statins are such effective cholesterol-lowering medications, does this mean that patients on these drugs may become complacent with their diets? A new study indicates that this is exactly what might be happening. Let’s look at the evidence.

Statins have been mired in controversy. Stock photo
Statins have been mired in controversy. 

Diet complacency

The “S” in statins does not stand for “superimmune to eating anything.” In a study published in JAMA Internal Medicine, results show that those who are taking statins tend to eat more calories and fats and, ultimately, increase their [body mass index] by gaining weight compared to those who were not taking statins (1).

In fact, in this study that used 11 years of NHANES data, results showed that there were a 14 percent increase in fat intake and an almost 10 percent increase in overall calorie intake among statin users. This resulted in a BMI that rose by 1.3 percent in those on statins, while in nonusers over the same period BMI only rose by 0.4 percent.

In other words, if you took an average male who was 5 feet 9 inches and weighed 200 lb, the difference between statin users and nonusers would be the difference between obesity and being just below obesity. Those on statins were consuming about 200 extra calories a day. This increase in calorie consumption occurred after they were placed on statins. Their weight also increased by 6.6 to 11 lb. This is especially concerning to the researchers, since the guidelines for statin use call for a prudent diet to help reduce fat and calorie intake with the ultimate goal of reducing weight.

However, the opposite was found to have happened — users consumed more calories and gained more weight. This is an observational study with over 27,000 participants, therefore no firm conclusions can be made. However, statins are not a license to gorge at the all-you-can-eat buffet line. We already know that statins may increase the risk of diabetes. Why worsen this risk with dietary indiscretions that are harmful to your BMI?

As an aside, the authors note that this increased calorie and fat consumption may be a contributing reason for the increased risk of diabetes with statins, but it’s too early to tell.

Impact on women

We tend to clump data together from trials that focus predominantly on one demographic, in this case men, and apply the results broadly to both men and women. However, in a May 5, 2014, New York Times article, “A New Women’s Issue: Statins,” some in the medical community, including the editor of JAMA, focus attention on this tendency, noting that this may be a mistake (2).

According to the dissenters, the thought process is that women have been underrepresented in statin trials, and cholesterol may not play the same role in women as it does in men. Yet almost half of the patients treated with statins are women. These physicians were referring to the use of statins in primary prevention, or in those who have high cholesterol but who do not have documented heart disease.

Lest you think their views are based solely on opinion or anecdotal data from clinical experience, this data on women was from the JUPITER trial, which looked at almost 7,000 initially healthy female participants (3). Statins did benefit women by reducing the occurrence of chest pain and reducing the number of stent placements and bypass surgeries, but they did not reach the primary end points of showing statistical significance in reducing the occurrence of a first heart attack, stroke or death.

The caveat is that there were not a large number of cardiovascular events — heart attacks, strokes or death — that occurred in either the treatment group or the control group. These results were in women over the age of 60. This may give slight pause when prescribing statins. By no means do I think these physicians are advocating to not give women statins, just that we may want to weigh the benefits and risks on a case-by-case basis.

Tamping down exercise benefits

If exercise is beneficial for lowering cardiovascular disease risk and so are statins, the logical presumption might be that the two together would create a synergistic effect that is greater than the two alone — or at least an added benefit from combining the two. Unfortunately, what seems straightforward is not always the case.

In a small, yet randomized controlled trial, participants who were put on statins and monitored for cardiopulmonary exercise saw a blunted aerobic effect compared to the control group, which exercised without the medication (4). In the treatment group, there was a marginal 1.5 percent improvement with aerobic exercise, while the control group experienced a much more robust 10 percent gain.

The reason for this disappointing discrepancy is that statins seem to interrupt the enzymes that are responsible for making the mitochondria (the powerhouse or energy source for the cell) more efficient. The most troubling aspect of this trial is that the participants chosen were out-of-shape, overweight individuals in need of aerobic exercise.

Whether or not a patient, male or female, is placed on cholesterol-lowering medication, one thing is clear: There is a strong need to make sure that lifestyle modifications are always emphasized to help reduce the risk of cardiovascular disease to its lowest levels. But the quandary becomes what to do with statins and exercise. And statins, as powerful and effective as they may be, still do have side effects, may reduce exercise benefits and may not have the same effects for women. Thus, they may not be appropriate for everyone. A healthy diet and exercise, however, are appropriate for all.

References: (1) JAMA Intern Med. online April 24, 2014. (2) nytimes.com. (3) N Engl J Med. 2008 Nov 20;359(21):2195-2207. (4) J Am Coll Cardiol. 2013;62(8):709-714.

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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Zoyzia grass is a tough, easy to grow lawn grass but turns brown with the cold weather. The small green sprouts are probably onion grass. Over time, zoyzia grass chokes out weeds. Photo by Ellen Barcel

By Ellen Barcel

Last week, we looked at the history of lawns. Since we live in suburbia, and since lawns are part of our gardening experience, let’s take a look at what grasses we grow and what needs to be done in autumn. Each of the grasses below has its advantages and disadvantages.

Zoysia grass, a native of Asia and my personal favorite, needs little in the way of fertilizer, spreads easily through underground runners, choking out weeds, and once established is somewhat drought tolerant. Its major disadvantage is that it thrives on very warm weather, meaning that come winter, it turns brown. Some people dislike this feature enough that they will dye the brown grass green. Me, I just ignore it.

I know that come next spring it will green up and be very easy to care for, something that really appeals to me. If you do add some fertilizer in the spring, make sure you wait until the grass has actually greened up so it can take up the fertilizer. Since it is a warm-weather grass, plant it is spring, not fall.

Kentucky bluegrass is a cool-weather grass. Like zoysia grass it can spread through underground rhizomes. Being more cold tolerant, it stays nice and green much longer than other grasses. However, in the heat of summer, it needs lots of water and it’s also not very shade tolerant. Kentucky bluegrass may have been cultivated in Kentucky, but, it, too is an import from Europe and the Middle East.

Ryegrass is also a cool-weather grass. It’s a tough grass, used in sports fields. It is, however, susceptible to a variety of diseases and winterkill. It’s common in lawn seed mixes and originated in Europe, Asia and North Africa.

Fescue grass, a native of Europe, is also a cool-weather grass but has the advantage of tolerating some shade. According to Oregon State University, it was not widely planted until the 1940s and ’50s — interestingly, the time of the growth of suburbia. Because each grass has some different characteristics, you will frequently find grass seed mixes. If you notice that many of the popular grasses are cool-weather grasses, it will come as no surprise that autumn, with its cooler weather, is a great time to refurbish your lawns. You’ll have less heat and therefore require less added watering.

If you want less work, you can buy sod. Like most everything it has its advantages and disadvantages. One advantage is that it is already sprouted. Disadvantages include cost (it’s more expensive) and you don’t get to select the variety of grasses available. Sod is ideal for refurbishing small areas.

Growing from seed is more time consuming and you need to make sure the seeds are well watered. But, growing from seed is cheaper. You can also get seed that has a covering that absorbs water and contains nutrients. This latter seed is more expensive, but it’s the kind used along roadways where there is no one to tend the new planting.

Since most of the grasses in lawn mixes are cool-weather crops, they grow well in September, October and November (and even a mild December). Remember, according to Suffolk County law, you can’t add fertilizer to your lawn past the end of October. The lawns won’t take up the nutrients — they’ll go into the water table, polluting it and running off into local waterways. In spring, you can’t add fertilizer before the beginning of April for the same reason. Use pre-emergent weed killer in early spring if needed.

A soil pH of 6.0 to 7 is ideal for lawns. Since most of Long Island’s soil is substantially below this level, that is, more acidic, you need to periodically add lime to raise the pH. Read the package directions for each manufacturer’s ideal timing, frequency and amount.

Make sure you remove fallen leaves from your lawn to keep the lawn healthier. Some old-school gardeners will scatter grass seed on bare spots in their lawn just before the first predicted snow fall. This way, the seed is ready to germinate come spring. Water will be provided by the melting snow. Remember that come winter and snow, try to avoid getting ice melt on the lawn.

Cornell Cooperative Extension of Suffolk (https://ccesuffok.org) has an extensive selection of horticulture fact sheets that can be downloaded, including Healthy Lawns, Lawn Care Without Pesticides, The Homeowner’s Lawn and Repetitive Overseeding.

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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Pumpkin Cheesecake with Gingersnap Crust

Pumpkins are readily available in fall, when people carve jack-o’-lanterns out of pumpkins for Halloween or serve up pumpkin pie after a hearty Thanksgiving dinner. But people who are unsatisfied with plain old pumpkin pie can add something new to their repertoire this fall by cooking up the following recipe for Pumpkin Cheesecake with Gingersnap Crust, courtesy of Lori Longbotham’s “Luscious Creamy Desserts” (Chronicle Books).

Pumpkin Cheesecake with Gingersnap Crust

YIELD: Serves 8 to 10

Pumpkin Cheesecake with Gingersnap Crust
Pumpkin Cheesecake with Gingersnap Crust

INGREDIENTS:

Crust

1½ cups gingersnap cookie crumbs

½ cup finely chopped hazelnuts

6 tablespoons unsalted butter, melted

¼ cup sugar

Filling

1½ pounds cream cheese, at room temperature

½ cup packed light brown sugar

¼ cup granulated sugar

2 large eggs

2 large egg yolks

1½ tablespoons all-purpose flour

2 teaspoons pumpkin pie spice

1 cup solid-pack pumpkin purée (not pumpkin pie mix)

½ cup créme fraîche, homemade (see below) or store bought, or sour cream

2 teaspoons pure vanilla extract

DIRECTIONS: Preheat the oven to 350 F. Lightly butter an 8- or 8½-inch springform pan. To make the crust: Stir together all of the ingredients in a medium bowl until the crumbs are moistened. Press the mixture over the bottom and up the sides of the pan. Bake the crust for 10 minutes. Let cool completely on a wire rack. Increase the oven temperature to 425 F.

To make the filling: With an electric mixer on medium speed, beat the cream cheese, brown sugar and granulated sugar in a large deep bowl until light and fluffy. Beat in the eggs and then the egg yolks one at a time, beating well after each addition. Add the flour and pumpkin pie spice and beat on low speed until just combined. Add the pumpkin purée, créme fraîche and vanilla, and beat until just combined. Pour the filling into the shell.

Place the cheesecake on a baking sheet and bake for 15 minutes. Reduce the oven temperature to 250 F and continue baking for 1 hour. Turn the oven off and let the cheesecake cool in the oven for 2½ hours. Then transfer to a wire rack and let cool to room temperature. Refrigerate, tightly covered, for at least 10 hours, until thoroughly chilled and set, or for up to 2 days.

To serve, run a knife around the side of the cheesecake and remove the side of the pan. Serve slightly chilled or at room temperature, cut into thin wedges with a sharp knife dipped into hot water and wiped dry after each cut.

Créme Fraîche (Makes about ½ cup) ½ cup heavy whipping cream ½ cup créme fraîche or sour cream with live culture Pour the cream into a glass jar with a tight-fitting lid and spoon in the créme fraîche. Let sit on the counter, with the lid slightly ajar, until the mixture thickens, from 4 to 24 hours, depending on the weather. Refrigerate, tightly covered, until ready to use.

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By Bob Lipinski

Laird’s is America’s first and oldest commercial distillery. Records indicate that William Laird, a County Fyfe Scotsman, settled in Monmouth County, N.J., and produced applejack as early as 1698. In 1780, Robert Laird, a Revolutionary War soldier who served under George Washington, established Laird’s Distillery (License #1) in the tiny community of Scobeyville, N.J.

Applejack is an 80-proof brandy made from apples such as Red Delicious, Golden Delicious, Rome, Winesap, Fuji, Stayman, Pippins, Granny Smith, Gala, Macintosh and Jonathan. It is estimated that about 7,000 pounds of apples are needed to make one 50-gallon barrel of apple brandy and about six pounds are needed to make one 750-ml (25.4-ounce) bottle of 80-proof applejack. Laird’s also makes a 100-proof apple brandy labeled Jersey Lighting, which is made from about 20 pounds of apples! By the way, applejack was originally distilled from frozen fermented apple cider, a process called jacking.

Laird’s 80-proof applejack is a blend of 35 percent apple brandy and 66 percent neutral grain spirits. Under U.S. law, it must be aged for two years, but Laird’s is aged for a minimum of three years in charred oak barrels. It is dry and full of deep, rich apple aroma and flavor. Very smooth in the mouth with a caramel finish and an ultra-smooth finish (meaning no burn).

Jersey Lighting is a term dating back to the mid-1800s for applejack, which was made in New Jersey. The brandy is clear in color with an unmistakable perfumed aroma of cider followed by a rich, dry apple taste, subtle, yet full of flavor. I like it either in a brandy snifter or sometimes on the rocks while listening to relaxing music. Applejack is also perfect for hot apple drinks and cocktails, such as Jack Rose and the Pink Lady.

The Jack Rose Cocktail (see recipe below) was supposedly named after “Bald Jack” Rose, a gangster who turned state’s evidence after the killing of Herman Rosenthal in a bar in Times Square in 1912. The Pink Lady Cocktail (see recipe below) was named after a play in 1911 of the same name and starring Hazel Dawn. In 1944, the Pink Lady enjoyed a revival in the play “Happy Birthday” in which Helen Hayes danced on the bar top after several drinks, including the Pink Lady.

Laird’s applejack is excellent for basting or creating a glaze for your turkey and is an essential ingredient for stuffing, which is generally made with apples. Simply add 1/4 to 1/3 of a cup applejack to your stuffing prior to cooking. That’s it… “Here’s to Apples.”

Jack Rose Cocktail

INGREDIENTS: 2 ounces applejack

1 ounce lemon juice

1/2 ounce grenadine

DIRECTIONS: Shake all ingredients with ice and strain into a cocktail glass.

Pink Lady Cocktail
Pink Lady Cocktail

Pink Lady Cocktail

INGREDIENTS: 1-1/2 ounces gin 1/2 ounce applejack 1/2 ounce lemon juice 1/4 ounce grenadine 1 egg white

DIRECTIONS: Shake all ingredients with ice and strain into a cocktail glass.

Bob Lipinski, a local author, has written 10 books, including “101: Everything You Need to Know About Whiskey” and “Italian Wine & Cheese Made Simple” (available on Amazon.com). He conducts training seminars on wine, spirits and food and is available for speaking engagements. He can be reached at www.boblipinski.com OR [email protected].

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A diet rich in fruits, vegetables, beans, nuts and oily fish may prevent breast cancer. Stock photo

By David Dunaief, M.D.

NFL players are wearing pink shoes and other sportswear this month, making a fashion statement to highlight Breast Cancer Awareness Month. This awareness is critical since annual invasive breast cancer incidence in the U.S. is 246,000 new cases, with approximately 40,000 patients dying from this disease each year (1). The good news is that from 1997 to 2008 there was a trend toward decreased incidence by 1.8 percent (2).

We can all agree that screening has merit. The commercials during NFL games tout that women in their 30s and early 40s have discovered breast cancer with a mammogram, usually after a lump was detected. Does this mean we should be screening earlier? Screening guidelines are based on the general population that is considered “healthy,” meaning no lumps were found, nor is there a personal or family history of breast cancer.

All guidelines hinge on the belief that mammograms are important, but at what age? Here is where divergence occurs; experts can’t agree on age and frequency. The U.S. Preventive Services Task Force recommends mammograms starting at 50 years old, after which time they should be done every other year (3). The American College of Obstetricians and Gynecologists recommends mammograms start at 40 years old and be done annually (4). Your decision should be based on a discussion with your physician.

The best way to treat breast cancer — and just as important as screening — is prevention, whether it is primary, preventing the disease from occurring, or secondary, preventing recurrence. We are always looking for ways to minimize risk. What are some potential ways of doing this? These may include lifestyle modifications, such as diet, exercise, obesity treatment and normalizing cholesterol levels. Additionally, although results are mixed, it seems that bisphosphonates do not reduce the risk of breast cancer nor its recurrence. Let’s look at the evidence.

Bisphosphonates

Bisphosphonates include Fosamax (alendronate), Zometa (zoledronic acid) and Boniva (ibandronate) used to treat osteoporosis. Do they have a role in breast cancer prevention? It depends on the population, and it depends on study quality.

In a meta-analysis involving two randomized controlled trials, results showed there was no benefit from the use of bisphosphonates in reducing breast cancer risk (5). The population used in this study involved postmenopausal women who had osteoporosis, but who did not have a personal history of breast cancer. In other words, the bisphosphonates were being used for primary prevention.

The study was prompted by previous studies that have shown antitumor effects with this class of drugs. This analysis involved over 14,000 women ranging in age from 55 to 89. The two trials were FIT and HORIZON-PFT, with durations of 3.8 and 2.8 years, respectively. The FIT study involved alendronate and the HORIZON-PFT study involved zoledronic acid, with these drugs compared to placebo. The researchers concluded that the data were not evident for the use of bisphosphonates in primary prevention of invasive breast cancer.

In a previous meta-analysis of two observational studies from the Women’s Health Initiative, results showed that bisphosphonates did indeed reduce the risk of invasive breast cancer in patients by as much as 32 percent (6). These results were statistically significant. However, there was an increase in risk of ductal carcinoma in situ (precancer cases) that was not explainable. These studies included over 150,000 patients with no breast cancer history. The patient type was similar to that used in the more current trial mentioned above. According to the authors, this suggested that bisphosphonates may have an antitumor effect. But not so fast!

The disparity in the above two bisphosphonate studies has to do with trial type. Randomized controlled trials are better designed than observational trials. Therefore, it is more likely that bisphosphonates do not work in reducing breast cancer risk in patients without a history of breast cancer or, in other words, in primary prevention.

In a third study, a meta-analysis (group of 36 post-hoc analyses — after trials were previously concluded) using bisphosphonates, results showed that zoledronic acid significantly reduced mortality risk, by as much as 17 percent, in those patients with early breast cancer (7). This benefit was seen in postmenopausal women but not in premenopausal women. The difference between this study and the previous study was the population. This was a trial for secondary prevention, where patients had a personal history of cancer.

However, in a RCT, the results showed that those with early breast cancer did not benefit overall from zoledronic acid in conjunction with standard treatments for this disease (8). The moral of the story: RCTs are needed to confirm results, and they don’t always coincide with other studies.

Exercise

We know exercise is important in diseases and breast cancer is no exception. In an observational trial, exercise reduced breast cancer risk in postmenopausal women significantly (9). These women exercised moderately; they walked four hours a week. The researchers stressed that it is never too late to exercise, since the effect was seen over four years. If they exercised previously, but not recently, for instance, five to nine years ago, no benefit was seen.

To make matters worse, only about one-third of women get the recommended level of exercise every week: 30 minutes for five days a week. Once diagnosed with breast cancer, women tend to exercise less, not more. The NFL, which does an admirable job of highlighting Breast Cancer Awareness Month, should go a step further and focus on the importance of exercise to prevent breast cancer or its recurrence, much as it has done to help motivate kids to exercise with it Play 60 campaign.

Soy intake

Contrary to popular belief, soy may be beneficial in reducing breast cancer risk. In a meta-analysis (a group of eight observational studies), those who consumed more soy saw a significant reduction in breast cancer compared to those who consumed less (10). There was a dose-response curve among three groups: high intake of >20 mg per day, moderate intake of 10 mg and low intake of <5 mg.

Those in the highest group had a 29 percent reduced risk, and those in the moderate group had a 12 percent reduced risk, when compared to those who consumed the least. Why have we not seen this in U.S. trials? The level of soy used in U.S. trials is a fraction of what is used in Asian trials. The benefit from soy is thought to come from isoflavones, plant-rich nutrients.

Western vs. Mediterranean diets

A Mediterranean diet may decrease the risk of breast cancer significantly.
A Mediterranean diet may decrease the risk of breast cancer significantly.

In an observational study, results showed that, while the Western diet increases breast cancer risk by 46 percent, the Spanish Mediterranean diet has the inverse effect, decreasing risk by 44 percent (11). The effect of the Mediterranean diet was even more powerful in triple-negative tumors, which tend to be difficult to treat. The authors concluded that diets rich in fruits, vegetables, beans, nuts and oily fish were potentially beneficial.

Hooray for Breast Cancer Awareness Month stressing the importance of mammographies and breast self-exams. However, we need to give significantly more attention to prevention of breast cancer and its recurrence. Through potentially more soy intake, as well as a Mediterranean diet and modest exercise, we may be able to accelerate the trend toward a lower breast cancer incidence.

References: (1) breastcancer.org. (2) J Natl Cancer Inst. 2011;103:714-736. (3) Ann Intern Med. 2009;151:716-726. (4) Obstet Gynecol. 2011;118:372-382. (5) JAMA Inter Med online. 2014 Aug. 11. (6) J Clin Oncol. 2010;28:3582-3590. (7) 2013 SABCS: Abstract S4-07. (8) Lancet Oncol. 2014;15:997-1006. (9) Cancer Epidemiol Biomarkers Prev online. 2014 Aug. 11. (10) Br J Cancer. 2008;98:9-14. (11) Br J Cancer. 2014;111:1454-1462.

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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Samantha Carroll and Jeremy Hudson sing ‘Follow Your Heart’ in a scene from ‘Urinetown.’ Photo courtesy of the SCPA

By Rebecca Anzel

“Urinetown: The Musical,” currently in production at the Smithtown Performing Arts Center through Nov. 6, has received rave reviews. The two lead characters, Hope Cladwell and Bobby Strong, are played by real-life couple Samantha Carroll and Jeremy Hudson. I sat down with the two actors on Saturday night before the show to ask them about their latest roles.

Samantha Carroll and Jeremy Hudson sing ‘Follow Your Heart’ in a scene from ‘Urinetown.’ Photo courtesy of SCPA
Samantha Carroll and Jeremy Hudson sing ‘Follow Your Heart’ in a scene from ‘Urinetown The Musical.’ Photo courtesy of SCPA

How did you two meet?

S: The first time we actually met was here at Smithtown Theater years ago when we both auditioned for Light in the Piazza, which was my first show. Jeremy didn’t make the cut but we read together on stage and I remembered it and I found him on Facebook—

J: She Facebook stalked me throughout college.

S: I just was like, “I read with this guy and he’s nice.” We became closer friends at the Engeman. We started doing children’s theater there together and he was in a production of White Christmas that I was a dresser.

J: Even before that though — Little Women.

S: Oh god yeah, and then we did Little Women together at CM. Our friendship and love, eventually, has come through working at all these different theaters. But we did actually meet at the Smithtown Center for the Performing Arts years ago. And here we are.

J: It was a long time ago. 2007.

What is it like being engaged to each other and starring opposite each other in a show?

S: I mean, it’s like any other day really. We met doing shows together so I guess it’s normal. It’s easier to learn the lines. I trust him on stage. Our families are even more excited than we are.

J: Yeah, it’s a fun opportunity that’s few and far between. It’s a chance to have both of our lives kind of converge at one point to be able to do a show like this together. We try and make the most of the time we have doing this show because —

S: We don’t know when it’ll come again to work together, so it’s very nice.

Photo courtesy of SCPA Samantha Carroll and Jeremy Hudson in a scene from ‘Urinetown The Musical.' Photo courtesy of SCPA
Photo courtesy of SCPA
Samantha Carroll and Jeremy Hudson in a scene from ‘Urinetown The Musical.’ Photo courtesy of SCPA

What other theaters have you both worked in?

S: Together, we worked at CM Performing Arts Center in Oakdale and the John W. Engeman in Northport. This is definitely our biggest roles together. Playing opposite each other is really, it’s silly but we’re both serious enough that we don’t just burst out laughing.

J: We can keep it together for five minutes.

 

You said that you performed at this theater in a teen production. Have you done any other shows here?

S: I have. I’ve been here my whole theater life. I’ve done many of the Wonderettes shows — they’re doing another Wonderettes coming this May and June. Light in the Piazza was my first really big one. Most recently, I’ve been in Violet, which was a really big favorite, and we were both actually in First Date together a few months ago as well.

J: Last March. More than a few months at this point.

S: But yeah, I was in Little Mermaid. The list goes on and on. And Jeremy’s worked here before as well.

J: I haven’t done quite as much but I have done a few shows in the past. I did Assassins here, I did Dirty Rotten Scoundrels. Bloody Bloody Andrew Jackson was another one I did here.

How old were you each when you decided that you wanted to be an actor? What attracted you to the profession?

S: I think I was probably about 6 or 7 when I started to be interested in it. My mom took me to see Beauty and the Beast on Broadway and at that point I was like, “Oh, well I have to be Belle.” I mean, I’m still waiting. I think my first acting class was probably at 8 years old and then I started singing lessons in sixth grade, so once I got to high school, I realized that this is what I want to do for the rest of my life. Beauty and the Beast, those princesses and those villains, inspired me to be where I am.

J: And I was in high school, I guess. My brother — my older brother, 10 years my senior so much older brother — used to do theater and growing up I would always go with my parents to see him do shows pretty consistently, so it was always kind of a part of my life. And then I did one myself and I was like, “Hey this is fun.” My first show was Grease, and then Guys and Dolls. I just enjoyed doing it, and having been a part of it my entire life, I just kind of slid into it myself.

Samantha Carroll in a scene from 'Urinetown The Musical," Photo courtesy of SCPA
Samantha Carroll in a scene from ‘Urinetown The Musical,” Photo courtesy of SCPA

Do you ever get nervous on stage?

S: For sure. Nerves are good, though, because it means you care about it and it keeps you focused.

J: The thing is, I forget there are audiences there, so I just am doing it and because I’ve done it so many times now, I’m used to people watching me do whatever. The only time I get more nervous, so to speak, is if I start to really think about it. Sometimes I’ll be on stage doing a scene and, not to say I won’t be in the moment, but I’ll just think, “I’m standing on a stage and there are people staring at me.” And then at that point what I’m doing starts to sink in, and then maybe at that point.

S: We don’t stay up at night thinking how terrifying it is to be on stage, or we wouldn’t do it. I think we get just general butterflies, especially when your parents are in the audience. You just want to be good. We’re perfectionists, unfortunately, to a fault.

What is it like watching each other perform?

S: It’s so cool. I do some stuff in Millbrook Playhouse in Pennsylvania, and Jeremy has come out to to see me in everything. I always just wait to hear what he has to say, because those mean the most to me. His words and his critiques, he doesn’t have many.

J: Not to her face at least.

S: And seeing Jeremy is amazing too. I got to see him in 1776 last year.

J: You don’t get to see me do as much as I see you.

S: He sees me a little more because he works a big-boy job too.

J: One of the many reasons we’re going to get married is just because it’s nice to share similar interests in this because it is a very time-consuming, very all-encompassing profession job. Being an actor or actress takes a lot out of you, so to be on the same page and to have that point of reference or common ground, so to speak, between the two of us is good.

What is it like when you get a standing ovation?

S: It’s not expected, but it’s very nice when it happens.

J: It’s good that an audience is that invested because it takes a lot to sit through a show, even a show you like, and then feel the need to stand up and show your appreciation for it afterwards means a lot.

Jeremy Hudson and cast in a scene from ‘Urinetown The Musical.’ Photo courtesy of SCPA
Jeremy Hudson and cast in a scene from ‘Urinetown The Musical.’ Photo courtesy of SCPA

Has anything strange ever happened out in the audience that you noticed while on stage?

J: All the time. People on their cell phones, people falling asleep.

S: Snoring!

J: People eating.

S: Choking. We’ve done so much children’s theater together, the kids are, you know, they just scream the whole time. We’ve seen it all.

J: Audiences feel like because they’re sitting in a dark theater that people don’t see them. But lo and behold, being on stage you see everyone and everything. I look out and scan the audience every once in awhile. If you’re doing something weird, I will see you, and we will be talking about you. Being an audience member requires just as much investment as being a performer on the stage. It’s why I don’t like sitting in the front row myself because I feel like I’m a part of the performance as well, because the actors can see you. They can see you throughout the show.

S: And they will look at you. It’s actually easy to see the front row, but a lot of other rows are harder to see. It depends on the cues, but you can always see the first row.

J: Always.

What is your dream role?

S: Currently — they change all the time — I would love to be Alice in Bright Star who was played by Carmen Cusack on Broadway.  And I would die and go to heaven to be anything in Waitress.

J: I mean, who doesn’t want to be in Le Mis, but I would like to play Jean Valjean in Les Misérables again. I did it in a teen production ten years ago, so I would like to do that again in a real production. That would be fun.

Do you have theaters in mind that you want to work in?

J: Anything between 7th and 8th Avenues between 42nd and 49th Street would be great.

S: Any theater that’s going to be professional and lovely, we would love to work at.

What attracted you to “Urinetown the Musical”? What made you want to audition?

S: I actually did “Urinetown” at the same theater 10 years ago in the teen production and I played Hope — the same part. I found out they were doing it again and Ken [Washington], the director, had talked to me about if I would like to reprise my role but on the main stage. I said absolutely. It’s a strange show, but it’s very funny and I like to be Hope so I wanted to do it again.

J: I saw the actual show 10 years ago and I have always liked it and wanted to be a part of it. It’s always been on my short list of shows to do, so I’m glad I’ve gotten the opportunity to do it at this point.

What is it like working with the director?

S: I have worked with Ken since I was 16 years old and he has seen me grow up. He is still the fun, grumpy man I remember he was, but you know, I think Ken has such a passion for theater. It’s definitely rubbed off in a good way. We love Ken.

J: He cares a great deal and he has a wealth of knowledge as far as theater goes, so it’s definitely something that is good to tap in to from time to time.

What is it like working with the cast?

S: Well, this cast specifically is a lot of, as we like to say, Long Island notables, just people who have kind of been doing this for such a long time. We’re very luck, honestly. A lot of big personalities, but in a really great way.

J: It’s a very eclectic group of people. All bring individual strengths [to the stage].

 

What is your favorite scene and song in the show?

S: My favorite scene and song is definitely “Follow Your Heart.” I’ve always loved it. “Be still, Hear it beating, It’s leading you, Follow your heart” was actually my yearbook quote for high school. It’s funny, it’s heartfelt and I get to do it with the best partner in the world.

J: I enjoy the scene leading up to “Run Freedom Run!” and that song. It’s just fun because it’s a bunch of strange people and it’s just very funny. It’s 80 percent the same every night and 20 percent slightly different, which always keeps things interesting.

Michael Newman and Samantha Carroll in a scene from 'Urinetown The Musical.' Photo from SCPA
Michael Newman and Samantha Carroll in a scene from ‘Urinetown The Musical.’ Photo from SCPA

Why should people come see the show?

S: If you ask any theater person at all, they’ll say to you, “‘Urinetown’ is the best,” or, “I love ‘Urinetown’.” I’ve been in it three times. It’s just one that people who don’t usually come to see theater don’t always come to, but they really should because it’s very, very funny. Hilarity ensues.

J: It’s just such an original piece of theater. The show came out in the early 2000s but it’s still very timely in terms of the current climate with politics. It has a lot of good things to say. The music is very catchy, and it’s one of those shows where you hear the name and you’re like, “I don’t know — it sounds weird,” but then you actually go to sit down and you see it and within 15, 20 minutes you’re like, “Wow, I’m glad I didn’t miss the opportunity to see this!”

What is up next for both of you?

S: I am very shortly starting Mary Poppins at the John W. Engeman. I’m in the ensemble but I’m covering a few different tracks of a lot of the character roles. I’m going to be doing that the whole Christmas season. And Jeremy will get one soon, but he’s—

J: Currently in between things. I have to, what with work and whatnot, I have to be a little more selective in what—

S: So he can make the dollar bills. It’s honestly either just you’re doing three shows at a time, one after the other, or you don’t do something for six months.

J: As long as we can make a living, or any wage, really, performing, that is the ideal. I would love to do theater but that doesn’t necessarily mean that’s the only thing I would like to do.

S: But we’ll always do it, regardless of if we have babies or have full-time jobs, we’ll definitely always come back and do theater because that’s what we love.

Is there anything else that you want to say to our readers?

J: This is a wonderful show, here, and Smithtown Performing Arts Center. There is a theater in Smithtown, it’s on Main Street.

S: Please come see Urinetown and everything else because everything they do here is really wonderful.

J: They put a lot of time and effort and thought into shows here. This is specifically a show that desperately needs an audience to enjoy it for it to really reach it’s maximum potential, so come on down everyone.

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From left, Robert Catell, chairman of the board, Advanced Energy Research and Technology Center; Vyacheslov Solovyov; Sergey Gelman, a Stony Brook engineering student; and Yacov Shamash, vice president for economic development at Stony Brook University. Photo from Stony Brook University

By Daniel Dunaief

It’s lighter, cheaper and just as strong. In the age of manufacturing the latest and greatest high-technology parts, that is a compelling combination. Indeed, the Department of Energy recently awarded the Brookhaven Technology Group, a business incubator tenant of the Advanced Energy Research and Technology Center at Stony Brook University, $1.15 million to develop a high-temperature superconductor cable with a new architecture. The grant supports the research of Vyacheslav Solovyov, an adjunct professor in the Department of Electrical Engineering at SBU and the principal investigator at Brookhaven Technology Group.

“Very few projects are funded, so we’re very excited that ours was chosen,” said Paul Farrell, the president at BTG. The potential applications for Solovyov’s Exocable, as the new architecture is called, span a wide range of uses, including in high field magnets for a new breed of accelerator. The work entails creating a high-temperature superconducting cable that is an integral ingredient in creating the superconducting machinery. The BTG process produces a high-temperature superconducting cable after removing the substrate, which is a single-crystal-like material. Solovyov transfers the superconducting layer to a supporting tape that can be engineered for strength and not for crystallinity.

This work reduces the weight of the tape by as much as 70 percent per unit length for the same current capacity. The potential for this new cable is that it can contribute to the growing field of research at Stony Brook and Brookhaven National Laboratory on superconductivity, said Jim Smith, assistant vice president of economic development at Stony Brook. “Maybe this is the next industry that replaces the Grummans and the aerospaces that have left,” he said. Semiconductors are of particular interest to manufacturers because they transmit energy with no resistance. Right now, about 6.5 percent of energy transmitted around the United States is lost in distribution wires, Smith said. Maintaining the energy that’s lost in the wires would have “tremendous benefits.”

To be sure, while the research at BTG could contribute to lower cost and improved efficiency in high-temperature superconductivity, there are hurdles to making this process and the applications of it work. For starters, the company needs to produce kilometers of ExoCable. “The challenge is to demonstrate that the properties will be as uniform as they were before the substrate removal,” explained Solovyov, who has been working in superconductivity since 1986.

Recently, Smith said he, Farrell and Solovyov met to discuss the wiring for their facility. “A lot of power and wiring will be installed in the next four to five weeks,” Smith said. Scientists who worked with Solovyov expressed admiration for his work and optimism about his results. Solovyov’s “new activity will definitely advance the long-promised practical application of superconductivity electrical power transmission, as well as in the development of high-field magnets for both industrial and scientific application,” David Welch, a former collaborator and retired senior materials scientist at Brookhaven National Laboratory, wrote in an email. Welch explained that Solovyov focused on methods for making composites of superconducting material with normally conducting metals in the form of wires, tapes and cables necessary for their practical application. “Such a combination of talents is unusual,” Welch continued. Early on, it was clear “that [Solovyov] was going to become an important member of the scientific staff at BNL.”

Solovyov started working on this process with BTG about a year and a half ago. When he first started collaborating with BTG, the company was working on a superconducting project funded by the army. When that work ended, Solovyov and BTG worked together to submit new proposals to the DOE. According to Solovyov, Stony Brook has been “very helpful in terms of providing facilities and lab space.” Stony Brook’s goal, Smith said, is to help companies like BTG succeed and measures that success in the number of new jobs created in the energy field.

Solovyov, who grew up in the Ukraine, said he has had several breakthroughs in his career. He helped develop a patented technology that can speed up the processing of superconducting materials by a factor of 10. “That has been used in production and I’m very proud of it,” Solovyov said. The professor lives in Rocky Point with his wife Olena Rybak and their two children, Natasha, 19, who attends Suffolk County Community College, and Dennis, 14, who is in high school. Solovyov said he enjoys Long Island, where he can fish for striped bass and bluefish. He pan fries what he catches.

As for his work, Solovyov has four patents and applications for three more. He and Farrell said the company is looking for opportunities for expansion. He is exploring ways to work with large-scale generators and wind turbines. Farrell explained that BTG has ambitions to become a larger company. BTG would “like to become a major contributor in this field,” Farrell said. That could include adding staff and developing more products that can be sold and used worldwide. “If our product is successful, in the sense that it improves the capability of superconductors to be used commercially, we’ll be adding people.” This work will need more funding, which the company plans to get either from the Department of Energy, from private investors or both.

“If you can improve the usefulness of superconductors and reduce the cost of the wire, there’ll be wider use than there is right now,” Farrell said.

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Panisse with Harissa Mayonnaise. Photo courtesy of Chef Guy Reuge

Guy Reuge, executive chef of Mirabelle Restaurant and the Mirabelle Tavern at the Three Village Inn in Stony Brook recently released his first book, “A Chef’s Odyssey: An Autobiographical Cookbook,” to rave reviews. “‘A Chef’s Odyssey’ is a charming and very personal memoir and cookbook by French chef Guy Reuge,” said Jacques Pepin. “From the simple, straightforward recipes of his youth to the sophisticated recipes he made at La Tulipe in New York City and later at Mirabelle, he vividly brings back memories of a time when French cooking rules the New York restaurant scene.”

Try this recipe for Panisse with Harissa Mayonnaise from “A Chef’s Odyssey.” In his cookbook, Chef Reuge writes, “Panisse are a treat from southeastern France. They are made with a chickpea flour batter that is deep-fried. I serve panisse as a snack and they are one our most requested menu items.”

Panisse with Harissa Mayonnaise

a-chefs-odysseyYIELD: Makes 50 panisse

INGREDIENTS:

4 cups whole milk

2 cups heavy cream

1⁄4 cup sliced shallots

1 sprig of thyme

salt and pepper

3 cups chickpea flour, sifted

olive oil for greasing the pan

vegetable oil for deep frying

2 cups mayonnaise, chilled

1 tablespoon harissa paste or sriracha sauce

DIRECTONS: In a large saucepan combine the milk, cream, shallots, and thyme, season the mixture with salt and pepper, and bring the liquid to a boil over moderately high heat. Reduce the heat to moderate and simmer the mixture for 5 minutes. Pass the mixture through a sieve into another saucepan and return the liquid to a boil over moderately high heat. Whisk in the chickpea flour, whisk the mixture until it thickens, and continue to whisk it for 4 minutes more. Transfer the batter to a food processor fitted with the steel blade and process it for 2 minutes or until it is smooth. Spread a 9- by 13½-inch sheet tray with the olive oil and spoon the batter into the pan, spreading it out. Level and smooth the top of the batter with an offset spatula. Chill the batter for 2 hours.

When the batter is solid unmold it by turning the tray onto a cutting board. Cut the panisse into 2½-inch lengths that look like thick french fries. In a deep-fryer heat the vegetable oil to 375 F and fry the panisse in small batches until they are golden. Transfer the panisse to paper towels as they are cooked and sprinkle them with salt. In a bowl combine the mayonnaise with the harissa. Serve the panisse with the mayonnaise on the side.

NOTE: The uncooked panisse can be stored refrigerated in a container with a tight lid for up to 3 days.

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This gardener cut back on lawn mowing by planting trees and shrubs. Notice that the lawn itself does not grow up against the trees. This way the trees are not damaged while mowing the lawn. Photo by Ellen Barcel

By Ellen Barcel

Many aspects of gardening that we on Long Island take for granted are actually imports. We take honeybees for granted, but in actuality they were imported from Europe. The honey that we routinely enjoy and the pollination benefits they provide for gardeners and farmers are a result of this import. The earthworms that gardeners love to see, creating fertile aerated soil, are also imports, again courtesy of the early Colonists.

Our lush green lawns are another thing we take for granted. Yet before Colonial times, the native peoples had no use for lawns. Natural grasslands, like the prairies of the Great Plains and many other parts of the U.S., supported the buffalo and other grazing animals. Where native peoples farmed, they removed the vegetation and planted, in particular, corn, beans and squash, referred to as the Three Sisters.

So, where did our lawns come from? It’s a long story, but in a nut shell, European grasses were imported into North America, but initially only the rich could afford their maintenance, both here and in Europe. Grasses were trimmed by humans with scythes or by animals grazing on the property.

Interestingly, goats are currently being used in New York State to help eliminate invasive plants in the same way that grazing animals kept grasses trimmed before the lawn mower. They are currently being used on the Underhill Preserve near Jericho Turnpike and Route 106 to clear the land of invasive plants. A particular benefit is that they eat the roots, so that these invasive plants are wiped out. Plans are to remove the goats in mid-October. Hopefully native plants will fill in.

During World War I, a flock of sheep was kept on the White House lawn. It saved manpower and the wool was sold to raise money for the Red Cross. But, no, I’m not suggesting that we as homeowners should keep animals grazing on our lawns. For one thing, in most cases zoning laws prevent it. For another, caring for these animals is work.

In 1830, the mechanical lawn mower was invented, and beginning in the 1870s lawns began to appear, but it wasn’t until the 1930s that front lawns proliferated. They are a product of suburbia. Look at cities and you’ll see very few, if any, in the way of front lawns, even in areas where single- or double-family houses are located. Where suburbs developed in areas of frequent drought, even to this day, there are fewer lawns.

Remember that unless you live in a community with strict landscaping regulations, you don’t even need to have a front lawn. You could plant a variety of ornamentals and ground covers together with statuary. Using native plants, in particular, means less concern with watering and, of course, less mowing. A gardening acquaintance of mine had two acres of manicured lawns. He complained bitterly of the amount of time he spent mowing each weekend. He could have planted more trees and shrubs, removing much of the lawn, just keeping enough in the front of the house for appearance and enough in the back for relaxation.

Next week, we’ll take a look at fall lawn maintenance for those who enjoy their lawns.

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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Full-fat and low-fat cheeses are no better for you than refined grains. Stock photo

By David Dunaief, M.D.

We are constantly redefining or at least tweaking our diets. We were told that fats were the culprit for cardiovascular disease (CVD). That the root cause was saturated fats, specifically. However, a recent study showed the sugar industry had a strong influence on the medical and scientific communities in the 1960s and 1970s, influencing this perception (1).

Why is this all important? Well, for one thing, about one out every two “healthy” 30-year-olds in the United States will most likely develop CVD in their lifetime (2). This is a sobering statistic. For another, CVD is still the reigning notorious champion when it comes to the top spot for deaths in this country. Except, this disease is preventable, for the most part.

What can prevent CVD? You guessed it, lifestyle modifications, including changes in our diet, exercise and smoking cessation. There is no better demonstration of this than what I refer to as the “new” China Study, which was done through the Harvard T.H. Chan School of Public Health. I call it “new,” because T. Colin Campbell published a book in 2013 with the same name pertaining to the benefits of the Chinese diet in certain provinces. However, the wealthier China has become in the last few decades by opening its borders, the more it has adopted a Western hemisphere-type lifestyle, and the worse its health has become overall. In a recent study published in the Journal of the American College of Cardiology, results show that over 20 years the rate of CVD has increased dramatically in China, and it is likely to continue worsening over time (3). High blood pressure, elevated “bad” cholesterol LDL levels, blood glucose (sugars), sedentary lifestyle and obesity were the most significant contributors to this rise. In 1979 about 8 percent of the population had high blood pressure, but by 2010, more than one-third of the population did.

Does this sound familiar? It should, since this is due to adopting a Western-type diet. The researchers highlighted increased consumption of red meat and soda, an increasingly sedentary lifestyle and, unlike us, half the population still smokes. But you can see just how powerful the effects of lifestyle are on the world’s largest population. There were 26,000 people and nine provinces involved.

Cardiologist embraces fat

We are going to focus on one area, diet. What is the most productive diet for preventing cardiovascular disease? In a recent New York Times article, entitled “An Unconventional Cardiologist Promotes a High-Fat Diet,” published on Aug. 23, 2016, the British cardiologist suggests that we should embrace fats, including saturated fats (4). He has bulletproof coffee for breakfast, with one tablespoon of butter and one tablespoon of coconut oil added to his coffee. He also promotes full-fat cheese as opposed to low-fat cheese. These are foods that contain 100 percent saturated fats. He believes dairy can protect against heart disease. Before you get yourself in a lather, either in agreement or in disgust, let’s look at the evidence.

The Cheesy Study

Alert! Before you read any further, know that this study was sponsored by the dairy industry in Denmark. Having said this, this study would presumably agree with the unconventional cardiologist. The results showed that full-fat cheese was equivalent to low-fat cheese and to carbohydrates when it came to blood chemistries for cardiovascular disease, as well as to waist circumference (5). These markers included cholesterol, LDL “bad” cholesterol levels, fasting glucose levels and insulin. There were three groups in this study: those who consumed three ounces of full-fat cheese, low-fat cheese or refined bread and jam. The authors suggested that full-fat cheese may be part of a healthy diet. This means we can eat full-fat cheese, right? NOT SO FAST.

The study was faulty. The control arm was refined carbohydrates. And since both cheeses had similar results to the refined carbohydrates, the more appropriate conclusion is that full-fat and low-fat cheeses are no better for you than refined grains.

What about dairy fat?

In a meta-analysis (involving three studies — the Professional Follow-Up Study and the Nurses’ Health Studies 1 and 2), the results refute the claim that dairy fat is beneficial for preventing CVD (6). The results show that substituting a small portion of energy intake from dairy fat with polyunsaturated fats results in a 24 percent reduction in CVD risk. And doing the same with vegetable fats in replacement of dairy fat resulted in a 10 percent reduction in risk. Dairy fat was slightly better when compared to other animal fat.

This meta-analysis involved observational studies with a duration of at least 20 years and involving more than 200,000 men and women. There needs to be a large randomized controlled trial. But, I would not rush to eat cheese, whether it was the full-fat or low-fat variety. Nor would I drink bulletproof coffee anytime soon.

Saturated fat: not so good

In a recent meta-analysis (involving three studies run by the Harvard School of Public Health), replacing just 5 percent of saturated fats with both mono- and polyunsaturated fats resulted in a substantial reduction in the risk of mortality, 27 and 13 percent, respectively (7). This is a blow to the theory that saturated fats are not harmful to your health. Also, the highest quintile of poly- and monounsaturated fat intake, compared to lowest, showed reductions in mortality that were significant, 19 and 11 percent, respectively. Again, this is an observational conglomeration of studies, using the same studies as with the dairy results above. This analysis suggests that the unconventional cardiologist’s approach is not the one you want to take.

The good news diet!

Here is the good news diet. In a recent randomized controlled trial (RCT), the gold standard of studies, results showed that high levels of polyphenols reduce the risk of cardiovascular disease (8). Polyphenols are from foods such as vegetables, fruits, berries especially and, yes, chocolate. The researchers divided the study population into two groups, high and low polyphenol intake. The biomarkers used for this study were endothelial (inner lining of the blood vessel) dependent and independent vasodilators. The more dilated the blood vessel, the lower the hypertension and the lower the CVD risk. These patients had hypertension, a risk factor for CVD. Those who consumed high levels of polyphenols had higher levels of nutrients such as carotenoids and vitamin C in their blood.

Is fish useful?

In a study, results show that eating a modest amount of fish decreases the risk of death from CVD by more than one-third (9). What is a modest amount? Consume fish once or twice a week. You want to focus on fish that are rich in omega 3s — docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA). These are fatty fish with plenty of unsaturated fats, such as salmon. Thus, more of a Mediterranean-style diet, involving fruits and vegetables, as well as mono- and polyunsaturated fats in the forms of olive oil, nuts, avocado and fish may reduce the risk of CVD, while a more traditional American diet, with lots of pure saturated fats and refined carbohydrates may have the opposite effect. The reason we can’t say for sure that pure saturated fat should be avoided is that there has not been a large randomized controlled trial. However, many studies continually point in this direction.

References: (1) JAMA Intern Med. online Sept. 12, 2016. (2) Lancet. 2014;383(9932):1899-1911. (3) J Am Coll Cardiol. 2016;68(8):818-833. (4) NYTimes.com. (5) Am J Clin Nutr. 2016;104(4):973-981. (6) Am J Clin Nutr. Online Aug. 24, 2016. (7) JAMA Intern Med. 2016;176(8):1134-1145. (8) Heart. 2016;102(17):1371-1379. (9) JAMA. 2007;297(6):590.

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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