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By Yusuf A. Hannun, M.D. 

Dr. Yusuf Hannun

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

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

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

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

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

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

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

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

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

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

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

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Flavorings in drinks can make the refreshment less healthy than it appears. Stock photo

By Chris Zenyuh

“Natural” is one of the most abused terms in food marketing.

Most “natural flavors,” for example, are simply chemical compounds synthesized in the same laboratories as artificial flavors using slightly different techniques and sources.  Similarly, “fruit sugar” or fructose has an enticing natural sounding name, but very little of our fructose consumption actually comes from fruit.  Instead, we typically accumulate fructose via table sugar — half of every teaspoon turns to fructose in our digestive system — and/or high fructose corn syrup found in almost all processed foods and beverages, even fruit juice. Though coffee and tea are, by themselves, free of fructose, the commonly consumed versions with syrups and flavoring from familiar national chains are more akin to soda, nutritionally.

When it comes to fructose, you should keep a few things in mind to keep a more healthful perspective. As a sweetener, fructose hits 170 on a scale that ranks table sugar at 100 and glucose at 70.  It also tastes sweet faster, browns faster, and holds more moisture than other sugars.  These characteristics have made fructose an industry favorite, especially once the chemistry behind high fructose corn syrup became cost efficient.

The only organ in your body that can process fructose is your liver.  Metabolically, your body makes very little distinction between alcohol and fructose.  Both are seen as poisons and both are detoxified by your liver accordingly.  The primary distinction is that your brain can metabolize about 10 percent of the alcohol consumed, thus inebriation. Chronic exposure to fructose generates much of the same metabolic dysfunction as alcohol, including liver disease. Unfortunately, there is no “drinking age” for fructose, so even the youngest of children are regularly exposed to fructose.

Glucose and fructose molecules can stick to proteins in your body.  This is known as glycation.  The more your cells are exposed to these sugars, the more frequently this occurs.  Your body does have the ability to disconnect these molecules, but too much glycation can overwhelm that system. Eventually, the attachments become permanent, known as ‘advanced glycation end-products’ or A.G.E.s (a telling acronym, for sure).

These compromised proteins cross-link with each other in a manner that disrupts their function. Collagen fibers that should slide past each other become rigid and tear under stress. Skin wrinkles, ligaments tear, and the lens of your eye can start to block light (glaucoma). Consistently high levels of exposure are recorded by your blood cells as the hemoglobin becomes glycated. Blood tests can thereby show your general glucose and fructose levels over the three months preceding the test and indicate a pre-diabetic condition.

Notably, fructose attaches to proteins seven to ten times faster than glucose, and it is harder for your body to undo these attachments.  Following simple logic, that makes you age up to ten times faster, or faster than your dog.

Eating a reasonable amount of fruit is not a problem.  Beware of how easy it is to consume too much dried fruit, though. And remember that the true nutritional value of fruit resides in its vitamins, antioxidants and fiber.  When consumed whole, the potential negative metabolic impact of the sugars within is greatly lessened by the presence of the other nutrients, especially the fiber. Consuming ‘fruit sugar’ isolated from these beneficial components of fruit, including fruit juice, is a far more dangerous game to play with your metabolism.

Knowing how your body responds to fructose enables you to make more healthful choices regarding food and beverages. Choose well, live well.

Chris Zenyuh is a science teacher at Harborfields High School and has been teaching for
30 years.

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By Matthew Kearns, DVM

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

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

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

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

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

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

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

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

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

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

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

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

By David Dunaief, M.D.

Dr. David Dunaief

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

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

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

Impact on life span

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

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

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

Heart disease mortality

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

Heart attacks

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

 Effect on kidney function

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

Eating fish

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

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

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

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

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

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A recent study showed that patients who are very obese could lose almost two decades of healthy living
Quality of life impacts are considerable

By David Dunaief, M.D.,

Dr. David Dunaief

The media is increasingly focused on covering obesity-related issues. With this in mind, let’s start off with a short quiz to test your knowledge of obesity-related issues. The answers and research are provided below. Regardless of your quiz score, it is important to understand the research.

1. Obesity reduces life span by up to:

A) Not at all

B) 4 years

C) 8 years

D) 10 years

2. Obesity shortens healthy years of life by:

A) 8 years

B) 12 years

C) 15 years

D) 20 years

3. Food cravings can be reduced for the short term by:

A) Counting to 20

B) Tapping your finger against your head

C) Watching TV

D) Texting on your cellphone

4. Obesity can lead to the following complication(s):

A) High blood pressure

B) Diabetes

C) Cancer

D) All of the above

Are you eager to find out the answers? I hope so, because there are some very salient points I am trying to make by providing multiple choice questions. The answers are: 1. D; 2. D; 3. B; 4. D. So how did you do? One of the questions was actually similar to a question on a medical website for doctors, so don’t be too hard on yourself if you did not get them all right. Let’s look at the research.

Mortality and effect on life span

Many of you know that obesity could have an impact on development of other chronic diseases and a decrease in quality of life, but to what extent? A 2013 study indicated that almost as many as one in five deaths in the U.S. is associated with obesity (1).

In a computer modeling study, the results showed that those who are obese may lose up to eight years, almost a decade, of their life span (2). But that is only part of the results. The other, more compelling result is that patients who are very obese, defined as a BMI >35 kg/m², could lose almost two decades of healthy living. According to the researchers, this means you may have diseases such as diabetes and cardiovascular disease. However, even those patients who were obese and those who were overweight also could have reductions in life span, up to 6 years and 3 years, respectively.

There were 3,992 adults between the ages of 20 and 79 evaluated in this study. The data was taken from an NHANES database from 2003 to 2010, which looked at participants who went on to develop diabetes and cardiovascular disease. Though this is not a clinical trial, and there is a need for more study, the results are eye-opening, with the youngest and very obese negatively impacted the most.

Cancer impact

Since it is very difficult to “cure” cancer, although hopefully someday soon we will, it is important to reduce modifiable risk factors. Obesity may be one of these contributing factors, although it is hotly debatable how much of an impact obesity has on cancer development.  The American Society of Clinical Oncologists (ASCO), in a position paper, supported the idea that it is important to treat obesity in the fight against cancer (3). The authors indicate obesity may make the prognosis worse, may hinder the delivery of therapies to treat cancer, and may increase the risk of malignancy.

Also, possibly reinforcing ASCO’s stance, a study suggested that upward of a half-million cases of cancer worldwide were related to being overweight or obese, with the overwhelming concentration in North American and Europe (4).

Possible solutions

A potential counterweight to both the reductions in life quality and life expectancy may be the Mediterranean diet. In a published analysis of the Nurses’ Health Study, results show that the Mediterranean diet helped slow shortening of the telomeres (5). Repeat sequences of DNA found at the end of chromosomes, telomeres, shorten with age; the shorter the telomere, the shorter life expectancy.

Thus, the Mediterranean diet may decrease occurrence of chronic diseases, increase life span and decrease premature mortality — hence, the opposite effect of obesity. In fact, it may help treat obesity, though this was not mentioned in the study. Interestingly, the effects of the Mediterranean diet were on a dose-response curve. The greater the adherence to the diet, rated on a scale of 0 to 9, the better the effect. Those who had an increase in adherence by three points saw a corresponding decrease in telomere aging by 4.5 years. There were 4,676 middle-aged women involved in this analysis. The researchers believe that the anti-inflammatory and antioxidant effects could be responsible for the diet’s effects.

According to an accompanying editorial, no individual component of the diet was identified as having beneficial effects by itself, so it may be the diet as a whole that is important (6).

Short-term solutions

There are easy-to-use distraction tactics that involve physical and mental techniques to reduce food cravings. These include tapping your foot on the floor, staring at a blank wall and, yes, alternating tapping your index finger against your forehead and your ear (7). The forehead and ear tapping was most effective, although probably most embarrassing in public. Among mental techniques, seeing pictures of foods that were unhealthy and focusing on their long-term detriments to health had the most impact (8). All of these short-term distractors were done for 30 seconds at a time. The results showed that in obese patients they indeed decreased food cravings.

Exercise impact

I have written about exercise and that it does not lead to fat percentage loss in adults. Well, before you write off exercise for fat loss, it seems that adolescents may benefit from exercise. In a randomized controlled trial, the gold standard of studies, results show that those in the resistance training group alone and those in a combined resistance and aerobic training group had significantly greater percentages of fat loss compared to a control group (9).

However, the aerobic group alone did not show a significant change in fat percent versus the control. There were 304 study participants, ages 14 to 18, followed for a six-month duration, and results were measured with MRI. The reason that resistance training was effective in reducing fat percentage may have to do with an increase in muscle mass rather than a decrease in actual fat. Still, exercise is important. It doesn’t matter if it decreases the fat percentage; it is still getting you to the goal.

Obesity can have devastating effects, from potentially inducing cancer or worsening it, to shortening life expectancy and substantially decreasing quality of life. Fortunately, there may be ways to help treat obesity with specific lifestyle modifications. The Mediterranean diet as a whole may be an effective step toward decreasing the burden of obesity and reducing its complications. Kids, teenagers specifically, should be encouraged to “Play 60,” as the NFL has encouraged, but also to do some resistance training. As we mentioned, there are simple techniques that may help reduce short-term food cravings.

References: (1) Am J Public Health. 2013;103:1895-1901. (2) The Lancet Diabetes & Endocrinology, online Dec. 5, 2014. (3) J Clin Oncol. 2014;32(31):3568-3574. (4) The Lancet Oncology. online Nov. 26, 2014. (5) BMJ. online Dec. 2, 2014. (6) BMJ 2014;349:g6843. (7) Obesity Week 2014 abstract T-2658-P. (8) Obesity Week 2014 abstract T-3023-OR. (9) JAMA Pediatr. 2014;168(11):1006-1014.

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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Maria Hoffman, Jane Fasullo, chair of the Long Island chapter of the Sierra Club, and George Hoffman attended the People’s Climate March in Washington D.C. Photo from Maria Hoffman

By George and Maria Hoffman

Two years ago the United States was the leading voice on global climate action at the Paris conference. Then came the November election and this week the new president will be deciding whether or not the U.S. will even remain in the Paris climate agreement.

Facing such a policy sea change, we decided to travel to Washington D.C. April 29 and join with more than 200,000 people from across the U.S. to show our support for continued government action in reducing greenhouse gas emissions that are dangerously warming
our planet.

At 2 a.m. our journey began, meeting a bus at Stony Brook University that was chartered by the local chapter of the Sierra Club. There we were joined by dozens of Long Islanders who like us were compelled to travel to Washington and take part in the People’s Climate March.

The bus was filled with college students, retirees and people of all ages in between, who joined together because of their concern about our planet.

We arrived at Robert F. Kennedy Memorial Stadium in the early hours of the morning, converging on Washington with hundreds of other buses filled with people from other states across the U.S. There was a friendly, small-town camaraderie as we were given instructions by march organizers about the day’s events and where we were to meet up by the Capitol building.

It was heartening to see so many people who were willing to wake up in the middle of the night to travel hundreds of miles to the Capitol for the purpose of using the power of our numbers to show our leaders that the issue of climate change needs action now.

As the sun climbed the morning sky, the April temperatures started to feel like summer, eventually reaching a record 91 degrees Fahrenheit degrees. But the marchers were not discouraged by the heat and marched from the Capitol down Pennsylvania Avenue to the White House with signs and banners supporting clean energy, staying in the Paris agreement and warnings that our seas were rising and the planet was in jeopardy.

As we walked to the White House, we noticed there were a lot of people carrying signs about the effect of climate change on honey bees. As beekeepers ourselves, we know that the effects of climate change—from extreme weather fluctuations to earlier flowering times—can have a devastating impact on both pollination and the survival of local bee colonies and wild pollinators.

One of the most powerful moments of the march happened as we passed the Newseum, the museum dedicated to the five freedoms of the First Amendment, and we saw etched on its facade the solid and simple words of the First Amendment that gave “the right of the people peaceably to assemble, and to petition the government for a redress of grievances.” To read this amendment carved in stone before us as we exercised the very freedoms made real by those words was profound and moving.

After the march was over and we returned to our buses for the long drive back to Long Island, many of us shared stories about the day’s events and how energized we were by taking part in a show of strength in our nation’s capital in support of continued action on climate change. 

After almost 24 hours from the start of our journey, we pulled back into the university. We were tired from our long march down Pennsylvania Avenue. But a spark returned as we spoke of that moment as we passed the Newseum and saw the words of the First Amendment. That moment seemed to be fundamental both to the day and to what it meant be an American citizen. We had peaceably assembled, and petitioned our leaders to accept the scientific consensus that the Earth is warming and to take action to prevent further harm.

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File photo

By Samuel L. Stanley, Jr.

Samuel L. Stanley Jr.

In recognition of his dedication to the cancer fight, Stony Brook University proudly honored the 47th Vice President of the United States Joseph R. Biden Jr. at the Stars of Stony Brook Gala — our annual fundraising event — on Wednesday, April 19.

Hosted by the Stony Brook Foundation, the gala generates funds for student financial aid and a select academic area of excellence. This year, the university raised $6,946,000 in gifts and pledges, including $2,051,000 for scholarships and $4,895,000 to support the Stony Brook University Cancer Center. Since 2000, the event has raised more than $50 million.

As vice president, Joe Biden led the White House Cancer Moonshot Task Force. Its mission: to double the rate of progress in preventing the disease that leads to more than 8 million deaths worldwide every year. The intention, said Biden in his remarks, was to infuse the cancer research culture with “the urgency of now.”

At Stony Brook, we share Joe Biden’s determination, sense of urgency and his fundamental confidence in our ability to make a difference in the fight against cancer. The Stony Brook Cancer Center brings together the brightest minds, enhancing purposeful collaboration, and creating strategic partnerships to share information and accelerate research.

Our researchers are receiving worldwide attention for a pioneering study of the genesis and behavior of cancer cells at the molecular level with the goal of one day helping to detect, treat and eventually eliminate the disease for good.

Through continual research and discovery, Stony Brook Cancer Center is on the forefront of cancer care. In the new Kavita and Lalit Bahl Center for Metabolomics and Imaging, for instance, Dr. Yusuf Hannun and Dr. Lina Obeid are receiving international recognition for their pioneering studies in the relationship between cancer and lipids, naturally occurring molecules in the body such as fats. Their work is changing what is known about the role lipids play in cancer and brings us closer to understanding how to prevent and treat the disease.

Next year, the Stony Brook Cancer Center will relocate from its current location on the Stony Brook Medicine campus to the new 254,000-square-foot Medical and Research Translation (MART) building, designed to enable scientists and physicians to work side by side to advance cancer research and imaging diagnostics.

We’re thrilled that for one big night, we shined a white-hot light on the cancer issue and worked to raise awareness and money that will no doubt play a continuing role in bringing an end to this disease.

Dr. Samuel L. Stanley Jr. is president of Stony Brook University.

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Hypertension risk factors include poor diet, lack of exercise, age and depression.
Complications are highest during sleeping hours

By David Dunaief, M.D.

Dr. David Dunaief

Hypertension (high blood pressure) deserves a substantial amount of attention. There are currently about 76 million people with high blood pressure in the U.S. Put another way, one in three adults have this disorder (1). If that isn’t scary enough, the Centers for Disease Control and Prevention reports that the number of people dying from complications of hypertension increased by 23 percent from 2000 to 2013 (2).

And talk about scary, it turns out that fear of the boogie man should take a back seat to high blood pressure during nighttime sleeping hours. This is when the probability of complications, such as cardiovascular events and mortality, may have their highest incidence.

Unfortunately, as adults, it does not matter what age or what sex you are; we are all at increased risk of complications from high blood pressure, even isolated systolic (top number) blood pressure, which means without having the diastolic (bottom number) elevated as well. Fortunately, hypertension is highly modifiable in terms of reducing the risk of cardiovascular disease and mortality (3). At least some of the risk factors are probably familiar to you. These include being significantly overweight and obese (BMI >27.5 kg/m²), smoking, poor diet, lack of exercise, family history, age, increased sodium, depression, low vitamin D, diabetes and too much alcohol (4).

Of course, antihypertensive (blood pressure) medications treat this disorder. In addition, there are nonpharmacological approaches that have benefits. These include lifestyle modifications with diet, exercise and potentially supplements. An item on the game show “Jeopardy” read: “You can treat it with diet and lifestyle changes as well as drugs: HBP.” The corresponding answer was, “What is high blood pressure?” We made the big time!

Risk factors matter, but not equally

In a study, results showed that those with poor diets had 2.19 times increased risk of developing high blood pressure. This was the greatest contributor to developing this disorder (5). Another risk factor with a significant impact was being at least modestly overweight (BMI >27.5 kg/m²) at 1.87 times increased risk. This surprisingly, albeit slightly, trumped cigarette smoking at 1.83 times increased risk. Interestingly, weekly binge drinking at 1.87 times increased risk was equivalent to being overweight. This study was observational and involved 2,763 participants. The moral is that a freewheeling lifestyle can have a detrimental impact on blood pressure and cause at least stage 1 hypertension (systolic between 140 and 159 mmHg and/or diastolic between 90 and 99 mmHg).

High blood pressure doesn’t discriminate

One of the most feared complications of hypertension is cardiovascular disease, because it can result in death. In a study, isolated systolic hypertension was shown to increase the risk of cardiovascular disease and death in both young and middle-aged men and women between 18 and 49 years old, compared to those who had optimal blood pressure (6). The effect was greatest in women, with a 55 percent increased risk in cardiovascular disease and 112 percent increased risk in heart disease death. High blood pressure has complications associated with it, regardless of onset age. Though this study was observational, which is not the best, it was very large and had a 31-year duration.

Nightmares that may be real

Measuring blood pressure in the clinic can be useful. However, in a meta-analysis (involving nine studies from Europe, South America and Asia), the results showed that high blood pressure measured at nighttime was potentially a better predictor of myocardial infarctions (heart attacks) and strokes, compared to daytime and clinic readings (7).

For every 10 mmHg rise in nighttime systolic blood pressure, there was a corresponding 25 percent increase in cardiovascular events. This was a large meta-analysis that utilized studies that were at least one year in duration. Does this mean that nighttime readings are superior in predicting risk? Not necessarily, but the results are interesting. The nighttime readings were made using 24-hour ambulatory blood pressure measurements (ABPM).

There is something referred to as masked uncontrolled hypertension (MUCH) that may increase the risk of cardiovascular events in the nighttime. MUCH occurs in those who are well-controlled during clinic readings for blood pressure; however, their nocturnal blood pressure is uncontrolled. In the Spanish Society of Hypertension ABPM Registry, MUCH was most commonly seen during nocturnal hours (8). Thus, the authors suggest that ABPM may be a better way to monitor those who have higher risk factors for MUCH, such as those whose pressure is borderline in the clinic and those who are smokers, obese or have diabetes.

Previously, a study suggested that taking at least one antihypertensive medication at night may be more effective than taking them all in the morning (9). Those who took one or more blood pressure medications at night saw a two-thirds reduction in cardiovascular event risk. Now we can potentially see why. These were patients who had chronic kidney disease (CKD). Generally, 85 to 95 percent of those with CKD have hypertension.

Dietary tidbits

Diet plays a role in controlling high blood pressure. In a study, blueberry powder (22 grams) in a daily equivalent to one cup of fresh blueberries reduced systolic blood pressure by a respectable 7 mmHg and diastolic blood pressure by 5 mmHg over 2 months (10). This is not bad, especially since the patients were prehypertensive, not hypertensive, at baseline, with a mean systolic blood pressure of 138 mmHg.

This is a modest amount of fruit with a significant impact, demonstrating exciting results in a small, preliminary, double-blind, placebo-controlled randomized trial. Blueberries increase a substance called nitric oxide, which helps blood vessels relax, reducing blood pressure.

The results of another study showed that girls who consumed higher levels of potassium-rich foods had a significant reduction in both systolic and diastolic blood pressure (11). The highest group consumed at least 2,400 mg of potassium daily, whereas the lowest group consumed less than 1,800 mg. The girls were 9 and 10 years old and were followed for a 10-year duration. Though the absolute change was not large, the baseline blood pressure was already optimal for both groups, so it is impressive to see a significant change.

In conclusion, nighttime can be scary for high blood pressure and its cardiovascular complications, but lifestyle modifications, such as taking antihypertensive medications at night and making dietary changes, can have a big impact in altering these serious risks.

References: (1) Health Stat Report 2011. (2) CDC.gov. (3) Diabetes Care 2011;34 Suppl 2:S308-312. (4) uptodate.com. (5) BMC Fam Pract 2015;16(26). (6) J Am Coll Cardiol 2015;65(4):327-335. (7) J Am Coll Cardiol 2015;65(4):327-335. (8) Eur Heart J 2015;35(46):3304-3312. (9) J Am Soc Nephrol 2011 Dec;22(12):2313-2321. (10) J Acad Nutr Diet 2015;115(3):369-377. (11) JAMA Pediatr online April 27, 2015.

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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Mediterranean Diet
Can we overcome our genes?

By David Dunaief, M.D.

Dr. David Dunaief

We have made great strides in the fight against heart disease, yet it remains the number one cause of death in the United States. Approximately one-third of Americans over the age of 35 will die of heart disease (1). I hope this statistic has captured your attention, because it should. What is causing or contributing to such high numbers of heart disease deaths: genetics, environment or both? Many of us have the propensity toward heart disease. Can we alter this course, or is it our destiny?

A 2013 study, involving the Paleo-type diet and other ancient diets, suggests that there is a significant genetic component to cardiovascular disease, while another study looking at the Mediterranean-type diet implies that we may be able to reduce risk factors greatly. Most of the risk factors for heart disease, such as high blood pressure, high cholesterol, sedentary lifestyle, diabetes, smoking and obesity are modifiable (2). Let’s look at the evidence.

Genetic components

In a study published online in The Lancet, researchers used computed tomography scans to look at 137 mummies from ancient times across the world, including Egypt, Peru, the Aleutian Islands and Southwestern America (3). The cultures were diverse, including hunter-gatherers (consumers of a Paleo-type diet), farmer-gatherers and solely farmers. Their diets were not vegetarian but rather involved significant amounts of animal protein: fish and/or cattle.

Researchers found that one-third of these mummies had atherosclerosis (plaques in the arteries), which is a precursor to heart disease. The ratio should sound familiar. It seems to coordinate with modern times.

Interestingly, but not surprisingly, the average age of death was 43. The authors concluded that atherosclerosis could be part of the aging process in humans. In other words, it may be a result of our genes. Being human, we all have a genetic propensity toward atherosclerosis and heart disease — some more than others — but many of us can reduce our risk factors significantly.

I am not saying that the Paleo-type diet specifically is not beneficial compared to the standard American diet. Rather, that we do not know it based on this study, which was not meant to provide the validity of the Paleo-type diet, but whether atherosclerosis is part of the normal aging process. However, other studies demonstrate that we can reduce our chances of getting heart disease with lifestyle changes, potentially by following a Mediterranean-type diet with an emphasis on a plant-rich approach.

Mediterranean-type diet

A study about the Mediterranean-type diet and its potential positive impact on cardiovascular disease risk was published in the New England Journal of Medicine (4). Here, two variations on the Mediterranean-type diet were compared to a low-fat diet. People were randomly assigned to three different groups. The two Mediterranean-type diet groups both showed about a 30 percent reduction in the risk of cardiovascular disease, with end points including heart attacks, strokes and mortality, compared to the low-fat diet. This improvement in risk profile occurred even though there was no significant weight loss.

The Mediterranean-type diets both consisted of significant amounts of fruits, vegetables, nuts, beans, fish, olive oil and potentially wine. I call them “the Mediterranean diet with opulence,” because both groups consuming this diet had either significant amount of nuts or olive oil and/or wine. If the participants in the Mediterranean diet groups drank wine, they were encouraged to drink at least one glass a day.

The study included three groups: a Mediterranean diet supplemented with mixed nuts (almonds, hazelnuts or walnuts), a Mediterranean diet supplemented with extra virgin olive oil (at least four tablespoons a day) and a low-fat control diet. The patient population included over 7,000 participants in Spain at high risk for cardiovascular disease. The high-risk population included those with high blood pressure (80 percent of the population), diabetes and those who were overweight and/or were smokers.

The strength of this study, beyond its high-risk population and its large size, was that it was a randomized clinical trial, the gold standard of trials. However, there was a significant flaw, and the results need to be tempered. The group assigned to the low-fat diet was not, in fact, able to maintain this diet throughout the study. Therefore, it really became a comparison between variations on the Mediterranean diet and the standard American diet.

What do the leaders in the field of cardiovascular disease and integrative medicine think of the Mediterranean diet study? Interestingly there are two diametrically opposed opinions, split by field. You may be surprised by which group liked it and which did not. Cardiologists hailed the study as a great achievement. They included Henry Black, M.D., who specializes in high blood pressure, and Eric Topol, M.D. They emphasized that now there is a large RCT measuring clinical outcomes, such as heart attacks, stroke and death.

On the other hand, the integrative medicine physicians, Caldwell Esselstyn, M.D., and Dean Ornish, M.D., both of whom stress a plant-rich diet that may be significantly more nutrient dense than the Mediterranean diet in the study, expressed disappointment with the results. They feel that heart disease and its risk factors can be reversed, not just reduced. Both clinicians have published small, well-designed studies showing significant benefits from plant-based diets (5, 6). Ornish actually showed a reversal of atherosclerosis in one of his studies (7).

So which group of physicians is correct about the Mediterranean diet? Each opinion has its merits. The cardiologists’ enthusiasm is warranted, because a Mediterranean diet, even one of “opulence,” will appeal to more participants, who will then realize the benefits. However, those who follow a more strict diet, with greater amounts of nutrient-dense foods, will potentially see a reversal in heart disease, minimizing risk — and not just reducing it.

Thus, even with a genetic proclivity toward cardiovascular disease, we can very much alter our destinies. The degree depends on the willingness of the participants. Potentially, we can have an impact that ranges from reduction to reversal.

References: (1) Circulation. 2008;117(4):e25. (2) www.uptodate.com. (3) The Lancet. 2013;Mar 11. (4) N Engl J Med. Online 2013;Feb 25. (5) J Fam Pract. 1995;41(6):560-568. (6) Am J Cardiol. 2011;108:498-507. (7) JAMA. 1998 Dec 16;280(23):2001-2007.

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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Honoree US Vice President Joe Biden (center) stands with Samuel L. Stanley Jr., President, Stony Brook University, Former and James H. Simons, Chair Emeritus, Stony Brook Fountation and IMAX CEO Richard L. Gelfond during the 2017 Stars of Stony Brook Gala at Chelsea Piers April 19, 2017, in New York, NY. (Mark Von Holden/AP Images for Stony Brook University)

Stony Brook University recognized the 47th vice president of the United States of America, the Honorable Joseph R. Biden Jr., at its 18th annual Stars of Stony Brook Gala on April 19 at Pier Sixty at Chelsea Piers in New York City. The former vice president was recognized for his outstanding career and dedication to the fight against cancer.

“Cancer touches us all in some way and at some point,” said Biden. “Everywhere I go, people share their stories of heartbreak and hope. And every day, I’m reminded that our work to end cancer as we know it is bigger than just a single person. It carries the hopes and dreams of millions of people who are praying that we succeed, praying for hope, praying for time — not someday, but now.”

As vice president, Biden led the White House Cancer Moonshot, with the mission to double the rate of progress in preventing and fighting the disease. Under his leadership, the White House Cancer Moonshot Task Force catalyzed novel, innovative and impactful collaborations among 20 government agencies, departments and White House offices and over 70 private sector collaborations designed to achieve a decades’ worth of progress in the prevention, diagnosis and treatment of cancer in just five years.

In addition, Biden helped lead the effort to pass the 21st Century Cures Act that provides $1.8 billion over seven years for the Cancer Moonshot’s scientific priorities.

“We are privileged to have the opportunity to honor former Vice President Biden,” said Stony Brook University President Samuel L. Stanley. “The Cancer Moonshot has the potential to transform cancer research and prevention around the world. This critical initiative is a reflection of the work our researchers and doctors are doing in Stony Brook Cancer Center labs — using insight, innovation and strategic collaborations to push the boundaries of what we know about how best to diagnose, treat and ultimately prevent the disease that is responsible for more than 8 million deaths a year worldwide.”

Research and discovery are at the heart of the Stony Brook ethos and the university’s Cancer Center is a shining example of its commitment to combating the malady. Stony Brook doctors are on the forefront of the next generation in cancer care.

The Cancer Center will relocate next year to the new 254,000 square-foot Medical and Research Translation facility (MART), which was designed to enable scientists and physicians to work side by side to advance cancer research and imaging diagnostic and will be the home to the new Bahl Center for Metabolomics and Imaging. Stony Brook researchers are receiving worldwide attention for their pioneering research into the genesis and behavior of cancer cells at the molecular level, which will one day help detect, treat, and eliminate the disease altogether.

Every spring the Stony Brook Foundation hosts the Stars of Stony Brook Gala to benefit student scholarships and a select academic program. Since its inception in 2000, the event has raised more than $42 million. A portion of the net proceeds from this year’s gala will support the Stony Brook Cancer Center.

Biden joins a distinguished roster of scholars, politicians, celebrities and luminaries who have been honored by the gala for their outstanding and relentless commitment to society, including Nobel Laureate CN Yang; actors Julie Andrews, Alan Alda and Ed Harris; founder of Renaissance Technologies Jim Simons; CA Technologies founder Charles Wang; and world-renowned conservationists Richard Leakey and Patricia Wright.

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