MOTHER NATURE’S COLOR PALETTE
Who needs fireworks when the sky can explode with color all by itself? Robert Hessner sent in this stunning sunset photo taken by his daughter Holly with her iPhone on June 27 after spending the day in picturesque Stony Brook Village.
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MEET MR. SMITHERS!
This week’s shelter pet is Mr. Smithers, an extremely friendly and affectionate senior cat currently up for adoption at the Smithtown Animal Shelter.
At 10 years old, Mr. Smithers is certainly not the shy or quiet type. This little chatterbox will let you know when he is in need of some more TLC or attention. If the occasional meow doesn’t do the trick, this dapper gentleman will cuddle up to you with a nudge to ask for more attention. He has a hyperthyroid condition that requires a little extra care, but this is easily managed with daily medications. Mr. Smithers would make a wonderful addition to any family!
If you are interested in meeting Mr. Smithers, please fill out an adoption application online at www.townofsmithtownanimalshelter.com.
The Smithtown Animal & Adoption Shelter is located at 410 Middle Country Road, Smithtown. For more information, call 631-360-7575.
By Barbara Beltrami
When it’s not dark enough yet for fireworks or when the fireworks are over and you’re hankering for a nice cup of coffee, it’s time to bring out the dessert. The following recipes are delicious finishes to a long day celebrating our independence They all are patriotically correct red, white and blue and sure to please.
Fireworks Cupcakes
YIELD: Makes about 2 dozen cupcakes
INGREDIENTS:
For the cupcakes:
1/2 cup unsalted butter, at room temperature
1 2/3 cups sugar
3 egg whites, at room temperature
2 teaspoons vanilla extract
2 1/4 cups flour
1 tablespoon baking powder
1/2 teaspoon salt
1 cup milk
1 cup vanilla cookie crumbs
For the frosting:
3/4 cup unsalted butter, at room temperature
6 cups sifted confectioners’ sugar
1/2 teaspoon vanilla extract
3 1/2 tablespoons milk
Red, white and blue sprinkles
Star sprinkles
DIRECTIONS:
For the cupcake batter:
Preheat oven to 350F. Line 24 cupcake pans with cupcake papers. In a large bowl, cream together butter and sugar. Add one egg white at a time beating well after each addition. Beat in vanilla. In another large bowl, thoroughly combine flour, baking powder and salt; add to creamed mixture alternately with milk, beating well after each addition. Fold in cookie crumbs.
Fill prepared cupcake tins two-thirds full; bake about 22 minutes or until a cake tester inserted in center comes out clean. Cool 10 minutes in pans, then transfer to wire racks to cool completely.
For the frosting:
In a large bowl combine the butter, confectioners’ sugar and vanilla extract. Add the milk very gradually to form a stiff frosting; beat until smooth. Spread the frosting on cooled cupcakes; top with sprinkles. Serve with coffee, milk or fruit punch.
Fourth of July Pie
YIELD: Makes 8 servings
INGREDIENTS:
One baked 9” pastry crust
1 pint raspberry sorbet, softened
2 cups sliced strawberries
1 pint strawberry ice cream, softened
2 cups blueberries
1 cup sweetened whipped cream
DIRECTIONS:
Spread baked pastry crust with raspberry sorbet; top with half the sliced strawberries; and freeze for one hour. Spread strawberry ice cream evenly over the strawberries; top with half the blueberries; freeze two hours. Top with whipped cream; arrange remaining berries in an attractive pattern on top. Let sit in refrigerator half an hour before serving or freeze, covered, for up to 48 hours. Serve with coffee, milk or fruit punch
Strawberry, Raspberry and Blueberry Cornmeal Cobbler
YIELD: Makes 8 servings
INGREDIENTS:
1 pint blueberries
1 pint raspberries
1 pint strawberries, hulled and halved
1/2 cup sugar
3 tablespoons cornstarch
1/3 cup sugar
2 tablespoons unsalted butter, at room temperature
1 egg
1 teaspoon vanilla
2/3 cup flour
1/3 cup yellow cornmeal
2 teaspoons baking powder
1/4 teaspoon coarse salt
1/4 cup milk
DIRECTIONS:
Preheat oven to 350 F. Grease an 8” x 8” square baking dish. In a large bowl toss together the berries, the half cup sugar and cornstarch.; transfer to baking dish. In a large bowl with mixer on medium speed, beat together the one-third cup sugar and butter until light and fluffy, about 2 to 3 minutes; add egg and vanilla and beat until well blended.
In a small bowl, combine flour, cornmeal, baking powder and salt. Add half the flour mixture to the butter mixture; beat on low speed just until combined; beat in the milk, then the remaining flour mixture. Drop the dough by spoonfuls onto the berries; bake until berries are bubbly and top is golden, about 45 minutes to one hour. Serve with vanilla ice cream.
By Daniel Dunaief
Pregnant women with access to the outdoors are less stressed during the pandemic.
In fact, according to an unpublished finding that isn’t yet peer reviewed, pregnant women who had outdoor access were 67 percent less likely to worry about contracting the virus and 63 percent less likely to feel stress about being unprepared for the birth.
Stony Brook University recently awarded a project led by Dr. Heidi Preis in the Department of Psychology, with co-Principal Investigators Dr. Marci Lobel in the Department of Psychology and Dr. Brittain Mahaffey in the Department of Psychiatry and Behavioral Health that explored the link between stress and pregnancy. The researchers are hoping to identify what helps pregnant women and what may make them more vulnerable to the impacts of stress.
Stony Brook provided a total of $398,200 in seed funding to 17 research projects in response to the pandemic. Researchers at Stony Brook had put together 63 submissions, using a peer review process to choose the projects to fund, including the COVID-19 Pregnancy Experiences (or COPE) Study. The funding, which is for one year, is designed to provide the kind of seed funding that will lead to further research and that other funding agencies will support.
The COPE study tapped into a global network of collaborators that Lobel, who is the Director of the Stress and Reproduction Lab at SBU, established over the past 30 years to compare the different factors that mitigate or exacerbate stress for pregnant women in Spain, Israel, Italy, Germany Poland and Switzerland.
“The biological impact of COVID-19 is getting the lion’s share of attention, as it should,” said Lobel. “We don’t yet know enough about how the psychological impact will affect vulnerable groups, like pregnant women.”
Indeed, Lobel has spent three decades studying the effect of stress and related psychological factors on pregnancy. In other studies, major stressors, such as earthquakes, ice storms, and periods of warfare, confirm the toxic impact of prenatal stress, particularly for preterm births and low birth weight, she said.
Lobel and her colleagues created a self-report instrument called the Pandemic-Related Pregnancy Stress Scale, or PREPS, in which women report their specific concerns or anxieties caused by COVID-19.
Throughout the United States, the team sought responses from about 4,500 women recruited through social media at the end of April and the beginning of May.
Among the women in the study, just over half of them were pregnant with their first child. In many studies that predated the current work, including some from her own research group, Lobel said women pregnant with their first child had higher levels of stress.
In some preliminary findings, 21.7 percent of pregnant women in the study reported severe levels of anxiety. “I think that is higher than what we typically would find in a population study of pregnant women,” Lobel said.
Women with a history of interpersonal violence also reported higher levels of stress and those whose prenatal appointments were canceled or altered were 1.78 times more likely to experience high stress related to a lack of preparedness and 1.49 times more likely to experience high stress related to worries about perinatal infection.
Some women in the study have found ways to reduce the accumulating stress about the health care crisis. The techniques that work for some women, Lobel said, may not work for others, suggesting that stress relief is specific to the individual and is usually determined by the situation itself.
“I don’t recommend any particular way of coping,” Lobel said. “What works for one may not work for another. It’s good to have a tool kit with lots of ways of coping.”
Indeed, some of the techniques pregnant women have found helpful include meditation, prayer, and faith-based practices. Pregnant women have also benefited from social support, which is particularly important during the pandemic when some women may feel “literally and figuratively isolated from others,” Lobel said.
Of all the research Lobel has done, the one that has received the most attention and landed her in the bible for pregnant women, “What to Expect When You’re Expecting,” was a study on optimism. She found that women who were more optimistic had better birth outcomes due in part to the better are they took of their health during pregnancy.
Coping with stress by avoidance predicts increases in emotional distress, Lobel explained. This corroborates much research which shows that avoidance is usually an ineffective way to cope with stress, except in limited cases such as when a stressful situation is brief and uncontrollable.
When people avoid the things that bother them, they can do it cognitively or through alcohol, which is especially dangerous for pregnant women and their developing fetuses. Avoidance can also involve excessive sleeping, as pregnant women may decide they don’t want to deal with life and stay in bed all day.
The scientists plan to collect a second set of data from these women, who were recruited through social media and who represent a diverse socioeconomic background, race and ethnicity, sexual orientation, and other factors, on July 15th.
Lobel said she already has some preliminary, unpublished findings from Poland, which are showing the same kinds of stressors and distress among pregnant women. Polish women have expressed stress related to worries about lack of preparation for birth during the pandemic and stress related to worries about infection.
Lobel said the researchers hope to explore a host of questions as they collect more information. They hope to look at obsessions and compulsions and would like to measure anger. They also will measure levels of depression and anxiety and will compare that to the norms for non-pregnant women.
On the other side of the stress meter, the group will study how being pregnant during the pandemic may help some women appreciate their pregnancy more. For some women, the pregnancy may give them strength to deal with the pandemic, as they focus on having a baby.
The researchers will also explore the level of control women feel over the outcome of their pregnancy and the health of their baby. Feeling in control can create a positive response associated with lower distress.
While Lobel and her colleagues won’t answer all these questions in a year, they hope their initial studies will lead to more funding and research. “Hopefully, we’ll get a [National Institutes of Health] grant to follow up these women for a couple of years to study them and their children to see if there are any developmental or mental or physical health effects” of the pandemic.
By Linda Toga, Esq.
With the COVID-19 pandemic on everyone’s mind, many people who have not engaged in estate planning have contacted me about how best to proceed with the development of an estate plan.
It seems that the fear of the virus has made people understand the need for estate planning. However, even if you have a will or a trust, a power of attorney and/or a healthcare proxy, now is a good time to review your documents to confirm that they still express your wishes and meet your needs. Advanced planning is not something you think about once and forget. Successful planning requires that you periodically review and possibly revise your documents to reflect changes in your life circumstances.
Some things to think about are:
Your beneficiaries: Have any of the beneficiaries named in your will or trust passed away? If so, you may want to name some new beneficiaries to share in your estate. Even if a beneficiary is still living, you should ask yourself if that person is still someone to whom you wish to leave a bequest. Relationships change over time. Are there new people in your life who are important to you? Are there beneficiaries named in your documents with whom you now have little or no contact, perhaps as the result of a divorce or relocation? Did you name a charity that no longer exists as a beneficiary? Are any of the beneficiaries now disabled? If you answered “yes” to any of these questions, you should consider making changes to your will or trust.
The bequests: If you financial situation has changed since you created your estate plan and you can now make more generous bequests, you may want to revisit the size of bequests made to certain individuals. The converse is also true. If your estate is likely to be significantly smaller, perhaps you want to limit the bequests you are making either by removing some beneficiaries or decreasing the amount or percent of your estate going to each beneficiary.
Your fiduciaries: The word fiduciaries refers to the people you have named as executor, trustee, agent and/or guardian in your estate planning documents. If any of the people you named as a fiduciary have passed, you should name a successor. If you named a sibling as an executor because your children were minor and now they are responsible adults, perhaps you want to name one of more of your children as the executor(s) of your estate.
Many clients revise their estate plans and name their children as agents on their powers of attorney or healthcare proxies when their children are older, more responsible and in a better position to make important decisions. This may be something you want to consider. If you named guardians to care for your children in the event you die when the children are still minors, it is very important to revisit this appointment. Perhaps your children have attained the age of majority and no longer need a guardian in which case the provision naming a guardian can be deleted.
If a guardian may still be needed, you should consider the relationship the named guardian has with your children. Perhaps the person you named no longer has a good relationship with your children, or they have moved out of state and could only serve if your children are relocated. Has the guardian’s financial situation or living arrangements changed to the point that taking in and caring for your children will be overly burdensome? Since the guardian you name may be raising your children, all of these issues deserve serious thought.
Although there are many issues to consider when reviewing your estate plan, the points mentioned above can provide a good starting point. Retaining an experienced estate planning attorney to review your documents with you and to discuss any changes you may want made will ensure that your estate plan will once again reflect your wishes.
Linda M. Toga, Esq provides legal services in the areas of estate planning and administration, real estate, small business services and litigation. Call 631-444-5605 or email Ms. Toga at [email protected] to schedule a consultation.
By Daniel Dunaief
At the beginning of this month, the North Atlantic started its annual hurricane season that will extend through the end of November.
Each year, the National Oceanic and Atmospheric Administration offers a forecast in May for the coming season. This year, NOAA’s Climate Prediction Center anticipates a 60 percent chance of an above-normal season. The Center anticipates 13 to 19 storms, although that number doesn’t indicate how many storms will make landfall.
These predictions have become the crystal ball through which forecasters and city planners prepare for a season that involves tracking disturbances that typically begin off the West coast of Africa and pick up energy and size as they travel west across the Atlantic towards Central America. While some storms travel back out to sea, others threaten landfall by moving up the Gulf Coast or along Atlantic Seaboard of the United States.
Kevin Reed, an Associate Professor at Stony Brook University’s School of Marine and Atmospheric Sciences, and Alyssa Stansfield, a graduate student in his lab, recently predicted the likely amount of rainfall from tropical cyclones.
Using climate change projection simulations, Reed and Stansfield came up with a good-news, bad-news scenario for the years 2070 through 2100. The good news in research they published in Geophysical Research Letters is they anticipate fewer hurricanes.
The bad news? The storms will likely have higher amounts of rain, with increased rain per hour.
“If you focus on storms that make landfall over the Eastern United States, they are more impactful from a rainfall standpoint,” Reed said. “The amount of rainfall per hour and the rainfall impact per year is expected to increase significantly in the future.”
In total, the amount of rainfall will be less because of the lower number of storms, although the intensity and overall precipitation will be sufficient to cause damaging rains and flooding.
Warmer oceans and the air above them will drive the increased rainfall, as these storms pass over higher sea surface temperatures where they can gain energy. Warmer, moist air gives the hurricanes more moisture to work with and therefore more potential rainfall.
“As the air gets warmer, it can hold more water in it,” Stansfield said. “There’s more potential rain in the air for the hurricanes before they make landfall.”
Stansfield said the predictions are consistent with what climatologists would expect, reflecting how the models line up with the theory behind them. She explored how climate change affects the size of storms in this paper, but she wants to do more research looking at hurricane size in the future.
“If hurricanes are larger, they will drop rainfall over a larger area,” which could increase the range of area over which policy makers might need to prepare for potential damage from flooding and high winds, Stansfield said.
While her models suggest that storms will be larger, she cautioned that the field hasn’t reached a consensus about the size of future storms. As for areas where there is greater consensus, such as the increased rainfall their models predict for storms at the end of the century, Stansfield suggested that the confidence in the community about their forecasts, which use different climate models, is becoming “more apparent as more modeling groups reach the same conclusion.”
In explaining the expectations for higher rainfall in future storms, Reed said that even storms that had the same intensity as current hurricanes would have an increase in precipitation because of the availability of more moisture at the surface.
While storms in recent years, such as Hurricanes Harvey, Florence and Dorian dumped considerable rain in their path because they moved more slowly, effectively dumping rain over a longer period of time in any one area, it’s “unclear” whether future storms would move more slowly or stall over land.
Several factors might contribute to a decrease in the number of storms. For starters, an increase in wind sheer could disrupt the formation of some storms. Vertical wind sheer is caused when wind speed and direction changes with increasing altitude. Pre-hurricane conditions may also change due to internal variability and the randomness of the atmosphere, according to Reed.
Reed said the team chose to use climate models to make predictions for the end of the century because it is common in climate science for comparison to the recent historical record. They also used a 30 year period to limit some of the uncertainty due to internal variability of weather systems.
Stansfield, who is in her third year of graduate school and anticipates spending another two years at Stony Brook University before defending her graduate thesis, said she became interested in studying hurricanes in part because of the effects of Superstorm Sandy in 2012.
When she was younger, she and her father Greg used to go to the beach when a hurricane passed hundreds of miles off the coast, where she would see the impact of the storm in larger waves. At some point, she would like to fly in a hurricane hunter plane, traveling directly into a storm to track its speed and direction.
Stansfield said one of the more common misconceptions about hurricanes is that the category somehow determines their destructive power. Indeed, Superstorm Sandy was a Category 1 hurricane when it hit New York and yet it caused $65 billion in damage, making it the 4th costliest hurricane in the United States, according to the NOAA.
After Stansfield earns her PhD, she said she wants to continue studying hurricanes. One question that she’d like to address at some point is why there are between 80 to 90 hurricanes around the world each year. This has been the case for about 50 years, since satellite records began.
“That’s consistent every year,” she said. “We don’t know why that’s the number. There’s no theory behind it.” She suggested that was a “central question” that is unanswered in her field.
Understanding what controls the number of hurricanes will inform predictions about how that number will change in response to climate change.
By Barbara Beltrami
I think of scallions as the kinder, gentler member of the onion family. They have the flavor without the bitter aftertaste but offer the nuances of an onion-y taste. Suited more to delicate dishes than robust ones, they are especially nice in Asian-style cuisine. The other day I dug a lot of them out of my garden, brought them inside and vigorously washed the dirt off them. Then I trimmed them and laid them in a beautiful pyramid on my cutting board and realized I had more than I could use. Or did I? What about a creamy scallion soup? Or scallion pancakes? Or a scallion salad with radishes, cucumbers and herbs?
Creamy Scallion Soup
YIELD: Makes 4 to 6 servings
INGREDIENTS:
6 to 7 bunches of scallions
2 tablespoons unsalted butter
2 tablespoons extra virgin olive oil
1 large potato, peeled and diced
6 cups chicken broth
Salt and freshly ground pepper
1/2 cup heavy cream
1/4 cup snipped chives for garnish
DIRECTIONS:
Wash, trim and thinly slice the scallions. In a medium saucepan over medium-low heat melt butter with the olive oil; add scallions and, stirring often, cook until wilted but not browned. Add potato and chicken broth and over medium-high heat, bring to a boil. Reduce heat to medium-low and cook until potato is mushy; season with salt and pepper. Let soup sit until cooled slightly, about 15 minutes, then puree in food processor until smooth. Stir in cream; garnish with chives and serve hot, warm, at room temperature or cold with crusty bread and a tomato and cucumber salad.
Scallion and Kimchi Pancakes
YIELD: Makes 4 to 6 servings
INGREDIENTS:
1 cup flour
1/2 cup rice flour
Coarse salt
1 egg, beaten
1 cup sparkling water, seltzer or club soda
6 scallions, washed, trimmed and thinly sliced
1 cup drained kimchi (Korean preserved cabbage)
1/4 cup liquid from kimchi
1 tablespoon minced fresh red chile pepper
4 tablespoons vegetable oil
DIRECTIONS:
Preheat oven to 300 F. In a large bowl, mix together the flour, rice flour, salt, egg, sparkling water and kimchi liquid. Stir in scallions, kimchi and chile pepper. In an 8″ nonstick skillet heat 1 to 2 teaspoons oil. Ladle half a cup of batter to cover bottom of skillet and form an 8” pancake. Cook, turning once, until golden brown, about 2 to 3 minutes each side; transfer to shallow baking pan or baking sheet and place in oven to keep warm. Repeat procedure with remaining batter. Cut each pancake into quarters and serve hot or warm with Korean dipping sauce.
Scallion and Herb Salad with Radishes and Cucumbers
YIELD: Makes 6 to 8 servings
INGREDIENTS:
8 scallions, washed and trimmed, whites and greens separated
3 tablespoons rice vinegar
1 teaspoon sugar
Coarse salt to taste
1 cup fresh cilantro leaves
1 cup fresh arugula
6 to 8 radishes, washed, trimmed and very thinly sliced
1 cucumber, peeled, seeded and minced,
1 red chile, thinly sliced
1 tablespoon toasted sesame oil
1/2 cup toasted sesame seeds
DIRECTIONS:
Thinly slice scallion whites. In a large bowl, toss them with rice vinegar, sugar and salt; let sit about 10 minutes. Thinly slice scallion greens. Add them along with cilantro, arugula, radishes, cucumber, red chile, sesame oil and sesame seeds to scallion whites. Toss to combine all ingredients. Serve immediately with fish, poultry, pork or beef.
SUMMER TIDE
Elyse Buchman snapped this peaceful scene in her hometown of Stony Brook on June 14 while having a sunset dinner with her husband at the Hercules Pavilion.
Send your photo of the week to [email protected]
This article originally appeared on the Three Village Historical Society website and is reprinted with permission.
By Tara Ebrahimian
Juneteenth, first established by the Black community of Texas in 1866, is now getting in New York State the recognition it has long deserved. On June 17, 2020 Governor Andrew M. Cuomo announced that he would, by Executive Order, recognize Juneteenth as a state holiday, and put it before the New York legislature to make this mandate, law. Although Juneteenth began in the South, it is widely observed throughout the country. It is annually observed in New York, including on Long Island, through independent and collaborative celebrations. Juneteenth’s historic and cultural relevance impacts the entire nation and remains hugely significant for Black heritage and United States history.
It commemorates June 19, 1865, when enslaved Blacks learned that they were legally free. Union Army General Gordon Granger arrived with his troops in Galveston, Texas, and made a profound announcement: the war and slavery were over. Technically the war ended when General Robert E. Lee surrendered on April 9, 1865, and the Emancipation Proclamation, effective January 1, 1863, freed enslaved persons in Confederate states, but the news had not been shared in Texas. It was the last stronghold of slavery. Since 1862, when New Orleans was captured, slave owners from Mississippi, Louisiana, and other southern states had moved with their slaves to Texas. There were approximately 250,000 enslaved people residing in Texas when the declaration was made.
Granger’s delivery of the news did not result in an immediate end of slavery. Blacks in Galveston initially celebrated the revelation, but the mayor contradicted the law and forced them to go back to work. It was largely left to the slave owners’ discretion whether they informed individuals that they were no longer enslaved. Many did not initially share the information and instead waited for the arrival of a government agent to tell them. Blacks were frequently not informed until after the harvest. A number of newly emancipated individuals ignored the censure to stay put and left for Arkansas, Louisiana, and Oklahoma. They did so at their own risk; there were numerous reports of Blacks being lynched as they tried to leave.
In 1866 freed people in Texas, in conjunction with the Freedmen’s Bureau, organized formal celebrations for “Jubilee Day.” During the years immediately after the war, Jubilee Day was sometimes celebrated on January 1st, a reference to the enactment of the Emancipation Proclamation. It also functioned as a rally for political and social advancement; Jubilee Day frequently offered instruction for voter registration and participation. The day became a mainstream event in Black communities and featured festivities, activities, and food.
Segregation in cities prohibited Blacks from going to public parks. Church grounds were often used as sites for the events. And, freed individuals pooled money to purchase land on which to hold celebrations. For example, Black community leaders, led by Reverend Jack Yates, raised $1000 in 1872 to purchase land that is now Houston’s Emancipation Park. These annual celebrations began drawing thousands of participants throughout Texas and expanding beyond the state. By the end of the century, Jubilee Day was known primarily as Juneteenth.
During this period, many southern states enacted punitive and punishing Jim Crow legislation that undermined or undid the economic and political progress Blacks had made during and after Reconstruction. These local and state laws were designed to subjugate and stymie Black social, economic, and political development. They disenfranchised Black people through segregation and policies such as the Grandfather Clause that limited or eliminated voting rights.
Many freed people left Texas and the South in search of greater opportunities in the North. Juneteenth was a still Southern celebration and attendance outside of Texas began to wane. Younger generations, more removed from the war and seeking to distance themselves from the legacy of slavery, also started to distance themselves from participating in the unofficial holiday. As the twentieth century progressed, and people moved from agricultural to industrial employment, it was increasingly unlikely that people would be granted time off work for Juneteenth. The Great Depression, in particular, caused a migration from the country to the cities.
The Civil Rights movement caused a resurgence in awareness about Juneteenth. Black youth joined their elders in the fight for Civil Rights. There was increased interest in and engagement with history and how the past informs the present. The Poor People’s March to Washington, D.C. served as a catalyst for renewed interest in Juneteenth. Participants returned to their home states and initiated Juneteenth celebrations in locations that had never before experienced them.
In 1980, Texas was the first state to formally recognize Juneteenth; it declared the date a “holiday of significance…” At the end of the decade, California, Illinois, Wisconsin, Georgia, and Washington, D.C., were among the places that presented major events for Juneteenth. Although Congress has remembered Juneteenth in different ways over the years, it is not yet a national holiday. In New York, “Juneteenth Freedom Day” was first identified as a commemorative holiday in 2004, per a state law signed by Governor George Pataki.
Long Island hosts a growing number of events and programs dedicated to this occasion. Frequently celebrated on the third Sunday in June, modern events share certain traits with their predecessors, including picnics, cookouts, historical reenactments, street fairs, parades, etc. This year’s festivities are scaled back due to COVID-19, but certain celebrations, such as the Long Island Unity March on June 19, were still scheduled.
Author Tara Ebrahimian is the Education Coordinator at the Three Village Historical Society in Setauket — www.tvhs.org.
By David Dunaief, M.D.
Wherever you look there is an advertisement for the treatment of heartburn or indigestion, both of which are related to reflux disease.
Reflux typically results in symptoms of heartburn and regurgitation, with stomach contents going backward up the esophagus. For some reason, the lower esophageal sphincter, the valve between the stomach and esophagus, inappropriately relaxes. No one is quite sure why it happens with some people and not others. Of course, a portion of reflux is physiologic (normal functioning), especially after a meal (1). As such, it typically doesn’t require medical treatment.
Gastroesophageal reflux disease (GERD), on the other hand, differs in that it’s long-lasting and more serious, affecting as much as 28 percent of the U.S. population (2). Can you understand why pharmaceutical firms give it so much attention?
GERD risk factors are diverse. They range from lifestyle — obesity, smoking cigarettes and diet — to medications, like calcium channel blockers and antihistamines. Other medical conditions, like hiatal hernia and pregnancy, also contribute (3). Diet issues include triggers like spicy foods, peppermint, fried foods and chocolate.
Smoking and Salt
One study showed that both smoking and salt consumption added to the risk of GERD significantly (4). Risk increased 70 percent in people who smoked. Surprisingly, people who used table salt regularly saw the same increased risk as seen with smokers.
Medications
The most common and effective medications for the treatment of GERD are H2 receptor blockers (e.g., Zantac and Tagamet), which partially block acid production, and proton pump inhibitors (e.g., Nexium and Prevacid), which almost completely block acid production (5). Both classes of medicines have two levels: over-the-counter and prescription strength. Here, I will focus on PPIs, for which more than 100 million prescriptions are written every year in the U.S. (6).
The most frequently prescribed PPIs include Prilosec (omeprazole), Protonix (pantoprazole), Nexium (esomeprazole), and Prevacid (lansoprazole). They have demonstrated efficacy for short-term use in the treatment of Helicobacter pylori-induced (bacteria overgrowth in the gut) peptic ulcers, GERD symptoms and complication prevention and gastric ulcer prophylaxis associated with NSAID use (aspirin, ibuprofen, etc.) as well as upper gastrointestinal bleeds.
However, they are often used long-term as maintenance therapy for GERD. PPIs used to be considered to have mild side effects. Unfortunately, evidence is showing that this may not be true. Most of the data in the package inserts is based on short-term studies lasting weeks, not years. The landmark study supporting long-term use approval was only one year, not 10 years. However, maintenance therapy usually continues over many years.
Side effects that have occurred after years of use are increased risk of bone fractures and calcium malabsorption; Clostridium difficile, a bacterial infection in the intestines; potential vitamin B12 deficiencies; and weight gain (7).
Bacterial infection risks
The FDA warned that patients who use PPIs may be at increased risk of a bacterial infection called C. difficile. This is a serious infection that occurs in the intestines and requires treatment with antibiotics. Unfortunately, it only responds to a few antibiotics and that number is dwindling. In the FDA’s meta-analysis, 23 of 28 studies showed increased risk of infection. Patients need to contact their physicians if they develop diarrhea when taking PPIs and the diarrhea doesn’t improve (8).
B12 deficiencies
Suppressing hydrochloric acid produced in the stomach may result in malabsorption issues if turned off for long periods of time. In a study where PPIs were associated with B12 malabsorption, it usually took at least three years’ duration to cause this effect. B12 was not absorbed properly from food, but the PPIs did not affect B12 levels from supplementation (9). Therefore, if you are taking a PPI chronically, it is worth getting your B12 and methylmalonic acid (a metabolite of B12) levels checked and discussing possible supplementation with your physician if you have a deficiency.
Lifestyle modifications
A number of modifications can improve GERD, such as raising the head of the bed about six inches, not eating prior to bedtime and obesity treatment, to name a few (10). In the same study already mentioned with smoking and salt, fiber and exercise both had the opposite effect, reducing the risk of GERD (5). This was a prospective (forward-looking) trial. The analysis by Journal Watch suggests that the fiber effect may be due to its ability to reduce nitric oxide production, a relaxant for the lower esophageal sphincter (11).
Obesity
In one study, obesity exacerbated GERD. What was interesting about the study is that researchers used manometry, which measures pressure, to show that obesity increases the pressure on the lower esophageal sphincter significantly (12). Intragastric (within the stomach) pressures were higher in both overweight and obese patients on inspiration and on expiration, compared to those with normal body mass index. This is yet another reason to lose weight.
Eating close to bedtime
Though it may be simple, it is one of the most powerful modifications we can make to avoid GERD. A study that showed a 700 percent increased risk of GERD for those who ate within three hours of bedtime, compared to those who ate four hours or more prior to bedtime. Of note, this is 10 times the increased risk of the smoking effect (13). Therefore, it is best to not eat right before bed and to avoid “midnight snacks.”
Although there are a number of ways to treat GERD, the most comprehensive have to do with modifiable risk factors. Drugs have their place in the arsenal of choices, but lifestyle changes are the first — and most effective — approach in many instances. Consult your physician before stopping PPIs, since there may be rebound hyperacidity (high acid produced) if they are stopped abruptly.
References:
(1) Gastroenterol Clin North Am. 1996;25(1):75. (2) Gut. 2014 Jun; 63(6):871-80. (3) emedicinehealth.com. (4) Gut 2004 Dec.; 53:1730-1735. (5) Gastroenterology. 2008;135(4):1392. (6) Proton Pump Inhibitor, ClinCalc DrugStats Database, Version 20.0. Updated December 23, 2019. Accessed June 23, 2020. (7) World J Gastroenterol. 2009;15(38):4794–4798. (8) www.FDA.gov/safety/medwatch/safetyinformation. (9) Linus Pauling Institute; lpi.oregonstate.edu. (10) Arch Intern Med. 2006;166:965-971. (11) JWatch Gastro. Feb. 16, 2005. (12) Gastroenterology 2006 Mar.; 130:639-649. (13) Am J Gastroenterol. 2005 Dec.;100(12):2633-2636.
Dr. David 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.
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