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A pet trust is effective immediately upon your death whereas a will can take months to execute.

By Linda Toga

Linda Toga, Esq.

THE FACTS: My mother has a dog, Fido, who means the world to her. When it comes to Fido, money is no object. She is very concerned about what will happen to Fido when she dies. Not only does she worry about who will care for Fido but also about who will pay for Fido’s care.

THE QUESTION: Should these issues be addressed in her will?

THE ANSWER: While the long-term care of Fido can be addressed in her will, your mother needs to make arrangements for Fido’s care for the period immediately following her death because the provisions of her will are not effective until the will is probated. That could take some time.

I always suggest that pet owners arrange in advance for someone to take care of their pet in the event they are unable to do so either because of disability or death. It is important that a caregiver is identified and is ready and willing to take the pet on relatively short notice. These temporary arrangements need not be in writing unless the owner feels that people are going to fight over who will care for the pet.

For example, if you and your siblings agree with your mother that Mary will take care of Fido, there is no need to put the arrangement in writing. However, if all of you want to take care of Fido, your mother should put her wishes in writing to avoid conflicts.

As for the long-term care of Fido after your mother’s passing and the cost of that care, I suggest that your mother include in her will a pet trust. When thinking about the provisions to include in the pet trust, your mother should not only consider who will care for Fido for the rest of his life but also whether the appointed caregiver has the resources to cover the costs associated with pet ownership.

Even if money is not an issue for the caregiver, your mother should confirm in advance that the caregiver’s living arrangements are suitable for Fido. Some apartment buildings and residential communities do not permit residents to own pets. If the caregiver of choice lives in such a community, or lives in a setting that is not large enough for Fido, your mother should consider naming someone else to adopt Fido after her death.

Once she has settled on a caregiver, your mother should think about the types of care she wants Fido to receive after she is gone. For example, does she want Fido groomed once a month or to have his teeth cleaned three times a year? Does she want Fido to be fed certain types of food? Does Fido suffer from any ailments that require medication or close monitoring? If so, these things should be addressed in the pet trust. If your mother has been using the same groomer and vet for years, she may want the caregiver to continue using the same providers. This is particularly important if Fido is receiving any specialized care or treatment. If this information is not included in the pet trust itself, your mother definitely should provide this information to the caregiver in a letter.

While the reason for including a pet trust in her will is to ensure that Fido will be cared for after she dies, it can also serve as a vehicle for providing the caregiver with instructions with respect to the handling of Fido’s remains after he dies. This information is important and useful to the caregiver who will certainly want to honor your mother’s wishes.

In addition to setting forth in the pet trust the name of the caregiver and the type of care she wants Fido to receive, both during his lifetime and upon death, your mother will need to allocate a certain amount of money to the trustee of the pet trust.

The job of the trustee is to distribute the funds in the trust to the caregiver as needed to be used for Fido’s benefit. The money will be used to pay for Fido’s food and care, but your mother can also allocate some of the money in the trust directly to the caregiver in recognition of the time, effort and responsibility he/she assumed by caring for Fido. If she wants, your mother can name the caregiver as trustee of the pet trust. She need not name two different people for these roles.

A final decision that your mother will have to make in connection with the pet trust is what happens to any of the funds left in the trust after Fido dies. Many people who have a pet trust direct that any money left in the trust after the death of their pet goes to the caregiver. Another popular arrangement is for the money to be donated to an organization that cares for abandoned and/or abused animals. Of course, your mother can also have the funds left in the pet trust divided between you and your siblings. Regardless of how she wants the funds distributed, it is important to include her wishes in the pet trust.

In light of the number of issues, your mother should discuss if she wants to create a pet trust, and the fact that it will be part of her will, with an experienced estate planning attorney. That is the best way to ensure that Fido will be cared for in accordance with her wishes.

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

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The informal gardens at Beatrix Potter's Hill Top Farm

By JoAnn Canino

Documenting your garden by keeping a garden journal not only creates a complete record but also allows you to make informed decisions to improve your garden from season to season. Now is a good time to start a garden journal. It is a way of extending the joy we get from our gardens well into the winter months.

Keeping a journal can be as simple as making notations in a notebook as you make your daily rounds in the garden. I use a lined composition notebook for observations and an unlined sketchbook to make drawings. To organize my notes, sketches and research I use a loose-leaf binder divided into sections. Setting up the binder, include a pocket to save plant tags, seed packets and receipts. Use graph paper for sketching layouts of each bed.

Sissinghurst Castle Garden

Vita Sackville-West, a noted garden writer, and her husband, Harold Nelson, diplomat and journalist, designed the Sissinghurst Castle Garden in Kent, England. They suggested careful planning should begin with a detailed architectural drawing that includes plans for color and seasonal changes.

Make lists of plants you would like to try. Keep plant profiles: date planted, care instructions, watering and fertilizing schedules. Include sketches and photos. For the kitchen garden, keep a plant and seed tracker. Include seed sources, date planted and germination date. Note success rate and expected harvest yield. Details can be recorded in your notebook then transferred to index cards for easy reference. Track the weather from season to season: Note dates of frost this year as compared to last year. How many inches of rain actually fell? How many days of sunshine? Remember to add photos to document the changes.

Monticello vegetable garden

Thomas Jefferson, president, architect, scientist and gardener, kept detailed notes of his observations and activities in his “Garden Kalender.” He noted dates seeds were planted, harvest schedules and when the beds were manuered at his plantation in Monticello. His notes were as simple as, “Peas killed by frost. Oct. 23, 1809.” But Jefferson’s vegetable garden was set up for experimentation. He imported squashes and broccoli from Italy, beans and salsify collected by the Lewis and Clark expedition, figs from France and peppers from Mexico. Jefferson’s intention was to eliminate “inferior” varieties. “I am curious to select one or two of the best species or variety of every garden vegetable and to reject others from the garden to avoid the dangers of mixing and degeneracy,” he wrote.

Recording your experiences and observations will allow you to develop a greater awareness of the changes that occur from day to day and from season to season. Be open to discovery, use your senses to look closely at nature in your own backyard. Listen to sounds and look for patterns. Create a habitat for wintering wildlife. Put up a birdbath or a small pond. Plant native plants, mulch leaves and add bird feeders.

The Mount garden

If you are exploring different garden themes, it is helpful to have a section in the binder for pictures of gardens that inspire you as well as articles and research on the typical needs of each design. For example, a formal garden with groomed hedges and a balanced symmetry would follow an Italianate design. Edith Wharton’s garden, The Mount, in Lenox, Massachusetts, follows this formal plan. Her gardens were a source of inspiration for her writing.

Beatrix Potter at Hill Top Farm in the Lake District, England, followed the philosophy of William Morris of the Arts and Crafts Movement, which celebrated fine craftsmanship. While she had a separate walled vegetable garden, her beds and borders were informal.

She mixed hardy flowers with bulbs and fruit shrubs. As an artist and naturalist, she made detailed studies of the plants and animals on her farm. Her much loved “Tales of Peter Rabbit” have entertained many readers. Illustrations for her books were painted in her garden.

Between 1883 and 1897, Potter studied and painted mushrooms and lichens. Her paper, “On the Germination of the Spores of Agaricinae,” was based on these studies. Consider how you are a part of the ecosystem and let your garden be your inspiration for writing, drawing and discovery.

Autumn tips for your garden

•Take time to observe where the sunlight falls now.

• Fill any gaps in borders with autumn flowering plants such as sedum, asters and chrysanthemums.

• Continue to feed and deadhead the hanging baskets to extend the color.

• As the weather cools, bring indoor plants back inside.

• Refresh the soil and repot to avoid bringing insects inside.

• Select flowering bulbs: tulips, narcissi, hyacinths, iris, allium and fritillaries to plant as temperatures cool.

• Cut hydrangea flowers for fall table designs and wreaths.

JoAnn Canino is an avid journal writer and gardener and a member of the Three Village Garden Club.

New England Clam Chowder

By Barbara Beltrami

If you’re wondering what the difference is between soup and chowder, don’t ask me. I have no idea, nor can I find anyone who knows. I do know they both are chunky mixtures with some featured ingredient usually enhanced by potatoes, celery and onions, sometimes cream, sometimes broth, often bacon and a few other veggies or herbs.

Most chowders I’ve come across emanate from New England, feature clams or local fish and are thick and creamy … except for Rhode Island’s which has a relatively clear broth and is full of the above-mentioned seafood as well as lots of diced veggies. Moving down the eastern seaboard we come to New York and its Manhattan clam chowder (which appalls New Englanders, by the way), which features tomatoes as well as lots of the potatoes and celery and generous sprinklings of thyme.

Then there is Maryland and its crab chowder. All this is not to say that chowders are indigenous to the east coast and middle Atlantic states. Further south chowders feature shrimp and other local products and across the continent it is hardly surprising to find salmon chowder from Washington, Oregon and Alaska.

What this tells us is that the best food comes from the nearby land and sea and that what is available is the engine that drives local and regional recipes. In the interests of geographic diversity I offer you New England Clam Chowder and Manhattan Clam Chowder. And some other time we’ll go into all the vegetarian versions of chowder … corn, bean, veggie, tofu … all of which corroborate my opening question. Really, what is the difference between soup and chowder?

All this is not to say that chowders are indigenous to the east coast and middle Atlantic states. Further south chowders feature shrimp and other local products and across the continent it is hardly surprising to find salmon chowder from Washington, Oregon and Alaska.

What this tells us is that the best food comes from the nearby land and sea and that what is available is the engine that drives local and regional recipes. In the interests of geographic diversity I offer you New England Clam Chowder, Manhattan Clam Chowder and Pacific Salmon Chowder. And some other time we’ll go into all the vegetarian versions of chowder…corn, bean, veggie, tofu…all of which corroborate my opening question. Really what is the difference between soup and chowder?

New England Clam Chowder

New England Clam Chowder

YIELD: Makes 6 to 8 servings

INGREDIENTS:

3 slices thick bacon, cut into thin strips crosswise

3 tablespoons unsalted butter

2 medium onions, diced

3 celery ribs with leaves, diced

4 cups clam broth

2 large potatoes, peeled and diced

¼ cup chopped fresh flat-leaf parsley

1 tablespoon fresh thyme leaves

One whole bay leaf

Salt and freshly ground pepper, to taste

1 cup half-and-half or light cream

2 cups chopped cooked clams, preferably fresh

DIRECTIONS: Place a large heavy saucepan or Dutch oven over medium heat, add bacon and cook until golden and just crisp. Remove pan from heat, drain bacon fat from pan, but leave bacon. Add butter to pan. Melt over low heat, add onions and celery and cook, stirring frequently, until the pieces are opaque and soft, about 10 minutes. Add the clam broth, potatoes, parsley, thyme, bay leaf and salt and pepper; cook over medium heat until potatoes are tender, about 10 to 15 minutes; discard bay leaf. Scoop 1½ cups of solids and ½ cup of liquid out of pot and transfer to food processor. Puree until smooth, then return to pot. Add cream and bring to a boil. Remove from heat, stir in clams and serve immediately with saltines, oyster crackers or pilot crackers.

Manhattan Clam Chowder

Manhattan Clam Chowder

YIELD: Makes 6 to 8 servings

INGREDIENTS:

4 dozen cherrystone clams

3 tablespoons olive oil

2 tablespoons unsalted butter

2½ cups diced onions

2 cups diced celery

1 cup diced carrots

One large clove garlic, minced

3 cups diced tomatoes

2½ cups dry white wine

3 cups peeled diced potatoes

1 tablespoon fresh thyme leaves or 1 teaspoon dried

Sea salt and black pepper, to taste

DIRECTIONS: Place 3 cups water and clams in a large shallow pan; cover and cook over medium heat until clams open, 5 or 6 minutes. With tongs remove clams from pan and set aside until cool enough to handle. Strain liquid several times through fine mesh sieve; set liquid aside. Place oil and butter in a large pot over medium heat. Add onions, celery, carrots and garlic and cook a few minutes until vegetables are slightly softened. Add tomatoes, 2½ cups of the clam broth, the wine, 4 cups water, the potatoes and herbs and simmer until potatoes are tender, about 10 to 15 minutes. Meanwhile remove clams from shells, dice, add to pot and simmer 3 to 5 minutes until heated through. Season with salt and pepper. Serve with saltines, oyster crackers or garlic bread.

Pacific Salmon Chowder

Pacific Salmon Chowder

YIELD: Makes 4 servings

INGREDIENTS:

4 slices bacon

½ cup diced onion

2 cups very hot fish broth

1 cup diced potatoes

1 pound fresh salmon, skinned, boned and cubed

2 cups hot milk

Salt and freshly ground black pepper, to taste

1 tablespoon chopped fresh flat-leaf parsley

1 tablespoon chopped fresh dill

DIRECTIONS: In a large skillet cook bacon until crisp. Remove and crumble; set aside. Saute onion until tender in remaining bacon fat. Gently and carefully pour in hot fish broth and potatoes and cook over low heat until potatoes are tender. Add salmon and cook until tender but not falling apart, about 10 minutes. Add milk, reserved bacon, salt, pepper and herbs and gently reheat. Serve with buttered pumpernickel toast and cucumber salad.

Above, Cairo. There are an estimated 600 military dogs on active duty right now in Afghanistan and Iraq.

By Matthew Kearns, DVM

I recently watched the movie “Megan Leavey” and realized that although recent events have forced many Americans to take sides on loyalty to First Amendment rights versus loyalty to the flag (as it stands for the sacrifice the military, police and rescue services make on our behalf), one belief is united: Man’s best friend has always been there for us, especially in times of war.

A quick review of dogs in the military reveals that their use goes as far back as the Egyptians (as seen in ancient murals) for both offensive and defensive purposes. The ancient Greeks, Romans, Attila the Hun, Spanish conquistadors, Napoleon and Frederick the Great all used dogs during times of war. These war dogs were unleashed on their enemies, used to guard prisoners and even to carry packs with supplies and messages.

In World War I dogs were used by the Germans to help the wounded on the battlefield. The Sanitatshunde, or “sanitary dogs” would head out onto battlefields in search of wounded soldiers. These brave dogs not only carried water and medical supplies to the wounded but also returned and guided soldiers to their injured comrades. One of the most famous American dogs, Rin Tin Tin, was actually rescued from a German training kennel by an American soldier at the end of the war.

The United States started incorporating dogs into the military services beginning in World War II. In 1942, the American Kennel Club and private citizens (including breeders and trainers) established the Dogs for Defense (DFD) organization. Later that year, the DFD was taken over by the U.S. Army Quartermaster. The dogs in the DFD were initially used for domestic sentry duty, but their role was quickly expanded to search and rescue, hauling, scouting and carrying messages. By 1944, thousands of military service dogs were used in the islands of the South Pacific and across Europe to help turn the tide of the war.

During the Korean War military dogs and handlers would routinely lead patrols to alert the troops of the possible presence of the enemy. This was expanded during the Vietnam War into what were termed Combat Tracking Teams (CTT).

The CTT consisted of a military dog, handler, team leader, visual tracker and radio operator. The job of this special unit was to make contact with the enemy, as well as detect any recent enemy activity in the area. Around this time the military also realized the canine’s sensitive sense of smell could be used for more than detecting the enemy. In 1971, programs were developed to teach military dogs to detect both bomb materials and narcotics. After the war U.S. Customs found these drug-sniffing dogs invaluable.

As recently as 2011 a military dog named Cairo (in photo above) was used in the SEAL team Operation Neptune Spear (which was responsible for killing Osama bin Laden). Today, military dogs are used in all capacities previously described. There are an estimated 600 military dogs on active duty right now in Afghanistan and Iraq. So, let’s tip our hats to these true American heroes.

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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If a man and a woman are seen together having lunch, the inevitable gossip ensues. The two of them may be colleagues or they may simply be friends. But rumors start. Does this always happen? Not always, of course, but often enough to discourage pairing off for an exchange of ideas or career advice perhaps in business. Now, with sexual harassment in the news, there is added pressure for the sexes to go their separate ways lest any movement or words be misunderstood between them. What nonsense.

Please be assured that I am as passionately against sexual harassment as anyone on the planet. Wherever it may be found, it should be exposed and halted. But the pendulum, I believe, may be swinging too far in the other direction. Recently Vice President Mike Pence mentioned that he doesn’t eat alone with a woman who is not his wife. Recent polls indicate that a majority of employees of both sexes feel it is inappropriate to have a drink or dinner together and, although less so, it may also be inappropriate for lunch. Even driving together in a car can be looked at askance.

This wariness, although perhaps helpful in avoiding situations of sexual harassment, is a loser for both sexes, especially in the workplace. For men, who are apparently unsure where the boundaries are for a touch on the arm or an innocent compliment on a colleague’s dress, there is the loss of diversity. Women can have different sensibilities and can offer different perspectives than men, to the benefit of both. A recent advertisement featuring a woman has just been yanked by a major company because it may be misinterpreted as racist. My guess is that no woman executive of that company saw the ad before it went public.

For women, the loss is perhaps greater. Since most of the leadership of companies and institutions is still made up of men, the mentorship and sponsorship of female employees is at least as vital, or even more so, than for male junior-level employees. But if a woman cannot enjoy a close professional working relationship with such a sponsor, she is often blocked from moving up in the ranks.

I am reminded of my own business life and the people who helped me advance. Yes, there were a couple of women mentors who were willing to share their skills with me and promote my status, but there were more men along the way who selected me for advancement. One local businessman volunteered important advice to me at a critical time in the early years of the newspaper. Another energetically proposed me as a candidate for president of the New York Press Association, a position for which I will always be grateful. Another supported my intuition at a decisive juncture, I’m sure I don’t know why, but it worked out well. Several others helped me with various financial matters.

Did I meet with them alone for lunch or dinner or, heavens, for a drink? You bet I did. How else to get private time for critical conversation? Meetings in the office are routinely interrupted or overheard. Did I ever meet alone with anyone of the opposite sex in his bedroom? You can put money on the answer being “no”! There are lines one doesn’t cross, no matter what generation one belongs to, and they really are not so difficult to decipher.

Are work colleagues ever sexually attracted to each other? As long as there are men and women, there can be attraction between them. But so what? That’s the way the two sexes were put forth. Presumably we adults know all about that and can conduct ourselves accordingly. Or, to return to square one, we can avoid each other completely.

We women have a great deal we can offer men and vice versa. It would be so foolish to limit our contacts to only half the population. And besides, it wouldn’t nearly be as much fun.

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What people don’t say can speak volumes.

Take the Harvey Weinstein allegations. Numerous women have come forward and described abhorrent behavior toward women by someone in power. That’s not a new phenomenon, but what’s new is the identity of the perpetrator and the time period involved — decades, it appears.

When asked about the allegations, President Donald Trump said he was “not at all surprised to see it.”

Hmm, not at all surprised? Didn’t the person whose every word and tweet gets splashed across headlines around the world have anything else to say, like, “If the allegations are true, it’s horrible and we should address this problem as a nation.” Or, “We as a country need to address this serious problem.”

No, he didn’t. In a follow-up question, a reporter asked if Weinstein’s behavior was inappropriate, and Trump responded that the movie executive said it was.

Again, not much there. I recognize this wasn’t a women’s rights forum and that he didn’t have prepared remarks or a flowing speech to cite, but he had an opportunity to address a real problem and he seemed more prepared to suggest he knew that Weinstein’s superstar public character had some tarnish.

The New York public transport system has run ads for years imploring, “If you see something, say something.”

That’s not always easy, especially when no one else might have been around to hear or see inappropriate comments or gestures.

This isn’t about political correctness: It’s about allowing people to do their best work without feeling threatened or uncomfortable. Locker room talk, or anything else that resembles a put-down for whatever reason, creates a hostile work environment.

Almost exactly a year ago, candidate Trump described several women who accused the Clintons of improper behavior towards women as “courageous” at a press conference before a debate with Hillary Clinton. While Trump hasn’t shared any such words of support for Weinstein’s victims, others have applauded them for coming forward. If Weinstein’s alleged victims had done so initially, taking on the equivalent of a movie icon could have put their careers at risk.

Gender politics are often a challenging and sore point at work. People can often dismiss inappropriate comments as being jokes or suggesting that their words weren’t what they intended.

Some jobs, like Wall Street trading, or, well, locker rooms, often involve a type of bawdy humor that is part of the culture.

But why should anyone have to tolerate it? With training and a heightened public awareness, the excuse “Well, that’s just the way it is” could turn into, “That’s not the way we do things around here.”

Pundits are suggesting that if eight women have come forward to accuse Weinstein, there are likely many more.

Then again, if he could and did engage in inappropriate conduct for decades, you have to imagine there are other men who did it, too.

Weinstein, in his own words, needs help. So, too, does the rest of society. He suggested he came from a different era. Others have taken him to task, indicating that somewhere along the line, he missed some major strides society made between whatever time period he imagined and today.

Who else is living in that era and how can we help them? Maybe, in addition to training the next set of up-and-coming managers, we should make sure the top executives — most of whom are men — understand what’s OK and what crosses a real line that is not only objectionable, but is also problematic for them and their careers.

We watch movies for many reasons: We want to be inspired, we want to understand other people and, sometimes, we want a perspective that helps us understand ourselves better. Maybe the inappropriate actions of a moviemaker can shed some more light on a problem that clearly isn’t unique to one person. A corollary to the transport ad, perhaps, should be, “If you hear something, say something.”

A short walk after eating may help lower blood sugar levels
Similar risks found in prediabetes and diabetes

By David Dunaief

Dr. David Dunaief

Let’s start with a quiz:

1. Compared to sitting, which has more benefit on diabetes?

a) Standing for five minutes every half hour

b) Walking for five minutes every half hour

c) Neither had benefit, the activities were too short

d) Both were potentially equal in benefit

2. True or false? Diabetes patients are predominantly obese and overweight.

Diabetes just won’t go away. It seems that every time I write about the disease, the news is doom and gloom about how it has become a pandemic. The prevalence, or the number with the disease, and the incidence, or the growth rate of the disease, always seem to be on the rise, with little end in sight.

Depression and stress

We don’t want to make you depressed or stressed, especially since these conditions combined with diabetes can have dangerous outcomes. In fact, in an observational study, results showed that diabetes patients with stress and/or depression had greater risk of cardiovascular events and death, compared to those with diabetes alone. When diabetes patients had stress or depression, there was a 53 percent increased risk of death from cardiovascular disease (1). And in those diabetes patients who had both stress and depression, there was two times greater risk of death from heart disease than in those without these mental health issues. These results need to be confirmed with more rigorous study.

Something to brighten your day!

However, there is good news. According to the Centers for Disease Control and Prevention, the incidence, or the rate of increase in new cases, has begun to slow for the first time in 25 years (2). There was a 20 percent reduction in the rate of new cases in the six-year period ending in 2014. This should help to brighten your day. However, your optimism should be cautious; it does not mean the disease has stopped growing, it means it has potentially turned a corner in terms of the growth rate, or at least we hope. This may relate in part to the fact that we have reduced our consumption of sugary drinks like soda and orange juice. By the way, the answers to the quiz questions are (1) d and (2) True, although not all patients have a weight issue.

Get up, stand up!

It may be easier than you think to reduce the risk of developing diabetes. This goes along with the answer to the first question: Standing and walking may be equivalent in certain circumstances for diabetes prevention. In a small, randomized control trial, the gold standard of studies, results showed that when sitting, those who either stood or walked for a five-minute duration every 30 minutes, had a substantial reduction in the risk of diabetes, compared to those who sat for long uninterrupted periods (3).

There was a postprandial, or postmeal, reduction in the rise of glucose of 34 percent in those who stood and 28 percent reduction in those who walked, both compared to those who sat for long periods continuously in the first day. The effects remained significant on the second day. A controlled diet was given to the patients. In this study, the difference in results for those who stood and those who walked was not statistically significant.

The participants were overweight, postmenopausal women who had prediabetes, HbA1C between 5.7 and 6.4 percent. The HbA1C gives an average glucose or sugar reading over three months. The researchers hypothesize that this effect of standing or walking may have to do with favorably changing the muscle physiology. So, in other words, a large effect can come from a very small but conscientious effort. This is a preliminary study, but the results are impressive.

Can prediabetes and diabetes have similar complications?

Diabetes is much more significant than prediabetes, or is it? It turns out that both stages of the disease can have substantial complications. In a study of those presenting in the emergency room with acute coronary syndrome (ACS), those who have either prediabetes or diabetes have a much poorer outcome. ACS is defined as a sudden reduction in blood flow to the heart, resulting in potentially severe events, such as heart attack or unstable angina (chest pain).

In the patients with diabetes or prediabetes, there was an increased risk of death with ACS as compared to those with normal sugars. The diabetes patients experienced an increased risk of greater than 100 percent, while those who had prediabetes had an almost 50 percent increased risk of mortality over and above the general population with ACS. Thus, both diabetes and prediabetes need to be taken seriously.

Sadly, most diabetes drugs do not reduce the risk of cardiac events. And bariatric surgery, which may reduce or put diabetes in remission for five years, did not have an impact on increasing survival (4).

What do the prevention guidelines tell us?

The United States Preventive Services Task Force renders recommendations on screening for diseases. On one hand, I commend them for changing their recommendation for diabetes screening. In 2008, the USPSTF did not believe the research provided enough results to screen asymptomatic patients for abnormal sugar levels and diabetes. However, in October 2015, the committee drafted guidelines suggesting that everyone more than 45 years old should be screened, but the final guidelines settled on screening a target population of those between the ages of 40 and 70 who are overweight or obese (5). They recommend that those with abnormal glucose levels pursue intensive lifestyle modification as a first step.

This is a great step forward, as most diabetes patients are overweight or obese; however, 15 to 20 percent of diabetes patients are within the normal range for body mass index (6). So this screening still misses a significant number of people.

Potassium: It’s not just for breakfast anymore

When we think of potassium, the first things that comes to mind is bananas, which do contain a significant amount of potassium, as do other plant-based foods. Those with rich amounts of potassium include dark green, leafy vegetables, almonds, avocado, beans and raisins. We know potassium is critical for blood pressure control, but why is this important to diabetes?

In an observational study, results showed that the greater the excretion of potassium through the kidneys, the lower the risk of cardiovascular disease and kidney dysfunction in those with diabetes (7). There were 623 Japanese participants with normal kidney function at the start of the trial. The duration was substantial, with a mean of 11 years of follow-up. Those who had the highest quartile of urinary potassium excretion were 67 percent less likely to experience a cardiovascular event or kidney event than those in the lowest quartile. The researchers suggested that higher urinary excretion of potassium is associated with higher intake of foods rich in potassium.

Where does this leave us for the prevention of diabetes and its complications? You guessed it: lifestyle modifications, the tried and true! Lifestyle should be the cornerstone, including diet, stress reduction and exercise, or at least mild to moderate physical activity.

References: (1) Diabetes Care, online Nov. 17, 2015. (2) cdc.gov. (3) Diabetes Care. online Dec. 1, 2015. (4) JAMA Surg. online Sept. 16, 2015. (5) Ann Intern Med. 2015;163(11):861-868. (6) JAMA. 2012;308(6):581-590. (7) Clin J Am Soc Nephrol. online Nov. 12, 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.

Carrie's Plum Crumble

By Barbara Beltrami

When little Jack Horner sat in a corner, stuck his thumb in a pie and pulled out a plum, I wonder if he knew what a prize he’d managed to get his hands on. There is something about cooked plums that far supersedes fresh raw ones, in my opinion. No matter how delicious the fresh fruit’s pulp may be, that sour skin is unpleasant. But when plums are cooked, stewed or poached with a little water and sugar, roasted or baked in a pie, cake, tart or crumble, they go through a magical metamorphosis as they release their sweet purple juices and become velvety and succulent. The recipes that follow are especially good made with plums but are also delicious when any stone fruit is substituted.

Plum Upside Down Cake

Plum Upside Down Cake

YIELD: Makes 8 servings

INGREDIENTS:

12 tablespoons unsalted butter at room temperature

¹/3 cup firmly packed brown sugar

6 to 8 medium plums, halved and pitted

1½ cups flour

¾ teaspoon baking powder

¼ teaspoon baking soda

¼ teaspoon salt

¾ cup sugar

1 teaspoon vanilla extract

½ teaspoon almond extract

3 large egg yolks

½ cup sour cream

DIRECTIONS: Preheat oven to 375 F. Butter an 8½-inch round springform pan. Line bottom with a circle of parchment paper. Melt two tablespoons butter; pour into pan and tip to distribute evenly over bottom. Sprinkle brown sugar over butter. Arrange plum halves, cut-side down, over brown sugar; leave as little space as possible between plums to allow for shrinkage during cooking. Sift together the flour, baking powder, baking soda and salt. Set aside.

In an electric mixer bowl fitted with a paddle attachment cream together the remaining 10 tablespoons butter and sugar until light and fluffy. Add vanilla and almond extracts, then the egg yolks, one at a time, beating well after each one. Beating continuously, add half the flour mixture, then the sour cream, then the remaining flour mixture. Pour batter over plums and spread evenly. Place on rimmed baking sheet on middle rack of oven and bake one hour or a little more until cake tester inserted in center of cake comes out clean.

Remove from oven and place on a wire rack to cool for one hour. Run a sharp knife around edge of cake, loosen ring of cake pan, then place plate on top of cake and invert onto plate. Serve warm or at room temperature with vanilla ice cream or whipped cream.

Carrie’s Plum Crumble

Carrie’s Plum Crumble

YIELD: Makes 4 servings

INGREDIENTS:

Nonstick cooking spray

1¼ cups flour

¾ cup oats (not quick cooking)

¼ cup chopped nuts (optional)

1 cup sugar

½ teaspoon cinnamon

1 stick chilled unsalted butter, cut in small pieces

2 pounds plums, pitted and cut into wedges

1 tablespoon apple or cranberry juice

DIRECTIONS: Preheat oven to 350 F. Spray a deep 9-inch round or square baking dish with nonstick cooking spray. In a medium bowl combine flour, oats, nuts (if using), half the sugar and cinnamon. Add the butter and with fingertips rub it into the flour mixture until it forms moist clumps. Toss plums with remaining sugar and juice together; transfer to baking dish. Sprinkle crumb topping over plums; bake until top is golden brown and fruit bubbles. Serve warm with vanilla ice cream.

Roasted Plums with Balsamic Vinegar and Mascarpone

Roasted Plums with Balsamic Vinegar and Marscapone

YIELD: Makes 6 servings

INGREDIENTS:

2 pounds plums, quartered and pitted

2 tablespoons butter, melted

4 tablespoons brown sugar

6 tablespoons sherry or port wine

½ cup balsamic vinegar

1 small sprig fresh rosemary

1 tablespoon granulated sugar

½ teaspoon vanilla extract

½ cup mascarpone

DIRECTIONS: Preheat oven to 425 F. Line a baking sheet with parchment paper. In a large bowl, combine the plums, butter and brown sugar; toss well to coat. Place plums with any remaining butter and sugar on parchment. Bake 15 minutes or until plums are softened and release their juices. Meanwhile in a small saucepan bring sherry or port to a boil, over medium heat; continue cooking until liquid is considerably reduced, to about 2 tablespoons. Add balsamic vinegar and rosemary and simmer until mixture is reduced to about ¼ cup, about 10 to 12 minutes.

Remove rosemary and discard. Stir in granulated sugar and vanilla until sugar is dissolved; remove from heat and let cool 5 minutes or until thickened. Place plums on individual plates, spoon balsamic mixture evenly over each serving, then top with a dollop of mascarpone. Serve with biscotti.