Columns

Sherif Abdelaziz. Photo by Juliana Thomas, SBU

By Daniel Dunaief

When the temperature drops dramatically, people put on extra layers of clothing or rush inside. At the other extreme, when the mercury climbs toward the top of thermometers, they turn on sprinklers, head to the beach or find cold drinks.

That, however, is not the case for the clay that is often underneath buildings, cliffs or the sides of hills on which people build picturesque homes. Clay shrinks after heating-cooking cycles in summer and also after freezing-thawing cycles in winter. “We want to understand why and how this behavior happens,” said Sherif Abdelaziz, an assistant professor in the Department of Civil Engineering at Stony Brook University.

Sherif Abdelaziz. Photo by Juliana Thomas, SBU

Abdalaziz recently received a prestigious Young Investigator Program award from the U.S. Army Research Office, which will provide $356,000 in funding over three years to study these properties. While the work will explore the basic science behind these clay materials, his findings could have a broad range of applications, from providing potential early-warning systems for future landslides or mudslides to monitoring coastal bluffs to keeping track of the soil around high-temperature nuclear waste buried in the ground.

Miriam Rafailovich, a distinguished professor in the Department of Materials Science at SBU who is beginning a collaboration with Abdelaziz, suggested that Abdelaziz’s work is relevant in multiple areas. “It applies to shoring infrastructure,” she wrote in an email. “The collapse of roadbeds under heavy traffic is a very common problem.”

Additionally, the clay around nuclear waste is subjected to very high temperatures during the period the waste is active. These temperatures recover to initial temperature with time, which will mainly subject the clay to a heating-cooling cycle that is part of this study, Abdelaziz explained. He is pleased to have the opportunity to explore these kinds of questions.

The Young Investigator Program award is “one of the most prestigious honors bestowed by the Army on outstanding scientists beginning their independent careers,” explained Julia Barzyk, a program manager in earth materials and processes at the U.S. Army Research Office, in an email. Abdelaziz’s research “is expected to contribute to improved approaches to mobility and siting and maintenance of infrastructure, especially in cold regions such as the Arctic.”

The field in which Abdelaziz works is called the thermomechanical behavior of soil. The challenge in this area, he said, is that the scientists are often divided into two groups. Some researchers focus on the heating effect on soil, while others explore cooling. In the real world, however, soil is exposed to both types of conditions, which could affect its ability to support structures above or around it.

In general, Abdelaziz has focused on clay. So far, scientists have looked at a piece or chunk of clay to see how it behaves. They haven’t done enough exploration at the microscale level, he said. “Our scientific approach crosses between the scales,” he said. In conducting experiments at SBU and at Brookhaven National Laboratory, he starts at the microscale and looks at the larger macroscale.

At the National Synchrotron Light Source II at BNL, Abdelaziz and his partners at BNL, including Eric Dooryhee, the beamline director for the X-ray Powder Diffraction beamline, change the temperature of the clay and look at the microstructure.

The challenge in the experiments they conducted last year was that they could change the temperature, but they couldn’t mimic the pressure conditions in the ground. Recently, they conducted the first experiments on a sample environment that involved a change in temperature and pressure and they got “good results so far,” Abdelaziz said in an email. He is looking for more beam time in the summer to finish the development of the sample environment. He is also seeking funding for a project to develop an early-warning system for coastal bluff stability.

“We are pretty good at predicting the weather,” Abdelaziz said. “What we don’t know is how this storm will impact our slopes.” The goal of the work he’s exploring now is to use what he learns from these experiments to predict potential changes in the soil. The purpose of this work is to better engineer mitigation techniques to avoid evacuations.

Abdelaziz’s work has focused on one clay type. He has, however, built a numerical model using experimental data. Once that model is validated, it will be able to predict the behavior of other clay, and he can include the heterogeneity of earth surface material in his numerical studies.

Rafailovich appreciates Abdelaziz’s dedication to his research. “He is very passionate about his work,” she wrote in an email. “He really hopes that he can change the world, one small road at a time.”

A native of Cairo, Egypt, Abdelaziz lives in Smithtown with his wife Heba Elnoby and their children Mohamed, 10, and Malak, 7. The father of two suggested that he “owes every single piece of success” in his career to the support he received from his wife.

The idea to study coastal bluff stability came to Abdelaziz when he was grilling on the beach a few years ago. He saw a sign that indicated that a bluff was unstable and that there was excessive movement. He related that to what he was studying. Abdelaziz is pleased with the funding and with the opportunity to contribute basic knowledge about clay to civil and military efforts. The financial support from the Army suggests that his “work is meaningful to the nation in general,” he said.

The last decade has taken a toll on Suffolk County’s economy. Stock photo

By Peggy Olness

Note: This article builds on the information contained in the TBR newspapers on March 2. www.tbrnewsmedia.com/making-democracy-work-suffolk-county-government-revenue/.

The $3.06 billion 2018 Suffolk County Adopted Operating Budget is an action plan to fund the county to provide services for its 1.5 million residents and to detail how revenue will be spent by the various departments and agencies during the fiscal year.

The County Executive’s Recommended Operating Budget is submitted to the Suffolk County Legislature whose Budget Review Office (BRO) reviews the budget to ensure that the projections for revenues and expenses are reasonable.MIt is the BRO’s job to look for possible problems and help develop a budget that the Legislature can adopt. Given the possibility of unforeseen events, the county government (the executive and Legislature) has over the years built up reserve funds to handle unexpected events that impact revenues such as the Great Recession of 2008-09 or impact expenses such as major hurricanes or nor’easters. Unfortunately, these funds do not completely cover major disruptions.

The last decade has taken its toll on the county’s economy. Since the Great Recession, the county sales tax revenue has not recovered enough to cover its previous percentage share of the county’s operating expenses, and current sales tax projections do not indicate a sufficient increase in future years to reach that percentage share of the county’s revenue total.

The annual property tax increase is restricted to a 2 percent maximum for some of the factors used in the complex calculation of the total property tax. However, the actual calculation brings the total property tax to slightly more than 3 percent above the previous year countywide.

During this last decade, county government has made a number of changes to cut costs. The county now contributes reduced funding to the nine health centers through community benefit grants, most of which will expire within two or three years, and the county nursing home has been closed and the building sold for less than expected.

The county executive’s recommended budgets for the 2017 and 2018 fiscal years eliminated the Public Health Nursing Program (budget cost less than $1 million). This would negatively impact prenatal and postpartum care services as well as Child Protective Services to Suffolk County residents in need. There are no other certified home health agencies in Suffolk County qualified to provide such services to high-risk mothers and children.

The Health Education and Tobacco Control Program (budget cost about $50,000) was also recommended for elimination. That would impact the tobacco cessation and education courses, sexually transmitted disease prevention programs, anti-bullying programs, diabetes prevention programs and reduces the support for 3,000 teachers trained in the HealthSmart curriculum.

There is concern that while cutting further programs saves money, the negative impact on a large number of residents’ health and welfare is not worth the savings. Both the Public Health Nursing program and the Health Education and Tobacco Control Program have been put back into the budget by the Legislature each year. Removing these programs would also lose approximately $400,000 in New York State Public Health Aid to Municipalities.

In the past decade our county government has used short-term borrowing to close the budget gap, expecting that the sales tax and property tax would rebound with enough surplus to cover the loans. This has not happened; since 2014, the county has borrowed $166.3 million and in 2018 the county must begin paying back this loan.

The search for additional revenue has led the county to impose other forms of “taxation” in the form of fees and charges; the county has increased the motor vehicle surcharge, and the tax map certification fee, and in 2017 a new mortgage administrative tax was added.

Suffolk County is facing a serious financial problem. Make your voice heard by doing research and educating yourself further, talking to your Suffolk County elected officials, and thinking deeply about the balance between community needs and community willingness to pay.

Peggy Olness is a board member of the League of Women Voters of Suffolk County, a nonprofit, nonpartisan organization that encourages the informed and active participation of citizens in government and influences public policy through education and advocacy. For more information, visit www.lwv-suffolkcounty.org, email [email protected] or call 631-862-6860.

Season allergies are triggered by pollen from trees, grass and weeds. Stock photo

By David Dunaief, M.D.

Dr. David Dunaief

After winter ends, we look forward to mild temperatures. The days get longer, trees and flowers bud and bloom, and grass becomes lush and green. It seems like heaven. But for people who suffer from seasonal allergic rhinitis, hay fever, seasonal allergies or whatever you would like to call it, life can be downright miserable. You probably can rate an allergy season with your own built-in personal barometer, the sneeze factor. How many times are you, your friends or your colleagues sneezing?

Approximately 20 million U.S. adults have had a diagnosis of seasonal allergies within the past year, just a little over 8 percent of the population, and an additional 6.1 million children have this disorder, or about 8.4 percent, according to the Centers for Disease Control and Prevention (1). Sadly, considering the number of people it affects, only a paltry amount of research has been published.

The triggers for seasonal allergies are diverse. They include pollen from leafy trees and shrubs, lush grass and beautiful flowering plants, as well as weeds, with the majority from ragweed (mostly in the fall) and fungus (summer and fall) (2).

What sparks allergies within the body? A chain reaction occurs in seasonal allergy sufferers. When foreign substances such as allergens (pollen, in this case) interact with immunoglobulin E (IgE), antibodies that are part of our immune system, it causes mast cells in the body’s tissues to degrade and release inflammatory mediators. These include histamines, leukotrienes and eosinophils in those who are susceptible. In other words, it is an allergic inflammatory response.

The revved up immune system then responds with sneezing; red, itchy and watery eyes; scratchy throat; congestion; sinus headaches; postnasal drip; runny nose; diminished taste and smell; and even coughing (3). Basically, it emulates a cold, but without the virus. If symptoms last more than 10 days and are recurrent, then it is more than likely you have allergies.

Risk factors for seasonal allergies are tied most strongly to family history and to having other personal allergies, such as eczema or food allergies, but also may include cigarette exposure, being male and, possibly, diet (4). If allergic rhinitis is not properly treated, complications such as ear infections, sinusitis, irritated throat, insomnia, chronic fatigue, headaches and even asthma can result (5).

To treat allergic rhinitis, we have a host of medications from classes including intranasal glucocorticoids (steroids), oral antihistamines, allergy shots, decongestants, antihistamine and decongestant eye drops and leukotriene modifiers (second-line only).

The best way to treat allergy attacks is to prevent them, but this is an arduous process that can mean closing yourself out from the enjoyment of spring by literally closing the windows, using the air-conditioning, and using recycling vents in your car.

The guidelines for treating seasonal allergic rhinitis with medications suggest that intranasal corticosteroids (steroids) should be used when quality of life is affected. If there is itchiness and sneezing, then second-generation oral antihistamines may be appropriate (6). Two well-known inhaled steroids that do not require a prescription are Nasocort (triamcinolone) and Flonase (fluticasone propionate). There does not seem to be a significant difference between them (7). While inhaled steroids are probably most effective in treating and preventing symptoms, they need to be used every day and are not without side effects.

Oral antihistamines, on the other hand, can be taken on an as-needed basis. Second-generation antihistamines include loratadine (Claritin), cetirizine (Zyrtec) and fexofenadine (Allegra), and they have less sleepiness as a side effect than first-generation antihistamines.

Surprisingly good news

Seasonal allergic rhinitis may actually be beneficial for longevity. In a study involving more than 200,000 participants, results showed that those who had allergies had a 25 percent reduction in the risk of heart attacks, a 19 percent reduction in strokes, and a whopping 49 percent reduction in mortality (8). Remember two things: this is an observational trial, which means that it is not the best of trials, and don’t wish allergies on yourself. This effect may be at least partially attributable to the type of white blood cell expressed in the immune system.

In other words, type 2 T helper (Th2) lymphocytes (white blood cells) are elevated with allergies instead of type 1 T helper (Th1) lymphocytes. Why is this important? Th2 is known to decrease cardiovascular disease, while Th1 is known to possibly increase cardiovascular disease. Unfortunately, the same cannot be said about asthma, where cardiovascular events are increased by 36 percent.

Alternative treatments

Butterbur (Petasites hybridus), an herb, may not be just for migraines. There are several small studies that indicate its efficacy in treating hay fever. In fact, in one study, results showed that butterbur was as effective as cetirizine (Zyrtec) in treating this disorder (9). This was a small, randomized, controlled trial involving 131 patients.

In another randomized, controlled trial, results showed that high doses of butterbur — 1 tablet given three times a day — was significantly more effective than placebo (10). The side effects were similar in the placebo group and the butterbur group. The researchers used butterbur Ze339 (carbon dioxide extract from the leaves of Petasites hybridus L., 8 mg petasines per tablet) in the trial. The authors concluded that butterbur would be potentially useful for intermittent allergic rhinitis. The duration of treatment for this study was two weeks.

Still another study, this one a post-marketing study done as a follow-up to the previous study, showed that with butterbur Ze339, symptoms improved in 90 percent of patients with allergic rhinitis (11). Interestingly, anti-allergic medications were co-administered in about half of the patient population, with no additional benefit over butterbur alone. There were 580 patients in this study, and the duration was two weeks. Gastrointestinal upset occurred as the most common side effect in 3.8 percent of the population.

The caveats to the use of butterbur are several. First, the studies were short in duration. Second, the leaf extract used in these studies was free of pyrrolizidine alkaloids (PAs); this is very important since PAs may not be safe. Third, the dose was well-measured, which may not be the case with over-the-counter extracts. Fourth, you need to ask about interactions with your prescription medications.

Diet

While there are no significant studies on diet, there is one review of literature that suggests that a plant-based diet may reduce symptoms of allergies, specifically rhinoconjunctivitis, affecting the nose and eyes, as well as eczema and asthma. This is according to the International Study of Asthma and Allergies in Childhood study in 13- to 14-year-old teens (12). In my clinical practice, I have seen patients who suffer from seasonal allergies improve and even reverse the course of allergies over time with a vegetable-rich, plant-based diet, possibly due to an anti-inflammatory effect.

While allergies can be miserable, there are a significant number of over-the-counter and prescription options to help to reduce symptoms. Diet may play a role in the disease process by reducing inflammation, though there are no formal studies. There does seem to be promise with some herbs, especially butterbur. However, alternative supplements and herbs lack large, randomized clinical trials with long durations. Always consult your doctor before starting any supplements, herbs or over-the-counter medications.

References: (1) CDC.gov. (2) acaai.org/allergies/types/pollen-allergy. (3) Allergy Clin Immunol. 2003;112(6):1021-1031. (4) umm.edu. (5) J Allergy Clin Immunol. 2010;125(1):16-29. (6) Otolaryngol Head Neck Surg. online February 2, 2015. (7) Otolaryngol Head Neck Surg. 2003;129(1):16. (8) AAAAI 2014: Abstract 811. (9) BMJ 2002;324:144. (10) Arch Otolaryngol Head Neck Surg. 2004;130(12):1381-1386. (11) Adv Ther. 2006;23(2):373-384. (12) Eur Respir J. 2001;17(3):436-443.

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.

The flowering plant Amborella trichopoda is the oldest ancestral form of the angiosperms .

By Elof Axel Carlson

Elof Axel Carlson

Flowering plants are familiar to us as bouquets and garden plantings that delight us as they emerge in spring and summer. They are collectively part of the angiosperms, which also include familiar trees with generous-sized leaves that are shed in the fall.

They first appear in the fossil record about 130 million years ago. For those not familiar with how old life on Earth is estimated to be by biologists, that is about 60 million years before the dinosaurs went extinct.

Ferns, mosses and conifer trees (like gingkoes) existed long before the angiosperms. If the angiosperms are arranged in a sequence from oldest to most recent types, the oldest ancestral form of the angiosperms alive today is found in the Pacific Ocean on New Caledonia, an island northeast of Australia and northwest of New Zealand. That flowering plant is known as Amborella trichopoda.

A lot has been learned about the biology and history of Amborella. Its pollen, or ovule, has 13 chromosomes (and thus its leaf, stem and root cells have 26 chromosomes each). The Amborella ancestor gave rise to 250,000 species of flowering plants. About 75 percent of them have seeds with two fleshy modified leaves called cotyledons.

If you eat a fresh green pea from a pod and look at it before you pop it into your mouth, it has two halves, which is why you call it split pea soup when you cook a bag of dried peas.

The flower of the Amborella trichopoda

The DNA of Amborella has been worked out. It has 870 million base pairs. These are organized as 25,347 genes. Shortly before Amborella arose, it had experienced a doubling of its chromosome number. No major changes have occurred in its chromosomes since that event. Its nuclear genes have few inserted repetitive sequences. But, curiously, its mitochondrial DNA has many horizontally transferred genes from algae, mosses and lichens.

The ancestral genome of the angiosperms can be inferred because the major branches of the angiosperms share that core set of genes. This will allow botanists and chemists studying plant evolution to work out the functions of these shared genes as well as the distinctive genes that gave rise to the six major branches of flowering plants.

Quite different is the loblolly pine. It is a gymnosperm rather than angiosperm. They have a much longer history on Earth than the angiosperms. The conifers are the most familiar of the gymnosperms whose seeds are “naked” and enclosed in cones. Imagine the pine cones used in foods and compare them to the peas and beans in your soups.

The loblolly pine can live up to 300 years.

The loblolly pine, or Pinus taeda, is a common pine tree found from Florida to Texas and as far north as New Jersey. The trees can live 300 years and they are a major source of industrial lumber and paper pulp. The name loblolly is from an English idiom for food boiled in pots producing soups, broths or porridges. It has the largest known genome of any living organism, 23.2 billion base pairs (about seven times more than human cells and about 22 times that of Amborella. Unlike Amborella, 82 percent of its DNA is repetitive (formerly called junk DNA) caused by infectious insertions of tiny sequences of DNA. It has 50,172 genes in its pollen, or ovule, genome and they are located in 12 chromosomes per gamete.

One of my six students who got their doctorates with me at UCLA, Ronald Sederoff, pioneered the molecular biology of woody plants using the loblolly pine. He devised a technique to insert genes into woody plants, enabling his laboratory to study how wood is formed and how genes could be studied without waiting many years to study their genetics.

I was very pleased to learn that he was the recipient of the Wallenberg Prize, which is given by the king of Sweden for a contribution to plant biology, a field that is usually overlooked in the Nobel physiology and medicine prize. He attended the ceremony in Stockholm last October.

Elof Axel Carlson is a distinguished teaching professor emeritus in the Department of Biochemistry and Cell Biology at Stony Brook University.

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This year the real March Madness wasn’t basketball. It was the number of nor’easters we in the Northeast endured. This will forever be the year of the nor’easters, one right after the other with snowfalls, flooding and especially the high winds. Many old trees are no longer with us. As the first quarter of the new year ends, we are hopeful that the old adage, “March comes in like a lion and goes out like a lamb,” will prove to be true. The forecasts are promising.

We have some exciting plans for the community that we believe will further enliven the next quarter of the year. On June 12, TBR News Media — that’s us — will offer a new event. It is called Cooks, Books & Corks, and it will be held at the Bates House in Setauket. For those who might not know the location, it is that lovely house inside Frank Melville Park, near the Mill Pond, usually used for wedding receptions, and it can be reached via a driveway opposite the Emma Clark Library and just past the two entrance roads to Strong’s Neck. We will have balloons and signage marking the way.

So what is Cooks, Books & Corks? It is to be a grand marriage of mind and body on a joyful June Tuesday evening, from 6 to 9 p.m., that will combine good food from local restaurants with good books by local authors, all of which will go down easily with some good wine. We are encouraging the restauranteurs to bring tastings of their favorite dishes and the authors to offer their books for sale throughout the event. The views from the bluestone patio and the picture window are beautiful and serene in the middle of the woods, and we will hope for a soft, summer breeze to erase all memories of past nor’easters.

Besides being just plain fun and a forum for our local restaurants, local wineries and celebrated authors, Cooks, Books & Corks is a fundraiser intended to pay for an intern from the Stony Brook University School of Journalism this summer. We have held such fundraisers for that purpose in the past, and the internships have helped launch several young journalists into their careers. Tickets will be $50 per person for the food and wine, and although not tax deductible, all funds will go toward paying the intern. The cost of any books you might choose to buy will be up to you. We hope there will be irresistible books for children offered for sale as well as for us adults.

Further, a ticket to Cooks, Books & Corks will enable the purchaser to have a reserved seat at the Stony Brook premiere of our film, “One Life to Give,” to be held on June 24, a Sunday evening. The film is a prequel of sorts to the story of the Culper Spy Ring that played a vital role in the Revolutionary War. Headquartered in Setauket, Washington’s spies fed critical intelligence to the Patriots of such high value that, in one instance, information enabled French soldiers to disembark safely from their ships and join the fight in the colonies. The cable channel, AMC, ran popular stories of the spies, “Turn: Washington’s Spies,” for four seasons, which ended last year. Our full-length film, by contrast, endeavors to be historically authentic.

More details about the premiere will be forthcoming. I do want to give you this heads-up for the coming enjoyable events we have planned for the community. We think they will make you proud of where you live. And why do we do this? That’s easy. We’re committed to strengthening the sense of community because we are the community paper. And website. And social media. And now producers of historical films. Happy Spring!

We’ve reached a period of outrageous outrageousness. Or maybe extremes of extremism.

I read recently about an advertisement by a beer company that seems overtly racist.

Now, I’m not going to name the company because that might accomplish what it could have been attempting in the first place, which is to get its brand name in front of people.

This company has caused quite a stir by linking the color of beer to its quality, which in turn is linked to race in the ad.

What’s happening in the country? Have we reached the stage where all news is good news?

We live in a world of such polarization, so many shrill messages and such a rapid news cycle that you almost have to be outrageous and ridiculous to get attention and to remain in the public’s eye for more than just a moment.

It’s not an unprecedented phenomenon. Borrowing from the fictional world, poor Roxie Hart from the show “Chicago” is “the name on everyone’s lips,” as the song goes. But then, once the gripping trial ends, the newest crime of passion captivates the city’s attention, relegating Roxie to a less prominent place in the
dramas of the Windy City.

In our real world, which sometimes seems to require a reality check, people doubt everything. Why, just the other year, the current president questioned the national origin of the previous one.

Doubt and cynicism are all by-products of a shrill time where people shout alternative facts from
the rooftops.

And to bring matters up to speed, current politicians are questioning the motives of the Parkland
shooting survivors. Some suggest that left-leaning people who want to take away everyone’s guns are manipulating America’s youth. These students are not too young to die, but are somehow considered too young to have formed such an energized national movement.

Are people becoming more extreme with their time, with their emotions and with their donations? Yes, without a doubt. As the ancient Greek physician Hippocrates suggested, “desperate times call for desperate measures.” He was describing the response to life-threatening diseases and not to people who feel their lives are threatened leaving their homes.

As Long Island native Billy Joel sang in 1989, “we didn’t start the fire.” While that’s true, and people have lived through periods of considerable instability and uncertainty, we are living in a time defined by extremes.

At some point, We the People have to decide what we can accept and what we can’t. That beer advertisement seems to be a cheap ploy put together by a cynical advertising executive, who has now pulled the ad after it may have served its purpose.

Maybe this executive got his or her wish and more. Not only are people talking about it, but the company may also not have to pay as much for the ad, because now they’re not running it anymore.

How do we combat such unacceptable messages and decide when a company has crossed the red line? One possible solution is to follow the example of the United States government. When other countries create intolerable situations for their citizens or our citizens or the world, we start by hitting these nations in their wallets and refuse to buy their products.

Maybe a decline in sales at a company would send the kind of message that defeats the notion that all press is good press. Other cynical executives might get the message if the stock price or sales fell after such an advertisement polluted the company’s image. With our consumer decisions, we can send messages that it’s not OK to be offensive and outrageous just to sell another product or a toxic idea.

Julia's Chocolate Chiffon Cake

By Barbara Beltrami

Last week I wrote about spring holiday meals and how much in common there is among the cuisines of various religions. From tender young vegetables to lots of eggs as decorations or ingredients, to light, fluffy desserts, everything seems to converge on the spring theme. Last week I also promised to give you a few recipes for those light-as-a-feather cakes that, whether angel food, sponge or chiffon, rely heavily on egg whites.

Spring-y and delicate, none are difficult to make. All of them make beautiful presentations, especially if decorated with seasonal pastels or confections and all of them function beautifully as complements to fruits, sauces, ice cream and sorbets. So tie on your apron, heat up that oven, get out your electric mixer and cake pans, take those eggs out of the refrigerator and let’s bake!

Julia’s Chocolate Chiffon Cake

Julia’s Chocolate Chiffon Cake

YIELD: Makes 8 to 12 servings

INGREDIENTS:

¾ cup boiling water

½ cup cocoa

1¾ cups cake flour

1¾ cups sugar

1½ teaspoons baking soda

1 teaspoon salt

½ cup vegetable oil

7 unbeaten egg yolks

2 teaspoons vanilla extract

7 egg whites

½ teaspoon cream of tartar

DIRECTIONS: Preheat oven to 325 F. Combine boiling water and cocoa; let cool. Sift together flour, sugar, baking soda and salt. Make a well in the center, then add oil, egg yolks, vanilla and cocoa mixture, and beat until smooth. Put egg whites and cream of tartar into large mixing bowl and beat until stiff peaks form. Pour egg yolk mixture in thin stream over entire surface of egg whites. With rubber spatula gently fold in until well blended. Pour into ungreased 10-inch tube pan. Bake 55 minutes, then raise heat to 350 F and bake another 10 to 15 minutes. Remove from oven; invert onto wire rack until cool. Remove from pan and decorate with your favorite frosting, if desired. Otherwise, serve with fudge sauce, whipped cream, liqueur or vanilla or chocolate ice cream.

Nana’s Orange Sponge Cake

Nana’s Orange Sponge Cake

YIELD: Makes 8 to 10 servings

INGREDIENTS:

6 eggs, separated

1/8 teaspoon salt

1 cup sugar

¼ cup freshly squeezed orange juice

½ cup Passover cake meal

¼ cup potato starch

Freshly grated rind of half an orange

DIRECTIONS: Preheat oven to 350 F. In a small bowl beat the egg whites and salt until soft peaks form. In another larger bowl combine the egg yolks, sugar and orange juice and beat until frothy and pale. In a third bowl combine the cake meal and potato starch and gradually beat into the egg yolk mixture until batter is smooth. Fold in the egg whites and orange rind. Transfer batter to an ungreased tube pan with a removable bottom and bake for one hour. Remove from oven and invert over wire rack until cool. Unmold and serve with orange sorbet, stewed fruit or fresh berries.

Rebecca’s Angel Food Cake

Rebecca’s Angel Food Cake

YIELD: Makes 8 to 10 servings

INGREDIENTS:

8 egg whites

¼ teaspoon salt

1 teaspoon cream of tartar

½ teaspoon almond extract

1 teaspoon vanilla extract

1¼ cups fine granulated sugar

1 cup cake flour

DIRECTIONS: Preheat oven to 325 F. Dust a 10-inch tube pan with flour but do not butter it. Beat egg whites with salt until foamy; add cream of tartar and continue beating until egg whites form soft peaks. Add almond and vanilla extracts; lightly stir once. Sift together the sugar and cake flour over a separate bowl; repeat three times. Using a whisk or spatula, gently fold the sifted mixture, two tablespoons at a time, into the beaten egg whites until the batter is completely blended. Spoon evenly into prepared tube pan. Bake for 50 minutes; turn the oven off and leave cake in for another 10 minutes. Turn cake upside down on a wire rack and let sit for one hour, then carefully unmold. Serve with chocolate sauce or pureed strawberries.

MEET DUDLEY AND SHANIA!

This week’s shelter pets are the sweet duo of, from left, Dudley, a lab mix, and Shania, a shepherd mix. They had a tough start to life when they were abandoned together at a Virginia farm and now they are waiting for a new home at Kent Animal Shelter.

These 4-year-old cuties truly are the best of friends and bring out the best personalities in each other. They have so much love to give to anyone willing to give them a chance! Hopefully Dudley and Shania can be adopted together but either way they are both looking for a great home. They come neutered/spayed, microchipped and up to date on all their vaccines.

Kent Animal Shelter is located at 2259 River Road in Calverton. The adoption center is open from 10 a.m. to 4 p.m. every day. For more information on Dudley, Shania and other adoptable pets at Kent, visit www.kentanimalshelter.com or call 631-727-5731.

*Update 10/5/18: Dudley and Shania have been adopted together! Happy life you two!

Symptoms of gallstones include dull or crampy abdominal pain that is exacerbated by meals and lasts one to five hours. Stock photo

By David Dunaief, M.D.

Dr. David Dunaief

Gallstones are a very common gastrointestinal disease; they affect up to 20 million Americans between the ages of 20 and 74, with a more than two-times increased occurrence in women than in men, according to the NHANES III survey (1). There are two types of gallstones, 80 percent of which are cholesterol stones and 20 percent of which are pigment stones.

Common symptoms

Gallstones may be asymptomatic; however, when gallstones block either the cystic or common bile ducts, symptoms occur. Symptoms include dull or crampy abdominal pain that is exacerbated by meals and lasts one to five hours. Jaundice, which includes yellowing of skin and eyes, is another symptom. Others include nausea and vomiting, rapid heart rate, hypotension (low blood pressure) and fever (2).

Tests used for diagnosis

Blood tests include complete blood count, where there may be a rise in white blood cells; liver enzymes; and the pancreatic enzymes lipase and amylase. In general, diagnostic tests that have more accuracy are the endoscopic ultrasonography (EUS) and endoscopic retrograde cholangiopancreatography (ERCP). However, these are invasive tests. Less accurate but noninvasive tests include abdominal X-ray, ultrasound and CAT scan (CT). The tests used also depend on where the stone may be located. Hepatobiliary (HIDA) scans are accurate if the stone is located in the cystic duct. And magnetic resonance retrograde cholangiopancreatography (MRCP) is used if the stone is thought to be located in the common bile duct (2).

What are the risk factors?

There are a multitude of risk factors. Some of these are modifiable, some others are not. The modifiable ones include obesity, measured by body mass index (BMI); rapid weight loss; fat consumption; hormone replacement therapy (HRT); oral contraceptives; decreased physical activity; Crohn’s disease; and certain drugs. One nonmodifiable risk factor is age; the older we get, the higher the risk, with age 40 being the demarcation line (3). Other risk factors are gender, with females being more predisposed; pregnancy; and family history (4). Let’s look at the evidence.

Obesity risks

Obesity may play an important role. Obesity is not age discriminant; it can impact both adults and children. The reason obesity is implicated is potentially due to bile becoming supersaturated (5). Bile is a substance produced in the liver and stored in the gallbladder. Bile aids in the digestion or breakdown of fats in the small intestines. Crystals may form, creating cholesterol gallstones from the bile.

Body mass index

A body mass index of greater than 30 kg/m² is considered obese. In a meta-analysis of two prospective, forward-looking observational trials, Copenhagen General Population Study and the Copenhagen City Heart Study, those in the highest quintile of BMI were almost three times as likely to experience symptomatic gallstones compared to those who were in the lowest quintile (6). The highest quintile was those who had a mean BMI of 32.5 kg/m² and thus were obese, whereas those in the lowest quintile had a mean BMI of 20.9 kg/m². This is a comparison of ideal to obese BMI. Not surprisingly, since women in general have a higher risk of gallstones, they also have a higher risk when their BMI is in the obese range compared to men, a 3.36-fold increase and 1.51-fold increase, respectively.

Also, the research showed that for every 1 kg/m² increase in BMI, there was a 7 percent increase in the risk of gallstones. Those who had genetic variants that increased their likelihood of an elevated BMI had an even greater increase in gallstone risk —17 percent — per 1 kg/m². In the study population of approximately 77,000, more than 4,000 participants became symptomatic for gallstones.

Gallstones in children

Sadly, obese children are not immune to gallstones, even though they are young. In a prospective observational study based on Kaiser Permanente data from southern California, children who were overweight had a twofold increased risk of gallstones (7). But if that is not enough, girls who were extremely obese had a higher propensity for gallstones, similar to women in the previous study, with a greater-than-sevenfold increase compared to a still very substantial greater-than-threefold increase for obese boys. Hispanic children were affected the most. The age range in this study was between 10 and 19 years old. Obesity is a disease that is blind to age.

Physical activity

We know physical activity is very important to stave off many diseases, but in this case, the lack of physical activity can be detrimental. In the Physicians’ Health Study, a prospective observational trial, those in the lowest quintile of activity between the ages of 40 and 64 had a 72 percent increased risk of gallstone formation, and those 65 and older had a 33 percent increased risk (8). Also, men who were 65 and older and watched television more than six hours a week were at least three times as likely to have gallstones as those who watched fewer hours. There was a substantial increased risk for those under 65, as well, though to a slightly lesser degree.

Diabetes rears its ugly head

Just like with obesity, diabetes is almost always a culprit for complications. In a prospective observational study, those with diabetes were at a significant 2.55-times greater risk of developing gallstones than those without (9). Again, women had a higher propensity than men, but both had significant increases in the risk of gallstone formation, 3.85-times and 2.03-times, respectively. There were almost 700 participants in this study. The researchers believe that an alteration in glucose (sugar) metabolism may create this disease risk.

Hormone replacement therapy

If you needed another reason to be leery of hormone replacement therapy (HRT), then gallstones might be it. In a prospective observational trial, women who used HRT, compared to those who did not, had a 10 percent increased risk in cholecystectomy — removal of the gallbladder — to treat gallstones (10). Though this may not sound like a large increase, oral HRT increased the risk 16 percent, and oral estrogen-only therapy without progestogens increased the risk the most, 38 percent. Transdermal HRT did not have a significantly increased risk.

It is never too early or too late to treat obesity before it causes, in this case, gallstones. With a lack of exercise, obesity is exacerbated and, not surprisingly, so is symptomatic gallstone formation. Diabetes needs to be controlled to prevent complications. HRT, unless menopausal symptoms are unbearable, continues to show why it may not be a good choice. Next week, we will look at the complications of gallstones and how to prevent them.

References: (1) Gastroenterology. 1999;117:632. (2) emedicine.medscape.com. (3) J Hepatol. 1993;18 Suppl 1:S43. (4) uptodate.com. (5) Best Pract Res Clin Gastroenterol. 2014 Aug;28:623-635. (6) Hepatology. 2013 Dec;58:2133-2141. (7) J Pediatr Gastroenterol Nutr. 2012;55:328-333. (8) Ann Intern Med. 1998;128:417. (9) Hepatology. 1997;2:787. (10) CMAJ. 2013;16;185:549-550.

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.