Sparkling wines can be red, white or rosé (pink) and dry, off-dry, semisweet or even sweet.
By Bob Lipinski
Bob Lipinski
The expression, “All that bubbles is not champagne,” might be overplayed, but it is true. Sparkling wines are made throughout the world in virtually every country that makes wine, and most countries have a local name for their “bubbly.” However, the term “champagne” is properly given to the sparkling wines made in the Champagne region of France. Sparkling wines made in the U.S. must provide a geographic term such as New York, American, or California before the word “Champagne.”
A sparkling wine is an effervescent wine (contains bubbles) resulting from the secondary fermentation of wine within a closed container (bottle or tank). Sparkling wines are made globally from a multitude of different grapes and grape blends. Sparkling wines can be red, white or rosé (pink) and dry, off-dry, semisweet or even sweet. Prices also range from inexpensive to very expensive, sometimes costing hundreds of dollars per bottle.
Some recently tasted sparkling wines that should satisfy anyone’s taste are:
Codorníu Cuvée Clásico “Cava Brut,” Spain (blend of macabeo, parellada and xarel-lo grapes): Fine pin-point bubbles with a bouquet of green apples, lemon and brioche. Dry, clean and crispy in the mouth with a pleasing aftertaste of almonds. Fabulous with fried calamari.
Codorníu Anna Blanc de Blancs, Brut Reserva, Spain (blend of chardonnay, parellada, xarel-lo and macabeo grapes): Delicately flavored, elegant and beautifully balanced with a nice creamy mouthfeel and a lively, fruity-spicy aftertaste. Raw oysters with a hint of mignonette sauce pairs well.
2016 Montesel Conegliano Valdobbiadene Prosecco Superiore, DOCG, Brut, Italy: A top-of-the-line dry prosecco, which has a fruity bouquet of apples, citrus and fennel. Flavors of ginger, stone fruit and anise round out this beauty. Did anyone say dark chocolate with some fresh raspberries!
Philippe Deval Brut Crémant de Loire, AOC Loire Valley, France (blend of chenin blanc and chardonnay grapes): A flowery aroma of apple cider, citrus, nuts and peaches. Dry and lemony with ripe melon flavors and almond aftertaste. Serve with a fruit-based sauce over pork.
Cococciola Brut Spumante, Abruzzo, Italy: Cococciola is a white grape variety grown in the Abruzzo (some in Apulia) region since the early 1900s and used mostly for blending. This is the first sparkling wine I have seen from the grape variety and it is amazing! Pale straw colored with a perfumed aroma of apricots, honeysuckle, lychee and wild flowers. Flavors of citrus and orange, with hints of sage and toasted almonds. The aftertaste begs for another glass (or bottle)! Pair this with some panettone, light fruit tarts or a bowl of strawberries with whipped cream.
By the way … the first recorded production of a bottle-fermented sparkling wine occurred as early as 1531 at the Abbey of Saint-Hilaire at Limoux in southern France, more than a century before Dom Pérignon arrived at Hautvillers.
Bob Lipinski, a local author, has written 10 books, including “101: Everything You Need to Know About Whiskey” and “Italian Wine & Cheese Made Simple,” available on Amazon.com. He conducts training seminars on wine, spirit and food and is available for speaking engagements. He can be reached at www.boblipinski.com or [email protected].
Chip is looking for her furever home. Photo from Kent Animal Shelter
MEET CHIP! Chip is an 8-month-old domestic short-haired female who has the best personality and loves to be around people. She has a sweet and playful nature, so she would be good in any home. Chip is very loving and purrs almost instantly when you pet her. She is up to date on all her shots, spayed and microchipped. Also she is free for the month of December! Come meet this sweetheart today! Kent Animal Shelter is located at 2259 River Road in Calverton. For more information on Chip and other adoptable pets at Kent, visit www.kentanimalshelter.com or call 631-727-5731.
As you become more active, Santa, you’ll find that you have more energy all year round, not just on Christmas Eve.
By David Dunaief, M.D.
Dr. David Dunaief
Dear Santa,
This time of year, people around the world are no doubt sending you lists of things they want through emails, blogs, tweets and old-fashioned letters. In the spirit of giving, I’d like to offer you — and maybe your reindeer — some advice.
Let’s face it: You aren’t exactly the model of good health. Think about the example you’re setting for all those people whose faces light up when they imagine you shimmying down their chimneys. You have what I’d describe as an abnormally high BMI (body mass index). To put it bluntly, you’re not just fat, you’re obese. Since you are a role model to millions, this sends the wrong message.
We already have an epidemic of overweight kids, leading to an ever increasing number of type 2 diabetics at younger and younger ages. According to the Centers for Disease Control and Prevention, as of 2015, more than 100 million U.S. adults are living with diabetes or prediabetes. It complicates the issue that approximately two-thirds of the U.S. population is overweight and/or obese. This is just one of many reasons we need you as a shining beacon of health.
Obesity has a much higher risk of shortening a person’s life span, not to mention quality of life and self-image. The most dangerous type of obesity is an increase in visceral adipose tissue, which means central belly fat. An easy way to tell if someone is too rotund is if a waistline, measured from the navel, is greater than or equal to 40 inches for a man, and is greater than or equal to 35 inches for a woman. The chances of diseases such as pancreatic cancer, breast cancer, liver cancer and heart disease increase dramatically with this increased fat.
Santa, here is a chance for you to lead by example (and, maybe, by summer, to fit into those skinny jeans you hide in the back of your closet). Think of the advantages to you of being slimmer and trimmer. For one thing, Santa, you would be so much more efficient if you were fit. Studies show that with a plant-based diet, focusing on fruits and vegetables, people can reverse atherosclerosis, clogging of the arteries.
The importance of a good diet not only helps you lose weight but avoid strokes, heart attacks, peripheral vascular diseases, etc. But you don’t have to be vegetarian; you just have to increase your fruits, vegetables and whole-grain foods significantly. With a simple change, like eating a handful of raw nuts a day, you can reduce your risk of heart disease by half. Santa, future generations need you. Losing weight will also change your center of gravity, so your belly doesn’t pull you forward. This will make it easier for you to keep your balance on those steep, icy rooftops.
Exercise will help, as well. Maybe for the first continent or so, you might want to consider walking or jogging alongside the sleigh. As you exercise, you’ll start to tighten your abs and slowly see fat disappear from your midsection, reducing risk and practicing preventive medicine. Your fans everywhere leave you cookies and milk when you deliver presents. It’s a tough cycle to break, but break it you must. You — and your fans — need to see a healthier Santa. You might let slip that the modern Santa enjoys fruits, especially berries, and veggies, with an emphasis on cruciferous veggies like broccoli florets dipped in humus, which have substantial antioxidant qualities and can help reverse disease.
As for your loyal fans, you could place fitness videos under the tree. In fact, you and your elves could make workout videos for those of us who need them, and we could follow along as you showed us “12 Days of Workouts with Santa and Friends.” Who knows, you might become a modern version of Jane Fonda or Richard Simmons or even the next Shaun T!
How about giving athletic equipment, such as baseball gloves, footballs and basketballs, instead of video games? You could even give wearable devices that track step counts and bike routes or stuff gift certificates for dance lessons into people’s stockings. These might influence the recipients to be more active.
By doing all this, you might also have the kind of energy that will make it easier for you to steal a base or two in this season’s North Pole Athletic League’s Softball Team. The elves don’t even bother holding you on base anymore, do they?
As you become more active, you’ll find that you have more energy all year round, not just on Christmas Eve. If you start soon, Santa, maybe by next year, you’ll find yourself parking the sleigh farther away and skipping from chimney to chimney.
The benefits of a healthier Santa will ripple across the world. Think about something much closer to home, even. Your reindeer won’t have to work so hard. You might also fit extra presents in your sleigh. And Santa, you will be sending kids and adults the world over the right message about taking control of their health through nutrition and exercise. That’s the best gift you could give!
Wishing you good health in the new year,
David
P.S. I could really use a new baseball bat, if you have a little extra room in your sleigh.
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.
Strata with Spinach, Bacon, Mushrooms and Gruyere Cheese
By Barbara Beltrami
Phew! Here it is Christmas Eve. Shopping done, presents wrapped, cookies baked, cards addressed and mailed (or not). And tomorrow is Christmas morning. Let’s see. OK, checklist: The kids put out cookies and milk for Santa and carrots for the reindeer and they have to get eaten; we’ve made sure the chimney is clear for Santa; better peek in and be sure the kids are finally asleep and dreaming of sugar plums, then put presents under the tree; and finally make strata for Christmas breakfast and put it in the refrigerator.
Strata? What’s that? It’s a wonderful eggy casserole-type dish with bread and whatever else you want to add — ham, cheese, bacon, sausage, cheese, onion, mushroom, spinach, broccoli, tomato, green pepper, fruit — whatever you’d put in an omelet or frittata or anything that strikes your fancy. It’s assembled ahead of time so the bread can soak up all the eggy liquid, then refrigerated and the next morning popped into the oven to bake while you sit and watch the kids open their presents.
Tip: It tastes best if you eat it while you’re in your pajamas.
Strata with Spinach, Bacon, Mushrooms and Gruyere Cheese
Strata with Spinach, Bacon, Mushrooms and Gruyere Cheese
YIELD: Makes 8 to 10 servings.
INGREDIENTS:
1 tablespoon butter
1 pound ready-to-eat crescent rolls, torn into chunks
12 large eggs
2½ cups half-and-half
Salt and freshly ground black pepper, to taste
¼ teaspoon cayenne pepper
¼ teaspoon freshly ground nutmeg
1 pound crispy bacon, crumbled
1 pound fresh spinach, cooked and squeezed dry
½ pound fresh mushrooms, sliced thin
¾ pound Gruyere cheese, shredded
DIRECTIONS: Grease a 9- by 13-inch baking dish with butter. Place half the crescent roll pieces evenly on bottom. In a large bowl, whisk together the eggs, half-and-half, salt and pepper, cayenne and nutmeg. Pour half the egg mixture over the crescent pieces. Let sit about 15 minutes until liquid is absorbed. Evenly distribute bacon, spinach, mushrooms and Gruyere in separate layers over soaked crescents. Top with remaining crescent pieces, then pour remaining liquid over them. Press down to ensure that all pieces are immersed. Cover with plastic wrap and refrigerate overnight. Preheat oven to 350 F. Remove plastic wrap. Bake strata for 45 minutes to one hour, until top is golden and a knife inserted in center comes out clean. Serve with hot coffee, tea or cocoa and a fruit salad.
Strata with Sausage, Eggs and Cheddar Cheese
YIELD: Makes 6 servings.
INGREDIENTS:
12 one-inch-thick slices of rustic white bread, cut into 1-inch cubes
½ cup cooked crumbled sausage meat
2 cups shredded cheddar cheese
12 large eggs
2½ cups half-and-half
1 teaspoon prepared Dijon mustard
DIRECTIONS: Combine the bread, sausage and cheese and pour into a greased 9- by 13-inch baking dish. In a large bowl whisk together the eggs, half-and-half and mustard; pour over bread mixture and press bread down to be sure all cubes are immersed in liquid. Cover with plastic wrap and refrigerate overnight. Preheat oven to 350 F, remove plastic wrap and place strata in oven. Bake for one hour, until top is golden and a knife inserted in center comes out clean. Serve hot or warm.
Strata with Pears, Raisins and Pecans
YIELD: Makes 8 to 10 servings.
INGREDIENTS:
One 1-pound loaf cinnamon raisin bread, cubed
1½ cups diced, pared and cored pears
1 cup raisins
²⁄₃ cup coarsely chopped pecans
10 large eggs
2½ cups half-and-half
4 tablespoons melted butter
1⁄₃ cup maple syrup
1 teaspoon vanilla extract
DIRECTIONS: Combine bread, pears, raisins and pecans; pour into a 9- by 13-inch greased baking dish. In a large bowl whisk together the eggs, half-and-half, butter, maple syrup and vanilla extract. Pour over bread mixture and press top to make sure all bread pieces are immersed in liquid. Cover with plastic wrap and refrigerate overnight. Preheat oven to 325 F. Remove plastic wrap; bake strata 45 minutes or until knife inserted in center comes out clean and top is golden. Serve hot or warm with bacon, or sausage, maple syrup and hot coffee, tea or cocoa.
In 2003, Theatre Three’s Douglas Quattrock and Jeffrey Sanzel sat down and wrote an adorable musical for children titled “Barnaby Saves Christmas,” about a little elf named Barnaby and a tiny reindeer called Franklynne who teach us that “Christmas lies within our hearts.” I recently had the opportunity to ask the two playwrights a few questions about the show that has become a beloved holiday tradition for families on the North Shore.
Can you believe it’s been 14 years?
DQ: No I can’t … it feels like just yesterday. I couldn’t possibly be getting that old!
What inspired you to write a holiday show for children?
JS: Doug conceived and created “Barnaby.” I had very little to do with its initial creation. He brought me a rough draft and the incredible score the summer before we premiered it. I was immediately taken by his terrific songs and I loved the idea of a holiday show that touched on another culture. During the fall, he continued to write and rewrite the show and went into rehearsal with it. It opened to great response and we knew we had our annual show.
Over the next several years, Doug and I worked on the book together, trading ideas, trying new things. Doug continued to add to the score and we have revised the show every year. The only thing that hasn’t changed is the beautiful score and the show’s great big heart — Barnaby and Franklynne are truly amazing holiday figures with as much character as Rudolph or Santa.
DQ: I have 13 nieces and nephews and I used to babysit when they were young and they would ask me to tell them bedtime stories. I used to make up stories for them, and one holiday season I started to tell them about a little elf and his reindeer friend. I always tried to put messages in the stories such as believing in yourself, believing that you can do anything, getting over fears and things like that.
They would get a little piece of the story at a time. Then I started writing songs to go along with that particular story and play them for the kids. Theatre Three always does “A Christmas Carol,” and that is a little scary for the young ones, and I wanted to offer a holiday show for the children. When I spoke to Jeff about the idea, he loved it and encouraged me to give it a shot. I was much more confident writing songs, which in themselves are stories, but writing an actual play was another thing. “Barnaby” was the first play I ever wrote and without Jeff’s extraordinary talent and guidance I don’t think I could have ever done it. His knowledge of theater and storytelling is second to none.
‘Barnaby’ is considered a Christmas story yet Hanukkah is very much a part of it. Why was it important to you to include the Festival of Lights in this story?
DQ: As people, I have always believed that we can all learn something from each other. Whatever your faith or beliefs, we are all here in this life together. We should respect and be open to others ways of living. The Festival of Lights celebrates a miracle and is a story of perseverance … not giving up. Barnaby and Franklynne are faced with a struggle at that point in the plot, and it struck me as the perfect opportunity to share that beautiful story. That’s where the song “Miracles” comes in.
JS: The fact that children get a small education on Hanukkah is an additional gift. We’ve had so many people thank us for adding that and finding the connection in the overall holiday spirit.
How does it make you feel when you hear the children laughing and see them enjoy the show?
DQ: It’s beyond gratifying and a little surreal. I love when the kids laugh and sing the songs on their way out of the theater.
What message did you hope to convey when you wrote this show?
DQ: The message of the story is really in some of the lyrics of the songs. “… Every day’s a golden opportunity to be better than you used to be…” “There are so many miracles that happen everyday” and lastly. “… Christmas lies within our hearts, The toys we give are just a sign of all the love we feel inside, and there’s enough to share for you and me.”
Theatre Three, 412 Main St., Port Jefferson will present “Barnaby Saves Christmas” on Dec. 23, 24, 28, 29 and 30 at 11 a.m. All seats are $10. To order, call 631-928-9100 or visit www.theatrethree.com.
Artist statement: ’Painting with pastels captures light in nature with a brilliance and mystery that takes me on a journey to the creative process!’
Jane McGraw Teubner is a Master Pastelist in the Pastel Society of America, as well as a Master Circle Recipient from the International Association of Pastel Societies. She is on the board of directors of the Catherine Lorillard Wolfe Art Club, which exhibits each year in the National Arts Club in Gramercy Park in New York City and is a Resident Artist of the famed Salmagundi Art Club, also located in the city. Recently her painting was on the cover of PleinAir Magazine, an international art journal devoted to outdoor painting. McGraw Teubner, who resides in East Northport with her husband Rich, recently answered some questions about her art.
Why are you drawn to pastels?
I am drawn to pastels because of the immediacy, vibrancy and permanence of the colors. Originally, I worked in oils but I was working full time, with limited time to paint. The paint would dry out on my palette and I was lazy about cleaning my brushes. When I discovered pastels about 30 years ago, it was the perfect medium for a busy person. They are already dry, no mixing of colors, no chemicals, no brush cleaning! The effects you can achieve with pastels are not matched by any other medium.
Can you describe your process for painting a pastel?
‘Autumn Splendor’
It is an incremental approach. I start each painting with a small study of the composition. If that works, I go to the next step to create a value-based underpainting, usually with one or two colors to achieve the correct lights and darks. If I am pleased with that, I continue on to placing colors.
Where do you like to paint?
I love painting outdoors. I do a lot of studio work too, but that studio work is heavily influenced by working directly from nature. You cannot duplicate the colors of nature with a camera. The lights are usually too light and the darks too dark. My “go-to” place is Sunken Meadow State Park.
What is it about an ordinary scene that you can transform into an extraordinary painting?
I try to put magic into my paintings. When someone looks at my work, I’d like them to say “How did she do that?” I like to take a scene and put something personal into it, my own vision and atmosphere. I use a limited color palette that helps enhance the serenity of my work.
I know that you teach pastel classes in your studio, as well as at the Teaching Studios of Art in Oyster Bay. What is the most important thing you can teach your students?
I teach my students to not be afraid to fail, that you learn more from your mistakes than your successes.
Are there any secrets that you can share about your process?
‘Lavendar Field’
Yes, when I am working in front of an easel, I am living in the present, appreciating every moment, not wanting to be anywhere else. I consider that to be one of the secrets to a good painting or a good life — being mindful of what you are doing. I not only get a true sense of accomplishment for the finished product, but even more from the journey that took me there.
How can someone who is not able to come to a workshop with you learn about your process?
A few years ago I made a DVD with American Artist Magazine, which is available through www.northlightshop.com. It was filmed in Colorado and it’s about creating a painting outdoors.
One of your paintings landed on the Oct./Nov. cover of Plein Air Magazine along with an extensive article. What was that experience like?
It was very exciting to have been chosen to be interviewed for the magazine, but to get on the cover was a special gift I never imagined that would happen. It was a matter of being prepared for the opportunity and luck. Steven Doherty, the editor, chose one of my paintings from my website and submitted it to the publisher, along with three other artists’ work. That’s where the luck came in when Eric Rhoads picked mine.
After winning so many national and local awards, is there one award that you consider your most memorable?
‘Tidal Wash’
I received the Gold Medal of Honor for Pastels and Drawing from the Catherine Lorillard Wolfe Art Club a few years ago. It was a national juried show with artists participating from all over the country and it was my first national award. I have also received two awards from the Plein Air Easton competition. Just the process of getting accepted into the most well-respected plein air show in the country is an honor, with hundreds of people applying for just 50 spots, but to win an award is an outstanding accomplishment.
Where can we see your work?
People are welcome to see my newest work, upcoming exhibits and latest painting adventures by visiting my website, which is www.janemcgrawteubner.com. I am represented on Long Island at the William Ris Gallery East in Jamesport.
Are any of your hobbies related to painting?
Running has been my main form of exercise for over 35 years. Learning to paint is like training for a marathon. Each single step is important. Running taught me to take baby steps and have patience with my painting. With much practice, you will get better.
BeLocal winners from left, Yuxin Xia, Luke Papazian, Manuela Corcho, Johnny Donza and their thesis advisor Harold Walker. File photo
By Daniel Dunaief
Yuxin Xia and Johnny Donza
Johnny Donza wants to use the training he’s received as an engineering undergraduate at Stony Brook University to help people 8,600 miles and another continent away in Madagascar.
The group leader of a senior project, Donza is working with Yuxin Xia, Luke Papazian and Manuela Corcho to design and hopefully help build a bridge that will cross a stream on the outskirts of the village of Mandrivany. People living in that village had been walking across a log that has broken to buy and sell food or get to a hospital.
“I wanted to be involved in something that would make an impact,” said Donza, who is studying civil engineering with a concentration in structural engineering. This project presented an opportunity to help “people on the opposite side of the world. I thought that was pretty cool.”
Donza’s project is one of 15 senior design efforts that arose from a collaboration between Stony Brook and a group called BeLocal. The company sent Stony Brook graduates Acacia Leakey and Leila Esmailzada to collect video footage this summer in Madagascar. They hoped to return with the kind of information about the needs and resources of the people they met.
“These projects create the perfect opportunity for students to manage a real engineering project,” Harold Walker, professor and chair of the Department of Civil Engineering, explained in an email. Walker is Donza’s senior advisor on the project. “The experience the students have with these projects will be invaluable as they start their engineering careers.”
Acacia Leakey, on left
Walker said he initially expected to have one team of four to five students work with BeLocal in Civil Engineering. Instead, 13 students signed up. Walker spoke with Leakey and they decided to divide the students into three teams, each of which is working on different types of bridges. “If the bridge design can be implemented locally in Madagascar, this will improve the safety of river crossings and also provide the community [with] greater access to education and other opportunities,” he continued. “A bridge may seem like a simple thing but it can really be transformative.”
In addition to the bridge project Donza and his teammates are developing, Stony Brook teams are working on projects including rice storage, rat control, rice processing and briquette manufacturing.
Eric Bergerson, one of the three founders of BeLocal along with Mickie and Jeff Nagel of Laurel Hollow, said the group was thrilled with the range and scope of the projects. The response is “overwhelming,” Bergerson said, and “we couldn’t be happier.” Bergerson is the director of research at the social data intelligence company TickerTags.
For their project, Donza’s group is exploring the use of bamboo to create the bridge. “Deforestation in the region is a major problem,” which reduces the ability to find and use hardwood, Donza said. “Bamboo grows rampantly, so there’s plenty of bamboo we can use.”
To gather information about the structural details about this material, Donza and his team are testing bamboo they harvested from the Stony Brook campus. Leakey, who is earning her master’s at SBU after she did a Madagascar senior design project last year, said using bamboo creates a useful supply chain. “It’s such a sustainable resource,” said Leakey, who speaks regularly with Donza and other project managers who are seeking additional information about how to use local resources to meet a demonstrated need in Madagascar.
The Stony Brook team is working to model its structure after the Rainbow Bridge, which is an ancient Chinese bridge. The Rainbow Bridge has a longer span and has a more exaggerated arch than the one Donza and his classmates are designing. The group plans to build a structure that will hold several people at the same time. During monsoon season, the stream below the bridge also floods. The design may need to include nails or bolts, creating a durable, longer-lasting bond between pieces of bamboo.
The team is also waiting to collect information about the soil around the stream, so they know what kind of foundation they can construct. In their design, they are trying to account for a likely increase in the population and future windy conditions.
Donza said he and his team are excited to make a meaningful contribution to life in Madagascar. “We’re not just doing this to graduate,” he said. “We’re doing this because we have a chance to help people. They need this bridge.”
Leila Esmailzada
The BeLocal approach to the collaborations with Stony Brook involves learning what people need by observing and interacting with them, rather than by imposing expectations based on experiences elsewhere. Esmailzada said they spoke with women about various materials because women were the ones using the charcoal and firewood.
At some point, BeLocal may also foster an exchange that allows students from Madagascar to come to Stony Brook to learn from their American counterparts while also sharing first-hand information about what might work in Madagascar. “It’d be great if we could get people to come” to Stony Brook, Bergerson said. “We’re just developing relationships with universities now.”
Leakey said Stony Brook students have shown genuine interest in life in Madagascar and, as a result, have found some surprises. People across various disciplines assume incorrectly that developing nations progress along the same technological path that America did, which leads them to the inaccurate expectation that Madagascar is 100 years behind the United States. When engineering students learned that “people in Madagascar have smartphones” with Twitter and Facebook accounts, “their jaws fall. It’s important to recognize that so you can realize it isn’t a simple story that you’re innovating for and that there is this mixture of technology that’s familiar in a lifestyle that’s unfamiliar.”
Even while these projects are still in the formative stages, with students continuing to gather information and refine their projects, Walker suggested they have already provided value to engineering students. “The students have already learned a great deal,” Walker explained. They appreciate how their classroom skills “can really transform the lives of people across the world.”
How do we protect one of our most valued assets, our infrastructure? Not roads and bridges, but our bones. When we think of bone fractures as a child or young adult, we think of short-term pain and inconvenience, but usually we recover without long-term consequences.
However, as we get older, fractures can be a lot more significant, with potentially life-altering or life-ending consequences. Osteoporosis is a silent disease that affects millions of patients, most commonly, but by no means exclusively, postmenopausal women. The trend is for low bone mass and osteoporosis diagnoses to increase by 29 percent from 2010 to 2030.
Osteoporosis is where there is bone loss, weakening of the bones and small deleterious changes in the architecture of the bone over time that may result in fractures with serious consequences (1).
One way to measure osteoporosis is with a dual-energy X-ray absorptiometry (DXA) scan for bone mineral density. Osteopenia is a slightly milder form that may be a precursor to osteoporosis. However, we should not rely on the DXA scan alone; risk factors are important, such as a family or personal history of fractures as we age. The Fracture Risk Assessment Tool (FRAX) is more thorough for determining the 10-year fracture risk. Those who have a risk of fracture that is 3 percent or more should consider treatment with medications. A link to the FRAX tool can be found at www.shef.ac.uk/FRAX.
Most of us have been told since we were young that we need more calcium to make sure we have strong bones. In fact, the National Osteoporosis Foundation recommends that we get 1,000 to 1,200 mg per day of calcium if we are over 50 years old (2). Recommendations vary by sex and age. This would be mostly from diet but also from supplements. However, the latest research suggests that calcium for osteoporosis prevention may not be as helpful as we thought.
The under/overmedication treatment paradox
Depending on the population, we could be overtreating or undertreating osteoporosis. In the elderly population that has been diagnosed with osteoporosis, there is undertreatment. One study showed that only 28 percent of patients who are candidates for osteoporosis drugs are taking the medication within the first year of diagnosis (3). The reason most were reluctant was that they had experienced a recent gastrointestinal event and did not want to induce another with osteoporosis medications, such as bisphosphonates. The data were taken from Medicare records of patients who were at least 66 years old.
On the other hand, as many as 66 percent of the women receiving osteoporosis medications may not have needed it, according to a retrospective study (4). This is the overtreatment population, with half these patients younger, between the ages of 40 and 64, and without any risk factors to indicate the need for a DXA scan. This younger population included many who had osteopenia, not osteoporosis.
Also, the DXA scan may have shown osteoporosis at what the researchers described as nonmain sites in one-third of patients diagnosed with the disease. Main sites, according to the International Society for Clinical Densitometry recommendations, would be the anterior-posterior spine, hip and femoral neck. A nonmain site in this review was the lateral lumbar spine. Before you get a DXA scan, make sure you have sufficient risk factors, such as family or personal history of fracture, age and smoking history. When the DXA scan is done, make sure it is interpreted at the main sites. If you are not sure, have another physician consult on the results.
We all need calcium to prevent osteoporosis, right?
Calcium has always been the forefront of prevention and treatment of osteoporosis. However, two studies would have us question this approach. Results of one meta-analysis of a group of 59 randomized controlled trials showed that dietary calcium and calcium supplements with or without vitamin D did increase the bone density significantly in most places in the body, including the femoral neck, spine and hip (5). Yet the changes were so small that they would not have much clinical benefit in terms of fracture prevention.
Another meta-analysis of a group of 44 observational dietary trials and 26 randomized controlled trials did not show a benefit with dietary or supplemental calcium with or without vitamin D (6). There was a slight reduction in nonsignificant vertebral fractures, but not in other places, such as the hip and forearm. Dietary calcium and supplements disappointed in these two trials.
Does this mean calcium is not useful? Not so fast!
In some individual studies that were part of the meta-analyses, the researchers mentioned that dairy, specifically milk, was the dietary source on record, and we know milk is not necessarily good for bones. But in many of the studies, the researcher did not differentiate between the sources of dietary calcium. This is a very important nuance. Calcium from animal products may increase inflammation and the acidity of the body and may actually leach calcium from the bone, while calcium from vegetable-rich, nutrient-dense sources may be better absorbed, providing more of an alkaline and anti-inflammatory approach. This would be a good follow-up study, comparing the effects of calcium from animal and plant-based dietary sources.
What can be done to improve the situation?
Studies have shown that yoga can help prevent osteoporosis by improving mobility, posture and strength.
Yoga used to be on the fringe of society. Now, it has become more prevalent and part of mainstream exercise. This is a good trend since this type of exercise may have a big impact on prevention and treatment of osteoporosis. In a small pilot study, the results showed that those who practiced yoga had an increase in their spine and hip bone density compared to those who did not (7). There were 18 participants in this trial.
The researchers were encouraged by these results, so they increased the number of participants in another study. The results showed that 12 minutes of yoga daily or every other day significantly increased the bone density from the start of the study in both the spine and femur, the thigh bone (8). There was also an increase in hip bone density, but this was not significant. The strength of the study includes its 10-year duration. However, one weakness was that this trial did not include a control group.
Another was that 741 participants started the trial, but only 227 finished, less than one-third. Of those, 202 were women. Significantly, prior to the study there were 109 fractures in the participants, most of whom had osteoporosis or osteopenia, but none had yoga-related fractures by the end of the trial. The “side effects” of yoga include improved mobility, posture, strength and a reduction in anxiety. The researchers gave a nice road map of specific beneficial poses. Before starting a program, consult your doctor.
The moral of the story is that exercise is beneficial. Yoga may be another simple addition to this exercise regimen. Calcium may be good or bad, depending on its dietary source. Be cautious with supplemental calcium; it does have side effects, including kidney stones, cardiovascular events and gastrointestinal symptoms, and consult with your doctor to assess whether you might be in an overtreatment or undertreatment group when it comes to medication.
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.
Donald Trump and now Aaron Boone? What’s going on?
A well-known businessman, who spent considerable time on TV after he had made his money, was elected president — in case you’ve been living in a hole somewhere for the last year or so — despite not having any experience whatsoever as a politician.
Then, recently, the New York Yankees, who expect a championship every year and aren’t fond of learning curves, went out and hired someone whose playing claim to fame as a Yankee came with one swing 14 years ago. After his playing career ended, Boone entered the broadcast booth where he talked about the game.
Like Trump, Boone was beamed into the leaving rooms of those who paused to watch the program that featured him.
And now, like Trump, Boone must do some quick on-the-job training, becoming a modern-day manager.
Now, I don’t expect Boone to attack other players, managers or umpires on Twitter, the way the president has done when he unloads written salvos against anyone who dares to defy or annoy him.
What I’m wondering, though, is how did these men get their jobs? Since when is experience doing a high profile job no longer necessary? What made Trump and Boone the choice of the Electoral College and the best candidate to make the Yankees greater again, respectively? These Yankees, after all, were surprisingly great this year, falling one game short of the fall classic.
One word may answer that question: television. Somehow we have gone from the comical notion, years ago that “I’m not a doctor, I play one on TV,” to the reality of “I know better because I seem that way on TV.”
Long ago, in 1960, when Richard Nixon and John F. Kennedy were running for president, TV helped sway voters, particularly those who watched an important debate. So, I suppose, it seems like a logical extension to imagine that TV helped fast track the careers of people who spent time sharing their thoughts, tag lines and observations with us through that same medium.
Sports and reality TV have commonalities. A sport is the ultimate live, unscripted event, where people offer off-the-cuff thoughts and analyses on fluid action. Each game and each moment can bring the unexpected — a triple play, an inside-the-park home run or a hidden-ball trick — that requires an instant reaction.
Similarly, albeit in a different way, the reality TV that brought Trump to the top of the political heap gave him a chance to respond to changing situations, offering a cutting analysis of the potential, or lack thereof, for people on his show.
While viewers watch these familiar faces and hear their voices, people can become convinced of the wisdom and abilities of these TV stars who become spokespersons and champions for their own brands.
So, does Trump offer any insight into Boone? The new Yankees manager may find that second-guessing other people is much easier than making decisions himself and working as a part, or a leader, of a team.
Trump has bristled at all the second-guessers. While he’s familiar with the media scrutiny, Boone, too, may find it irritating that so many other New Yorkers are absolutely sure they know better when it comes to in-game decisions that affect the outcome of a Yankees contest.
Perhaps what Boone and Trump teach us is that selling your ideas or yourself on TV has become a replacement for experience. TV experience has become a training ground for those selling their ideas to the huddled masses yearning for a chance to cheer.
Strange as it may seem amid the frenetic shopping, the seasonal music and the rounds of holiday parties, there are some who are deeply lonely. They may or may not seem so, they may be among the elderly or adolescents, they may appear depressed or not, but they are indeed lonely. And lonely can be bad for one’s health.
Loneliness has lots of causes. For a widow or widower, the approach of the holidays makes more grievous the loss of a spouse. Holidays are typically family time, and one member is gone. Or perhaps a close friend has died and is sorely missed. For those who have outlived their contemporaries, the gaiety and excitement of the holidays are a sad contrast with their lives. Or with children and grandchildren scattered over three continents, it may not be possible to be together for the celebrations. Perhaps worst of all are those in unsatisfying relationships who are perceived to be coupled but are in reality painfully lonely.
Loneliness, health studies have shown, can cause increased risk of heart disease, type 2 diabetes, arthritis, depression, accelerated cognitive decline and even trigger suicide. And in this world of electronic devices operating on the internet, even a phone call with the sound of a warm voice is now often replaced by a tidy and sanitized email or text message.
How are we to respond to such feelings of loneliness?
First is to be aware that those around us may not be so caught up in the spirit of the season. For those who have plenty, whether in worldly goods or in simple joy, this is the time for sharing. Sometimes it is not so obvious when others are hurting. If a neighbor is a shut-in, it is easy to guess that the person would like a visit, even a short one, or an errand run on their behalf. These are immediate solutions. But social isolation and loneliness are not necessarily the same. That neighbor may have few social connections but enjoy an existence rich with books, music or hobbies. On the other hand, loneliness is a subjective condition in which a person feels isolated, even if surrounded by people most of the time. That person is just as needy, or more so, for human interaction but that need may be harder to discern. Research at the University of California, San Francisco, reveals that “most lonely people are married, live with others and are not clinically depressed,” according to a recent article by Jane Brody in The New York Times.
Some more obvious remedies for those who are lonely or socially isolated to help themselves might be volunteering at a hospital or assisted living center, a soup kitchen or a nursery school. Giving to others in need brings its own rewards. Joining a group with shared interests — anything from quilting to trivial pursuit — can help. A book club or a class is a way to keep the mind engaged while perhaps finding others with whom to socialize. And the fail-safe solution for those who desire interaction with others is to get a dog. It is not possible to take a dog for its walk three times a day, day after day, and not get into conversation with someone along the way unless the walk is in the woods.
But back to how we can help others who cannot help themselves. It seems to me that one of the greatest compliments one human can give to another is the willingness to listen. This may sound easier than it really is. Many people practice mindfulness, being in the moment, meditation and so forth for their own enrichment. In order to listen to another person, to really hear them, one has to practice that skill too, until it becomes almost an art. We who live in our small villages, where people have more opportunity to connect with neighbors in the supermarket or at concerts or school baseball games, we are lucky enough, if we are so interested, to be available to listen to each other.
We can learn when we listen. And for the lonely, genuinely being heard is a balm.
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