Ernest Hemingway once wrote that “Paris is a moveable feast.” I think he might have meant “transportable,” because a moveable feast changes dates but not location, whereas a transportable feast goes wherever you do. But what do I know?

Holidays, like Easter or Passover, that move around the calendar are known as “moveable feasts.” But I would argue that any occasion that kicks off brunch season — whether it’s Mother’s Day or the first sunny Sunday after months of rain — is the ultimate moveable feast.

Adding a whole egg adds richness to a Ramos Fizz. (Ross Taylor/The Virginian-Pilot)

And brunch is really just a fancy way of saying, “I want an alcoholic drink with my breakfast.” (We are not here to judge!) So with that idea in mind, we’re offering up the trinity of brunch cocktails — the Bloody Mary, the Mimosa and the Ramos Fizz — all localized and elevated by the addition of one or two new-ish ingredients.

It is the beginning of spring after all, and spring is all about new beginnings and new things. Hemingway also wrote: “When spring came, even the false spring, there were no problems except where to be happiest.”

If that doesn’t scream Northern California — this year in particular — I don’t know what does.

Recipes

A Fizz for Spring

2 ounces Alamere Spirits London Dry Gin
2 ounces unsweetened organic coconut cream (not Coco Lopez)
½ ounce Cointreau or other good-quality clear triple sec
½ ounce fresh-squeezed Meyer lemon juice
1 whole egg
1 orange zest
Fresh grated nutmeg

Directions: Combine the gin, cream, Cointreau, lemon juice and whole egg in a shaker glass with ice. Shake until foamy. Strain into a chilled coupe glass, being sure to pile up foam on top. Garnish with orange zest and top with grated nutmeg.

Note: Eggs are not a new idea (see Golden Fizz) but the richness of the yolk adds a great weight to this fluffy drink. Swapping out the milk cream for coconut cream also adds richness and eliminates any possible curdling, which can happen when combining citrus and milk. Orange flower water (another classic ingredient) is neither very tasty nor readily available. Triple sec, with its high sugar content, not only adds sweetness but also a delicate orangey flavor.

A Rosy Mimosa

4 ounces Schug Winery 2019 sparkling rosé
2 ounces fresh-squeezed tangerine juice
¼ ounce Hanson of Sonoma organic mandarin vodka
1 strip tangerine zest

Directions: Combine the first three ingredients in a mixing glass and stir once to combine. Allow foam to subside and transfer to a chilled champagne flute. Garnish with zest. By combining ingredients in a separate glass first, you can eliminate the explosive citrus juice foam that happens when you combine sparkling wine with fresh citrus juice.

Note: Mimosas are named for the color of mimosa blossoms. Tangerine juice adds a wonderful tartness to this drink, and the mandarin vodka complements that nicely. This version does have a slightly different color, but its tart, fresh flavor more than makes up for the color variation.

Umami Snapper

2 ounces Sausalito Liquor Co. Marin Coastal Gin
3 ounces organic tomato juice
1 dash Worcestershire sauce (about 1/8 teaspoon)
1 dash hoisin sauce
1 dash Sol Food Pique hot sauce
1 teaspoon fresh ground black pepper
1 dash good-quality Thai/Vietnamese fish sauce
King Floyd’s Black Lava salt for rimming

Directions: Partially rim a pint glass with the black lava salt by wetting the rim with the fleshy side of a piece of citrus and then dabbing the glass into salt before filling with ice. In a separate mixing glass, combine the first seven ingredients and stir. When thoroughly combined pour mixture into rimmed glass.

Note: The Red Snapper is a later gin version of the Bloody Mary. The Bloody Caesar is a Bloody Mary made with Clamato juice. This take combines the best elements of those two: the aromatics of the gin and the umami of the fish sauce (fish sauce doesn’t actually taste like fish, just like Clamato doesn’t actually taste like clam). The result is a testament to that elusive fifth taste: umami, which is really more of a sensation than a taste.

Jeff Burkhart is the author of “Twenty Years Behind Bars: The Spirited Adventures of a Real Bartender, Vol. I and II,” the host of the Barfly Podcast on iTunes and an award-winning bartender. Follow him at jeffburkhart.net and contact him at jeffbarflyIJ@outlook.com.

A surprising thing is happening to some women on weight-loss drugs who’ve struggled with fertility issues: They’re getting pregnant. That’s leading to questions about the safety of medications from Novo Nordisk A/S and Eli Lilly & Co. during pregnancy.

“I thought I couldn’t have any more kids,” said Torria Leggett, 40, who had been trying for another after her first child was born in 2018. In 2022, the social worker from Whiteville, North Carolina, began taking Novo’s Ozempic to treat obesity, then switched to Lilly’s Mounjaro. As the pounds melted off, there was soon another reason to celebrate. She was expecting.

“The weight loss, that’s likely what jump-started it,” she said. “I couldn’t believe it.”

Stories like these are encouraging doctors to use GLP-1 drugs to treat polycystic ovary syndrome, one of the leading causes of infertility in U.S. women. Yet they’re doing so without much data on the drugs’ impact on pregnancy.

“The ‘oops’ babies on Ozempic and Wegovy are happening all over the place,” said Melanie Cree, director of the PCOS clinic at Children’s Hospital Colorado in Aurora. “It’s very exciting, but it’s a bit scary because we’re moving forward without all the data.”

The need for treatments is severe. Despite its prevalence, no drugs are approved for PCOS, and experts are divided on whether commonly recommended diet programs work. Some doctors and patients are willing to try almost anything, and the successes are tantalizing.

GLP-1 drugs have been marketed for nearly 20 years to treat diabetes, and their use in obesity is fueling a new market that’s expected to hit $100 billion in 2030. The problem is, companies haven’t systematically studied GLP-1’s use in PCOS – and don’t plan to anytime soon. In the absence of data, researchers are doing studies of their own to figure out if the drugs work for PCOS, and U.S. regulators have asked the companies to collect any information they can about their use during pregnancy.

Limited Information

So far, the safety data look promising. A recent study of the health records of 50,000 women with type 2 diabetes found no increase in birth defects among those who used the drugs in very early pregnancy compared with those who took insulin.

Still, the study’s authors said additional confirmation is needed, especially in women without diabetes. Researchers from Copenhagen concurred last year in a review of GLP-1 drugs, saying that there’s “limited information on their long-term safety, particularly concerning pregnancy outcomes.”

Reasons for concern come mostly from animal experiments. The active ingredient in Novo’s drugs, semaglutide, has been linked to increased birth defects in animals. Similar studies of Lilly’s drugs have shown there “may be risks to the fetus” from exposure during pregnancy, the company said.

Related Articles

Why taking steps to combat loneliness can be good for your overall health

Solving the puzzle: Autism diagnosis often takes longer for girls, whose symptoms can differ from boys’

States want to make it harder for health insurers to deny care, but firms might evade enforcement

‘Are nursing homes our only option?’ These centers offer older adults an alternative

Sugar cravings could be caused by loneliness, study finds

No one is exactly sure how — or even whether — the drugs contribute to women becoming pregnant. Weight loss is known to boost fertility in women with PCOS, and studies have shown that Saxenda, an older obesity drug, also raised pregnancy rates in women with the disorder who were overweight. GLP-1s may also have hormonal effects that promote fertility, and may blunt the impact of oral contraceptives. Some experts think the drugs might even have a role in male infertility.

Rekha Kumar, a reproductive endocrinologist at Weill Cornell Medicine, says GLP-1 drugs “wake up the ovaries,” resetting the reproductive environment for normal function. After treating patients with infertility and obesity for more than 15 years, one thing is clear, Kumar said: “These patients are becoming very fertile.”

Pregnant people and those planning to get pregnant were excluded from trials of GLP-1s. Trial participants have been required to use contraception, and treatment was discontinued for those who became pregnant during clinical trials of Mounjaro and Zepbound, Lilly said.

Experts Split

Experts are split on how soon patients should stop taking the medications before a planned pregnancy. Some doctors are telling patients that up to four weeks is safe; others say it’s fine to keep using them up until the time of pregnancy. Wegovy’s label says people should stop taking the drug at least two months before trying to get pregnant, while Zepbound’s recommends that people who become pregnant stop the drug.

In Colorado, Cree is running a study to find out how Novo’s Wegovy affects ovulation in women with PCOS, but ongoing supply problems with the popular drug present a challenge. Novo won’t provide free supplies because the patients won’t be on birth control, she said, a decision she called “very disappointing.”

Meanwhile, a study found that the number of women exposed to GLP-1 drugs during early pregnancy appears to be increasing, as more turn to them for diabetes and other conditions. The Facebook group “I got Pregnant on Ozempic” has 597 members; on TikTok, dozens have said they’ve become pregnant while taking a GLP-1 drug.

The U.S. Food and Drug Administration asked Novo to set up a registry to collect data on those who got pregnant while taking Wegovy, but the company has yet to share any results. It’s also required to do an additional pregnancy study using insurance claims or electronic medical records, the FDA said. Lilly is planning to set up a similar registry, but declined to say when. Meanwhile, Cree and a handful of researchers are scrambling to set up their own databases to track pregnancy outcomes in GLP-1 patients.

Not A Cure

PCOS is a somewhat mysterious condition that typically involves irregular ovulation and high levels of male hormones called androgens. It’s the most common hormonal disorder in women, putting them at increased risk of diabetes, heart disease and mental health issues.

Those with the condition frequently make too much testosterone, leading to effects like extra hair growth, acne and weight gain, and blocking ovulation. They also don’t respond properly to insulin, and the weight-loss effects of GLP-1s may improve sensitivity to the hormone.

The new drugs “are not going to cure you, but it’s going to improve the symptoms significantly,” said Ricardo Azziz, a PCOS expert and professor at the University of Alabama at Birmingham and SUNY Albany in New York. Still, he thinks more data is needed before doctors recommend the drugs for fertility.

People like Leggett, who got pregnant on a weight-loss drug, also have some questions. She sometimes wonders why her daughter is smaller than other kids the same age.

“She’s teeny-tiny,” Leggett said. “I’d like to know more about that.”

With assistance from Jessica Nix and Naomi Kresge.

©2024 Bloomberg L.P. Visit bloomberg.com. Distributed by Tribune Content Agency, LLC.

Related Articles

Why taking steps to combat loneliness can be good for your overall health

Solving the puzzle: Autism diagnosis often takes longer for girls, whose symptoms can differ from boys’

Sugar cravings could be caused by loneliness, study finds

National Jewish study looks to sand as possible explanation for combat veterans’ breathing problems

To close racial gap in maternal health, some states take aim at ‘implicit bias’

Lauren J. Mapp | The San Diego Union-Tribune (TNS)

SAN DIEGO — Donning one of her favorite unicorn-themed nightgowns and perched comfortably in an extra large beanbag chair, Alyssa Tracy watches videos on her tablet.

It’s a quiet, early April morning at the Lakeside, California, home where the 10-year-old lives with her parents, Dustin and Debra Tracy, and older sister Grace Tracy, age 12.

But just a few minutes earlier, Alyssa was a little fussy. Being on spring break means her school routine is disrupted. Plus, there’s a reporter and photographer visiting.

Alyssa Tracy, 10, engages with an activity on her tablet at home. In some cases, an autism diagnosis is delayed because girls may be seen merely as quieter or shy, rather than demonstrating clear symptoms. Research over the past decade has helped reveal that boys and girls may present symptoms in different ways. (Alejandro Tamayo/The San Diego Union-Tribune/TNS)

Having a stable routine can be really important for children like Alyssa, who is diagnosed with autism spectrum disorder.

“Her hair, her routine, it always has to be done a certain way,” said her mom. “She has to have ponytails every day. It can’t be braids. It used to be braids for a while, for a few years. But now it’s just ponytails.”

Autism spectrum disorder is a developmental disorder, characterized by difficulty with communication, social interactions and behavior, the Centers for Disease Control and Prevention reports.

Some early signs of autism are when a child fails to make or keep eye contact or if they don’t respond to their name by the time they’re 9 months old. They may also seem unaware when someone speaks to them. At a year old, they might use few or no gestures — such as not waving goodbye — and they may not play simple games, like pat-a-cake.

While Alyssa was diagnosed with autism at age 2 — under the average diagnosis age of 4½, according to the CDC — many other girls and women with the condition are not diagnosed until much later than their male counterparts. That latent diagnosis can impact when or if they receive support therapies, which experts says are key to improved long-term outcomes.

Gender-based differences in autism

The Organization for Autism Research reports that while 25 percent of boys with autism are diagnosed before age 6, only 8 percent of girls receive a diagnosis by that time. By 11 years old, about half of boys have been diagnosed, compared with 20 percent of girls.

UCLA Health reports that nearly 80 percent of autistic women are undiagnosed at age 18.

Among those not diagnosed until adulthood is Jennifer Cook, author of the memoir“Autism in Heels” and nine other books about autism. Her virtual coaching for neurodiverse people is featured on the Netflix series “Love on the Spectrum U.S.,” which was renewed for a third season earlier this month.

In 2011, Cook was identified as being on the spectrum at 35, after her three children were diagnosed. At the time, some of the specialists working with her daughter, then 7, would ask questions about why Cook was using specific methods during home school lessons.

After several specialists asked similar questions, Cook started to question whether she, too, had autism spectrum disorder. But at the time, she couldn’t find information about what autism looked like in women and girls.

So, Cook listed how she thought the condition showed up in her life, “Chicklist Check List,” which she later published in her memoir. She brought it to her therapist, who agreed with her self-assessment.

She said that while getting a diagnosis can be self-affirming, people shouldn’t think it in any way limits who they are and what they are capable of.

“I went to two Ivy League schools, I was the social chair for my sorority and a college cheerleader,” Cook said. “I don’t fit the bill of what a stereotypical autistic person looks like and I think that’s cool.”

Why fewer girls and women get diagnosed early

There are several reasons that may cause a gender-based disparity.

Because a lot of autism research has historically focused on males, the diagnostic criteria has long been based on how they experience the condition. That has led to biases in screening practices, leading to girls and women being less likely to be identified.

“It’s really in the last decade or so that we have been trying to get better at looking at some of the differences between girls and boys in terms of their presentation,” Yanan Guo said.

Related Articles

States want to make it harder for health insurers to deny care, but firms might evade enforcement

‘Are nursing homes our only option?’ These centers offer older adults an alternative

Sugar cravings could be caused by loneliness, study finds

When rogue brokers switch people’s ACA policies, tax surprises can follow

Emergency rooms refused to treat pregnant women, leaving one to miscarry in a lobby restroom

She is a licensed clinical psychologist at the Developmental Evaluation Clinic with Rady Children’s Hospital and board-certified behavior analyst who specialized in autism spectrum disorder before starting her doctorate.

One way autism can differ between genders is that autistic girls can sometimes present as being more social. They also might be quiet and less disruptive, meaning they might not be perceived as needing additional services, said Doris Trauner, Department of Neurosciences professor emerita at UC San Diego School of Medicine.

There are also cultural biases at play.

“If a 3- or 4-year-old girl doesn’t want to talk to anybody else, kind of hides behind her mother or wants to look at books instead of talking to people, they are described as shy,” Trauner said. “If a boy wants to do that, that’s sometimes deemed to be more concerning because boys are supposed to be running around and playing with other kids.”

Girls and women with autism are more likely to employ camouflaging strategies, masking their symptoms by imitating neurotypical social behaviors. This adaptive technique allows them to blend in with their peers, often leading to difficulties in receiving an accurate or early diagnosis.

“Even though they do these things, they’re not necessarily understanding the nuance of the more subtle things that are included in these social relationships,” Guo said.

Big sister Grace Tracy, 12, speaks to a reporter at the family’s Lakeside home. (Alejandro Tamayo/The San Diego Union-Tribune/TNS)

This coping mechanism, aimed at fitting in, can also lead to increased mental health challenges for autistic girls and women.

“It’s very stressful for somebody to do that because they’re not being themselves, and so that may actually end up resulting in more behavior problems because of the stress and anxiety,” Trauner said.

Camouflaging can also lead to someone being misdiagnosed. Some common diagnoses girls and women with autism receive include borderline personality disorder, eating disorders, Tourette syndrome, bipolar disorder, social anxiety disorder or generalized anxiety disorder, the Autistic Women & Nonbinary Network reports.

“I’ll see kids who come with a diagnosis of anxiety disorder, oppositional defiant disorder, attention deficit disorder, obsessive compulsive disorder, one kid with four or five different diagnoses,” Trauner said. “It turns out when you put it all together, they meet criteria for autism.”

Getting connected to autism resources

Researchers say early diagnosis is imperative because the therapies to support children with autism are most effective when they receive those resources before they’re 3 years old.

Speech therapy for children with autism focuses on improving communication skills, occupational therapy enhances everyday functional abilities and independence, and behavioral therapy helps manage behaviors, developing coping strategies for social interaction and emotional regulation.

All three can play important roles in supporting people with autism, fostering their communication skills, independence and emotional well-being.

These therapies provide tailored support, recognizing the unique strengths and challenges of each person, and empowering them to navigate the world with confidence and autonomy. By focusing on holistic approaches and respecting the diverse abilities of people with autism, these therapies promote inclusivity and ensure that everyone has the opportunity to thrive.

Alyssa Tracy, who is on the autism spectrum, plays on her tablet during spring break while her father, Dustin, offers help. Dustin Tracy points out that they were fortunate that their primary care physician understood autism. It meant they could start the intervention process sooner rather than later. (Alejandro Tamayo/The San Diego Union-Tribune/TNS)

Having an early diagnosis helps families learn what support is available and can help them gain access to the services, especially if there are long wait lists for programs.

“You have to keep advocating for your children to make sure that they get what they need,” Guo said.

Dustin Tracy said that his older daughter, who does not have autism, had worked with a speech therapist when she was young because she had a minor speech delay. When Alyssa was experiencing delayed speech a few years later, he and his wife initially thought that she was following in Grace’s footsteps.

By the time Alyssa was about 18 months old, she was using about 20 to 30 words, but became nonspeaking by the time she turned 2. That’s when the Tracys brought Alyssa to her primary care physician, who screened and diagnosed her with autism.

“We were really fortunate that our primary care physician understood autism because not all of them do, especially when it comes to recognizing those symptoms in women,” Dustin Taylor said.

The San Diego Regional Center— which reports that about 40 percent of clients have autism — supports individuals with intellectual or developmental disabilities and their families from birth throughout their lives. The center is the local coordinator of the California Early Start Program, which ensures that eligible infants and toddlers receive evaluation and support services.

Parents can also work with their child’s school to start the process of receiving an Individualized Education Program, a personalized plan tailored to their unique strengths and challenges.

In some cases, parents may also qualify to be paid for the care they provide their children through the county’s In-Home Supportive Services. Debra Tracy said that because she may need to pick up Alyssa from school at a moment’s notice if an issue arises, working a job outside the home is not possible at this time.

“I’ve always been a very independent woman, so being able to say that I’m providing for my family, it’s a big thing,” she said.

Because his daughter was so young when she was diagnosed, Dustin Tracy said they were able to get Alyssa connected to resources through the San Diego Regional Center and the Autism Society San Diego, the latter of which he’s the treasurer. Alyssa received early intervention services for speech therapy and occupational therapy, and her mom and dad were able to learn from other parents in local support groups.

Alyssa continues to work with specialists, which Dustin Tracy said contributed to the success of a recent vacation to Hawaii.

“We never thought we could travel with her or anything like that just based on early experience and her behaviors,” he said. “We were able to get on the plane, go out for a week and have an incredible time in a place we never thought we’d visit together and really enjoy ourselves.”

©2024 The San Diego Union-Tribune. Visit sandiegouniontribune.com. Distributed by Tribune Content Agency, LLC.