Omega-3 Supplements: Do They Have to be So Fishy?

It's no secret that omega-3 fatty acids are good for your heart. These healthy fats, known as DHA and EPA, are usually derived from fish oil, and protect us in several important ways. First, they help prevent life-threatening heart rhythms by stabilizing our heart muscle cells. We can also use omega-3's to lower triglyceride levels and raise good cholesterol. For people with very high levels, we cardiologists often prescribe a drug called Lovaza, which is a highly purified, FDA-regulated product derived from fish oil. Most people will not require this, and can use a supplement for prevention instead.(If you eat fatty fish like salmon 2-3 times a week, you probably can take a pass on supplemental omega-3’s).

So how do you decide what supplement to take? There are literally hundreds of choices. The problem with most supplements is that they are extracted from the bodies of fish that are caught specifically for that purpose. Much of it comes from the Menhaden fish, which is in serious danger of being over-fished. That's why I am so excited about Cardiotabs (www.cardiotabs.com), a product developed by cardiologists at the MidAmerica Heart Institute in Kansas City, Missouri. This supplement is made using calamari that are basically cast-offs from the food industry. That means no overfishing, and a safe, sustainable source of omega-3's. Even better, the product is far more purified than most supplements (meaning less potentially harmful contaminants), and, because it is flavored, it doesn't tend to give that fishy aftertaste so common with many other products.

What if you're a vegetarian? In the past, there were no good options. Flax seed oil is a plant-based omega-3, but our bodies cannot put the oil to use right away. Instead, after we swallow the capsule, flaxseed oil undergoes a complicated and highly inefficient conversion process that transforms the oil into usable DHA and EPA. Ultimately, the amount of DHA and EPA created from this process is about 10% of the starting dose. Recently, an algae-based form of DHA has hit the market. There are a number of different brands, so the best way to choose is to compare the milligrams of DHA per capsule. One example is Spring Valley - ALGAL-900, DHA 900 mg, Fish Free Omega-3, 30 Ct  There is some debate as to whether you are missing out by not getting the EPA as well, but several small studies have shown a similar lowering of triglycerides with DHA as compared to DHA+EPA, and it appears that, nutritionally speaking, algal-oil DHA is basically the same as salmon-oil DHA.

Should You Choose Organic?

As a huge fan of fresh fruits and vegetables, I am often asked whether organic foods trump conventionally grown produce. The answer is not as neat and simple as it might seem.

Aesthetically and ethically, I prefer the idea of eating organic. Less reliance on pesticides and man-made fertilizers means less of these potentially dangerous chemicals end up in our bodies, the bodies of our children, and in our ecosystem.

Although the EPA and other organizations regulate pesticide use in order to ensure public safety, these chemicals are, by definition, unsafe, since they are designed to kill bugs and other unwanted pests. In most cases, careful washing of produce should get rid of any minute amounts of residual pesticide. However, that certainly does not ensure that the pesticides do not enter the local groundwater and from there our waterways and wildlife.

What many people don't realize is that organic foods are often grown with pesticides as well. It's just that those pesticides are naturally derived. Although they are often less toxic, being organic doesn't necessarily make them all that much safer.

There is a very practical and pragmatic reason that pesticides are so widely used. The simple truth is that without them, farmers would be much less productive, costs would go up, and consequently, fresh produce would be much more expensive and harder to come by. For a more complete discussion, EcoWorld.com has a great review of pesticide use, both natural and organic ( www.ecoworld.com/animals/safe-pesticides.html )

In 2009, a group of British researchers set out to settle the organic debate by painstakingly reviewing fifty years of research into the question. The verdict: there was virtually no difference in nutritional quality between organically and conventionally grown produce.

For a few months, we could all breathe a sigh of relief. The debate resurfaced this year when a collaboration of researchers from Harvard and the University of Montreal, Canada reported that children with high levels of urinary organophosphates were twice as likely to develop ADHD (attention deficit/hyperactivity disorder) than children with no evidence of exposure. Organophosphates are commonly used pesticides frequently detected in fresh and frozen produce, but also found in commonly used home bug sprays.

My take on the very controversial question? Go organic when it is feasible, but don't avoid conventionally grown fruits and vegetables because of pesticide fears. Washing produce with running water will usually remove most pesticide residue, as well as other potentially harmful hangers-on like the e.coli bacteria, which has shown up in organic and conventionally grown produce alike. (Unfortunately, not all bacteria washes off, as we have learned from recent outbreaks). Keep your knives and cutting surfaces clean, to avoid cross-contamination, and if you are cutting a fruit with a rind, like a watermelon, wash it, too, since your knife can transfer dirt from the outside back into the fruit.

Conventionally grown foods such as apples, nectarines, peaches, pears, raspberries, strawberries, potatoes and spinach are most likely to have high pesticide exposure, so organically grown alternatives are worth considering. Bananas, broccoli, cauliflower, and onions generally are lower in pesticide residue, so organic versions may not offer as much of an advantage.

How Many Calories Do I Need?

When it comes to losing weight or maintaining a healthy weight, sooner or later, most people realize that calories count. For women, that hard truth usually hits us hard during our college years. The sad reality is that we usually need fewer calories than we would like to believe. The average person requires somewhere between 1,600 to 2,200 calories each day to maintain a healthy weight. Of course, depending on your activity level, degree of physical fitness, age, and gender, your needs may differ.

In order to know your caloric needs, calculate your basal metabolic rate (BMR), more commonly known as your “metabolism.” This will show you the number of calories your body requires to function properly at rest—before you factor in activity and exercise.

To roughly estimate your personal BMR, multiply your current weight in pounds by 10. If you weigh 150 pounds, for instance, your BMR is roughly 150 X 10, or 1500 calories. (A more complicated formula, known as the Harris-Benedict equation, takes into account gender, height and age. I've given you the equation at the bottom of this post). None of these formulas are perfect. Many factors affect your BMR. The leaner you are, the higher your BMR, and the more fat your body carries, the lower your BMR will be. Children, especially when going through rapid growth spurts, have a higher metabolism, as do pregnant women.

Once you calculate your BMR, it’s easy to figure out how many calories your body needs, based on how much energy you burn. To keep it simple, we can estimate based upon your average activity level.

If you are a typical couch potato, multiply your BMR by 20 percent (for example 1500 X 20% = 300). Someone who engages in light activity, such as walking around at work for several hours over the course of the day, will multiply her BMR by 30 percent. If your fitness level is moderate (say you exercise several times a week or have a physically active job) multiply your BMR by 40 percent. Finally, someone who is extremely active at work, or who gets moving at least four hours every day and rarely sits still, should multiply by 50 percent. Once you determine this number, add it to your BMR.

For example, the 150 pound sedentary person would add 1500 plus 300 (1500 x 0.20 = 300) to reach a total of 1800 calories.

If you want to lose weight, calculate the BMR for the weight you desire. For example, let's say you would rather weight 130 lbs. Your BMR would be 1300. If you stay pretty sedentary, your daily calorie allotment would be only 1560 calories (1300 + 1300 x 0.2). Now you can see that if you want to continue to eat the same way you did as a sedentary 150 lb person, you're going to have to either increase your daily activity level, or add on some serious exercise.

Once you know how many calories your body will burn, it's time to calculate the number of calories you actually eat every day. There are a number of good references available for this purpose. (Try www.nal.usda.gov/fnic/foodcomp/search).The important thing is to be honest. Study after study shows that most people are not aware of their portion sizes and frequently underestimate the amount that they eat, often by as much as 500 calories per day.


The Harris-Benedict Equation for BMR
For women:
BMR = 655 + (4.35 x W) + (4.7 x H) – (4.7 x A)
For men:
BMR = 66 + (6.23 x W) + (12.7 x H) – (6.8 x A)
W = weight in pounds
H = height in inches
A = age in years

Nine Heart Smart Trends for Spring 2010

Last year, I was asked by Neiman Marcus in Northpark (Dallas, Texas) to come up with nine "Heart Smart Trends for Spring", to complement Neiman's Nine Fashion Trends for Spring. Unlike the wayward whims of fashion, these little numbers are always in style. Happy Spring!

1. Take charge of your numbers. Get ahead of the game by knowing your waist size, body mass index, blood pressure, cholesterol, and blood sugar.
2. Explore the Mediterranean. Enjoy the fabulously healthy foods of the Mediterranean islands, including fresh fish, luxurious olive oil, whole grains, and rich green vegetables.
3. Journey to Japan. Discover the longevity secrets of soy, green tea, and sweet potatoes, and follow the time-honored Japanese custom of finishing a meal before you feel full.
4. Don’t fall for fakery. Stay away from artificial sweeteners and other imposters. Just like the perfect handbag, the real deal is always the smartest choice.
5. Enjoy a good cup of tea or coffee without a spoonful of guilt. As long as you don’t overdo it, this is one little indulgence that will keep your heart happy and your mind snappy.
6. A glass of wine is perfectly fine. The redder the better, but even white will do. If alcohol is not your thing, purple grape juice is a brilliant alternative.
7. Get a move on. Walk like you mean it, dance to your own music, or hit the gym. Whatever your inclination, commit to two and a half hours every week to achieve optimal health and vitality.
8. Listen to your mother. Keep your pearly whites shining, sleep at least seven hours a night, and never, ever skip breakfast.
9. Nurture your friendships. A friend will lift your heart when your spirits are sagging and support you when your willpower is lagging. A good laugh with a friend may be the best therapy of all.

I love granola!

Granola is one of my favorite morning treats. It's delicious, healthy, and super easy to make ahead. Honestly, there's no reason to spend your hard earned cash on the cloyingly sweet, over-processed, high fat stuff you find in most grocery stores. You won't believe how much better my made-from-scratch, extra healthy version tastes. The only thing not love about granola? It's easy to go overboard and gobble up a bowlful of calories. That's why I like to add a quarter cup of granola to my Cheerios or oat bran flakes. It makes breakfast ever so much more interesting.

My recipe is adapted from a recipe published in the late, great Gourmet Magazine in 2008, which itself was derived from a recipe created by Melissa Hotek, of L'Auberge Provencale. Half a cup provides 207 calories, 5.6 grams of protein, 21.8 carbohydrate grams, and 12.2 grams of fat (including one gram of saturated fat). Conversely, commercial varieties may contain 3-4 grams of saturated fat (up to 20% of your recommended daily max) and 35-40 grams of carbs.

The great thing about this recipe is that you can switch out ingredients and experiment with abandon. Try flax seed or oat bran instead of wheat germ (or just mix them all in together). Play with a variety of nuts and dried fruit, or change up the honey or maple syrup for a subtly different flavor. I also love the idea of adding cocoa nibs (try Cacao Nibs, 8 oz, Sunfood (peeled, raw, certified organic) or Navitas Naturals Organic Raw Chocolate Nibs, King of Cacao 16 Ounce Pouch (Pack of 2) ) for a morning hit of chocolate.

Doctor Sarah's Favorite Granola

1/2 cup canola oil
1/2 cup mild honey or maple syrup
1 cup raw wheat germ
1 tablespoon pure vanilla extract
3 1/2 cups old-fashioned oats
1 1/2 cups chopped mixed nuts (almonds, walnuts, and pecans)
2 cups dried fruit (I love dried California apricots (Sun Maid California Apricots, 6-Ounce Pouches (Pack of 4) ) ; avoid the Turkish ones, since they are too soft and sugary)

Preheat oven to 375°F with rack in middle.
Stir together, oil, honey, wheat germ, vanilla, and 1/2 teaspoon salt in a large bowl, then stir in oats and nuts.
Bake 15 minutes, then stir and continue to bake, checking and stirring every few minutes, until golden brown, about 10 minutes more.
Stir in dried fruit and cool to room temperature
Makes about 6 cups

Good News about Soy and Breast Cancer

For years, doctors and scientists have fretted over whether to recommend soy foods to women at risk for breast cancer. On the one hand, we know these foods help to protect against heart disease. They do so mainly by providing a high quality source of protein without all the saturated fat and other toxins found in meat products. Soy foods may also improve LDL and HDL cholesterol numbers, especially in women. Yet there has been concern that because soy has "phytoestrogenic" properties, it might stimulate the growth of estrogen sensitive cancer cells. (By phytoestrogen, we mean a plant-based substance that has the ability to bind to estrogen receptors on our cells, thus potentially modifying the way the cell behaves).

In the past year, a number of very reassuring studies have been published that give us much more clarity about soy and breast health. The most notable comes from my alma mater, Vanderbilt University, and from the Shanghai Institute of Preventive Medicine. Researchers followed over 5000 Chinese breast cancer surivivors, ages 20-25, for nearly 4 years. They found that those women who included moderate amounts (more than 5.3 grams of soy protein) in their daily diets were about 30% less likely to have recurrence of breast cancer than those who avoided soy. In general, the more soy a woman ate, the healthier she was likely to be, regardless of whether her cancer was estrogen-sensitive or not. The researchers  were quick to make the point that they studied soy food intake, and not supplements, which have not been shown to have the same health benfits.

Researchers from Shanghai also followed younger, healthy women for more than 7 years, and found that those who chose more soy foods had about half the risk of developing breast cancer than those who preferred a meat-based diet. The same group found that a higher carbohydrate diet, especially starchy carbs, appeared to raise breast cancer risk in women uner 50.  In a similar vein, a study from Colorado State University in cooperation with USC, the University of Minnesota, and the National University of Singapore reported that a diet based on vegetables, fruit, and soy was associated with a 30% lower risk of breast cancer in post-menopausal women, when compared with a meat and starch diet.


In a separate study, researchers from USC reported that Asian American women who ate the most typical meat-and-potato Western diets had over twice the breast cancer risk as women who chose more soy foods and vegetables.

While we've known for years that soy is heart-friendly, these studies provide some much needed clarity on the subject of soy and breast health. As always, before you make a major change in your diet, it makes sense to talk with your doctor first.

The Lastest Buzz on Coffee

If you're sensitive to caffeine, a cup of joe may make your heart jump and jive, but for many people, it's a wake-up essential. In my practice as a cardiologist, I find that people are often a little embarrassed to tell me about their coffee habits, worried that I will try to snatch away this little bit of morning comfort. Now coffee drinkers can take heart. There is some really good news on the horizon about the effects of coffee on our health and well-being.

First off, recent research from both the United States and Finland suggests that coffee drinkers might live a little longer. The therory is that the antioxidants in coffee might help protect the heart arteries against cholesterol build-up. Coffee also may help protect the brain, with several studies suggesting a lower risk for strokes and Parkinson's disease in coffee lovers. There is even evidence that coffee may help protect against diabetes.

Even more surprising is a recent report that coffee quaffers might be less prone to irregular heart rhythms. This sure seems counterintuitive to me, but a report from the Kaiser Permanente Division of Research found that people who drank at least 4 cups of coffee every day were significantly less likely to be hospitalized for heart rhythm problems. Even more surprising was the finding that those who chose decaf did not appear to have this protection.

Now a word from Dr. Sarah: If coffee makes your heart race- don't drink it! Some people are very sensitive to caffeine, and just need to avoid it. Another important caveat is that coffee prepared without a filter (eg boiled coffee or French press coffee) can raise levels of cholesterol, so it's best to limit your coffee to the filtered stuff. And as always, check with your doctor before you make any drastic changes.