Fall is the perfect time for this soup with fantastic flavors and a fragrant aroma, especially when evenings are cool and crisp and the ingredients are at their best. This dish is packed with nutrients to help optimize your sense of vitality.

Prep Time:     20 minutes

Baking Time: 30-40 minutes

Simmering Time: 15 minutes

Serves: 6-8 (makes fabulous leftovers)

Ingredients

1 medium butternut squash, baked

2 tsp canola oil

1 medium onion, diced

1 tsp sea salt

1 Tbsp ginger root, grated (or powdered if you don’t have fresh ginger, but better fresh)

1/2 tsp curry powder

1 cup fennel root, chopped

1/4 cup white wine (or apple juice)

2 cups nonfat milk (or almond milk or coconut milk)

1 cup vegetable stock

2 Tbsp maple syrup

Garnish

1/2 cup sprigs fennel leaves

Directions

Preheat oven to 350 degrees F.

Cut squash in half, scoop out seeds, bake face down in a pyrex dish or cookie tray for 30-40 minutes, until soft. (Bake seeds with a dash of salt and cinnamon separately for a great snack!)

Heat a skillet over medium-high heat and add oil. Saute onion with salt until onion is soft, about 2 minutes.

Add ginger, curry, cumin powder, and fennel. Heat 3 minutes, stirring occasionally. Stir in wine (or apple juice), heat 30 seconds. Add milk, stock, and maple syrup. Stir and remove from heat. Puree in a blender.

Scoop squash pulp from its skin and add to pureed ingredients. Process in the blender until smooth, 1-2 minutes.

To serve, garnish with fennel leaves. Optimally, garnish with a swirl of nonfat plain yogurt.

Calories: 145

Sodium 697 mg

Fiber 1.3 grams

Total fat 2.5 grams; % fat calories: 14.8%

If you saw the media headlines over the last week on supplement use, you might be confused. A key problem with news reporting these days is that the media seems willing to share misinformation to create sensationalized news.

I contend that people should continue to take a personalized, high-quality supplement regimen to optimize their health. Read more to see why.

The Iowa Women’s Health Study does provide interesting information, but the news reports did not reflect the true results from the study.  In brief, 38,000 older women (average age 62) self-reported supplement use in 1986, 1997, and 2004. Their cause of death over 20 years was assessed in 2008. The authors published conclusions were that some supplements (especially iron and copper) may be associated with increased health risk, while calcium appears to have a health benefit. In contrast, the media reported that multivitamins are harmful. Some health experts (see womentowomen.com) have stated that “bad science is being used to push a political agenda that seeks to prevent individuals from making their own healthcare choices.” I think the scientists at womentowomen might be right on!

The study, published in the Archives of Internal Medicine October 10th, 2011 provides five critical points worth discussion.

1. Women after menopause should NOT take iron. It will make them “rust” (oxidize) more quickly from the inside out. Of course people with iron deficiency anemic may need iron, as do growing children and menstruating women, but men, and women after menopause should not take iron.
2. Excessive copper is harmful. I can’t see why anyone would take extra copper, but this study helps to confirm that excessive copper is very bad. Most experts recommend taking zinc and copper together with a 20 to 1, perhaps 15 to 1 ratio, but not more. And hardly anyone would need more than 1-2 mg of copper daily.
3. Many studies have shown that 80% of Americans are nutrient deficient, and the Iowa Health Study authors did comment that supplements should be customized to correct deficiencies. I totally agree that we should be assessing people’s nutrient intake from food first, and prescribing a supplement regimen that includes food intake when aiming to achieve personalized nutrient needs. See my Personalize Your Supplement Regimen for details. Far too often, medical providers add supplements without calculating food nutrient intake, which can easily lead to excessive dosing and potential harm.
4. If you take a supplement, it should be high quality, or I’d suggest stopping it. Very likely most of the supplement users in the Iowa’s health study were taking poor quality supplements with harmful ingredients. For example, many studies have now shown that vitamin E in the form of alpha tocopherol is harmful (both increased cardiac harm and prostate cancer risk); if you take vitamin E it should be from mixed tocopherols. Likewise, B-carotene has been associated with increased cancer risk, and supplements should be using mixed carotenoids. However, most cheap supplements (the ones most likely taken by women in the Iowa women’s health study) are full of poor quality ingredients, including alpha tocopherol and beta carotene without mixed carotenoids.
5. Of interest, in contrast to many other studies, this study showed no benefit from people taking vitamin D. Yet likely the dosages of vitamin D in this study for the 1980s to 1990s would have been 200 to 400 IU daily, which is clearly inadequate with most experts suggesting 1000 to 2000 IU of vitamin D daily.
6. Lastly, studies assessing supplement use typically have two major problems. First, in non-randomized vitamin trials people with chronic medical problems often over consume supplements in a desperate effort to treat themselves, which makes supplement use look bad. In fact, the Iowa Health Study authors mentioned this limitation in their study. Second, in randomized supplement trials, most of the people who enroll have extremely good nutrient intake; hence they are not deficient and benefit less than most Americans. In contrast, 80% of Americans have major nutrient deficiencies, which is exactly what we see in our patient population when we first meet people for their evaluations. Thus the results from randomized trials don’t reflect the benefits that average Americans should receive, which was emphasized in an article recently published in JAMA. Morris MC, Tangney CC.A Potential Design Flaw of Randomized Trials of Vitamin Supplements.JAMA 2011;305:1348-49.

For me, the bottom line from the Iowa Women’s Health Study is that we should have our nutrient intake assessed, and take a high-quality, personalized regimen to meet our unique nutrient needs and correct any obvious deficiencies. We need to avoid excessive iron, copper, and other cheap supplement ingredients that are proven to be harmful but are common in the marketplace, and we also need adequate vitamin D and calcium from either food, sunshine, and/or a supplement source.

For people who have had a heart attack or cardiac procedure, cardiac rehabilitation decreases the risk for heart attacks, death, and the need for future cardiac procedures by an incredible 20-25%, yet only about 20% of Americans who are eligible go to cardiac rehab.

I spoke on this topic this month at the American Academy of Family Physicians annual assembly with nearly 5,000 physicians in Orlando, Florida.

Cardiac rehab is a comprehensive, longterm program involving medical evaluation, prescribed exercise, cardiac risk factor modification, nutrition education, and counseling. It is designed to reduce physiological & psychological effects of cardiovascular disease, reduce the risk for sudden death and/or repeat heart attacks, control cardiac symptoms, and enhance psychosocial & vocational status. Participants typically attend 1-2 sessions per week over a 12-week program, then return to the care of their physician.

I feel fortunate that we offer this type of proactive educational program to all our patients at the Masley Optimal Health Center, yet most of my patient’s relatives miss out.

Who Qualifies for Cardiac Rehab?

If you or a relative meet the following criteria, you would qualify for cardiac rehab and likely your insurance would pay for your participation too.

• Heart attack within the preceding 12 months
• Coronary artery bypass surgery (no time limitations)
• Coronary angioplasty or cardiac stenting procedure (no time limitations)
• Current stable angina
• Class III or IV congestive heart failure unresponsive to medical therapy
• Heart or heart-lung transplant, or heart valve repair/replacement
• Sustained ventricular tachycardia

Why Don’t People Attend Cardiac Rehab if they Qualify?

The number one reason people don’t attend cardiac rehab is that their physician doesn’t refer them. I have discussed this with various physicians, but nobody understands why referral rates are so poor. It may be that hospital physicians assume the primary care doctors will take care of it, and the primary care thinks the hospitalists will do the same, but nobody really knows for sure.

Other barriers to enrolling in cardiac rehab are advanced age, very poor fitness, and not having medical insurance to cover these services. Although people with advanced age and poor fitness benefit greatly from attending.

We do know that if the physicians tells their patients (face to face) that cardiac rehab will benefit them, they are much more likely to attend. If the physician or someone on the doctor’s team also calls the patients family and/or spouse and encourages attendance, they are even more likely to enroll, even if they are elderly or have poor fitness.

Obviously physicians can do a better job, but families can also make a huge difference by requesting (insisting upon) cardiac rehab when people qualify.

The Ten Years Younger Program was Designed to Prevent and Reverse Cardiovascular Disease.

Keep in mind that the Ten Years Younger Program was originally designed as a program to reverse heart disease and reverse type 2 diabetes; it was the Discovery Show that recommended changing the name of this program to Ten Years Younger. The bottom line is that the principles behind Ten Years Younger will help to reverse cardiovascular disease and help to prevent future heart attacks and strokes.

For details, please CLICK HERE to view my article on preventing a heart attack or stroke.

Dr. Masley was invited to give a cooking demonstration for the American Heart Association kick off for their annual fund raising walk.

He prepared salmon, an avocado-tortilla salad, plus a yogurt-mixed fruit parfait. The challenge today  is preparing easy-to-make, delicious meals that nourish our selves, rather than expanding our waistlines.

The key to using vaccum-packed, frozen salmon is the marinade. Be sure to choose an acid-based marinade, such as orange juice (with salt), terriyaki sauce, or vinegar-based salad dressings.

“Dr. Masley Shows us how we can take control of the aging process.  Follow this simple ten-week plan, and you’ll find yourself getting younger, day by day.” – Mehmet Oz, M.D.

Tampa Bay Fox News anchor, Russel Rhodes, interviewed Dr. Masley on the newly released Cooper Clinic study showing that high levels of aerobic performance help to decrease cardiovascular disease risk. Dr. Masley confirmed these findings and shared that data from Masley Optimal Health Center shows that the most powerful predictor of growing arterial plaque is low aerobic capacity. After testing over 500 Tampa Bay executives, the surprising finding is that their inability to run up a hill on a treadmill test is a stronger predictor of growing arterial plaque than cholesterol, blood pressure, or blood sugar levels. Dr. Masley uses carotid IMT in his office to clarify arterial plaque growth over time.

The keys to building aerobic fitness are a consistent program, usually for 4-5 days per week for 30-60 minutes (running, elliptical machine, cycling, etc) with elevated heart rates. If you cannot talk in two sentences when exercising that is pushing it too hard. If you can sing, then it is too easy and you need to up the pace.

For more information on the Masley Optimal Health Center, see more….

Florida Family Physician; Winter 2010 Issue

The Top Seven Clinically Important Nutrient Deficiencies in Women

By Steven Masley, MD, FAAFP, CNS, FACN, CCD

During the 1999 to 2000 National Nutrition Assessment, the USDA Center for Nutrition Policy and Promotion noted that only 10% of the U.S. population had an adequate diet, while 74% were rated as inadequate and 16% were rated as poor, markedly increasing the risk for major health problems. Poor or inadequate diets are linked to four of the top 10 causes of death in America: heart disease, cancer, stroke and diabetes; these are strongly related to obesity and osteoporosis. Projections for the 2000 to 2010 national nutrition assessment anticipate the US diet will worsen, making the goal to enhance nutrient intake a high priority.

Most of Florida’s women are motivated to meet their nutrient needs yet need proper guidance from Florida’s family physicians to ensure their success. The top seven nutrient deficiencies that are common in women and with correction would make a substantial improvement in health are:

1. Fiber
2. Vitamin D
3. Magnesium
4. Calcium
5. EPA & DHA (fish oils)
6. Vitamin K
7. Iron

#1: Fiber

The most clinically important deficiency in the American diet is fiber. Fiber intake in the US averages 12-15 gm daily, while nearly all national organizations suggest 30-50 gm. Fiber consumption is inversely associated with insulin levels[i], weight gain, GI function, and many CVD risk factors[ii] (central adiposity, BP, HDL and LDL, fibrinogen, and triglycerides).

Fiber comes in two forms—insoluble and soluble. Both forms are essential; they reduce calorie intake by improving satiety, result in good weight control, and are nutrient dense. Insoluble fiber (good sources are whole grains) enhances GI function. Soluble fiber (found in fruits, vegetables, oats, nuts, and beans) lowers cholesterol and blood sugar levels. Half of our 30 gm of fiber intake should come from fruits and vegetables, such as two pieces of fruit, a salad, and 2-3 cups of colorful vegetables per day.

This deficiency applies to women of all ages and has a large impact on their health.

#2: Vitamin D

Vitamin D is well known to enhance calcium absorption and is essential for maintaining bone density. Low levels of vitamin D are strongly associated with an increased risk for both autoimmune diseases (especially multiple sclerosis[iii]) and cancer; in addition, treatment with vitamin D in RCTs has been shown to improve outcomes. Vitamin D inhibits the proliferation of malignant tumor cells such as those that may occur in the colon, prostate, or breast.[iv] 62% of elderly women’s diets are deficient in vitamin D and 32% of young adults have deficient vitamin D levels (on blood determinations) during winter. Compounding dietary deficiency is the reduction of sun exposure for many Americans. Adequate sun allows the skin to synthesize vitamin D from cholesterol but sun block prevents this production. Concerns regarding both skin cancer risk and skin aging have kept many out of the sun. Vitamin D deficiency exists in most Floridians. Controversy surrounds the current recommended intake for vitamin D; 200 IU has been shown to prevent rickets and is the amount noted on nutrition food labels. Yet at this intake level, rates for multiple sclerosis, osteoporosis, and many forms of cancer increase substantially. Data shows that 1,000 IU daily is the evidence-based intake to minimize disease risk in young adults, and 2,000 to 3,000 IU daily has an excellent safety record and may be required to achieve optimal levels in the elderly[v]. The good news is that vitamin D deficiencies can be easily eradicated at minimal expense if patients ensure adequate intake.

There are times when vitamin D levels (a 25-hydroxyvitamin D level, not 1,25-dihydroxyvitamin D) should be measured to clarify optimal dosing, e.g., suspicions of rickets, osteoporosis, or an autoimmune disorder. Most laboratories list 30-32 ng/mL as a normal level, although the most common expert-opinion goal is a level of 40-70 ng/mL.

#3: Magnesium

Magnesium (Mg) is required for more than 300 chemical reactions in the human body affecting cardiac function, bowel function, blood sugar control, BP, and bone health. Mg deficiency plays a role in cardiac deaths, poor BP control, and GI problems, in particular constipation. About half of Mg stores are intracellular and half are combined with calcium and phosphorus in bone. Only 1% of Mg is found in blood; thus serum Mg levels are a poor reflection of Mg stores and the simplest measure is a RBC Mg level. The RDAs for Mg varies by age and gender but ranges from 300 to 420 mg daily, increasing by 40 mg during pregnancy.

Sources of Mg are green leafy vegetables, whole grains, nuts and seeds, wheat and oat bran, and soy products. Not only are 75%-85% of U.S. diets deficient in Mg (the average diet contains 50%-60% of the RDA) but several common factors lead to Mg depletion, including diuretic use, elevated glucose levels, diarrhea, alcohol intake, and malabsorption related to GI diseases.

Complicating Mg deficiency is that calcium supplements block Mg absorption and worsen what is already a national Mg deficiency. This problem is complicated by the lack of quality clinical outcome studies identifying the optimal calcium/Mg supplement recommendation, but expert opinion regarding combining these supplements ranges from a 2:1 to 3:1 calcium/Mg ratio. Symptoms associated with Mg deficiency include muscle cramps, tingling, numbness, abnormal heart rhythms, coronary spasm, seizures, confusion, disorientation, loss of appetite, and depression. Mg is commonly supplemented in the form of Mg oxide, but this frequently acts as a GI irritant. Better tolerated and absorbed forms of Mg include chelated Mg (protein-bound rather than salt bound), Mg citrate, or Mg glycinate.

#4: Calcium

Calcium (Ca) is well established as essential for bone health and is associated with membrane stability, impacting BP control and cardiac function. More recently, Ca deficiency has

been associated with weight control and metabolic rate. Ca deficiency is of high clinical importance as the average diet contains only 40%-50% of the RDA (800-1,200 mg daily, varying with age and gender). This is especially important for adolescents girls as they must build their life time calcium stores between age 13-21 (essentially their calcium bank account for life). Daily intake of 1,500 mg is recommended for people with osteopenia or osteoporosis. More than 2,000 mg of Ca daily is excessive and has been associated with an increased cancer risk. Too often, physicians recommend Ca supplementation without assessing dietary intake, which leads to inappropriate Ca dosing. Subtracting the amount of Ca in foods ingested from the patient’s Ca-intake will yield the amount of Ca that must be provided from either a supplement or a daily food source. As significant calcium isn’t in a multivitamin tablet, it needs to be consumed in food or may require several Ca pills daily to reach the recommended intake. The most commonly sold Ca supplement is the inexpensive Ca carbonate, which is popular, as it creates the smallest pill size. However, it must be taken with food to be absorbed, may contain lead[vi], and is associated with GI symptoms, including constipation. The best absorbed and tolerated form of Ca is protein-bound or chelated Ca, but it is more expensive and twice the size of Ca carbonate pills. Ca citrate is less constipating than Ca carbonate, does not need to be taken with food, but it remains a large pill, with similar absorption as Ca carbonate.

#5: Long-chain omega-3 fats

Long-chain omega-3 fats, EPA and DHA, come from seafood and have been shown to have multiple clinical benefits. They reduce triglyceride levels and clot formation, improve insulin sensitivity, and lower inflammation in patients with Crohn’s disease and rheumatoid arthritis. RCT studies have shown that fish oil decreases the risk for CVD events and reduce mortality, and increasing fish oil intake is more important than cutting saturated fat intake.

Medium-chain omega-3 fatty acids from plants (soybased foods, ground flax seed, and nuts) are healthy sources of fiber and nutrients and will lower cholesterol levels , but they do not have the same proven benefits as EPA and DHA.

Fish-oil dosing varies with the indication. One gram daily, obtained from eating cold-water oily fish three times/week enhances blood sugar metabolism[vii], reduces the risk of arrhythmias, and lowers CVD risk[viii]. Higher dosages (2-4 g daily) are required to lower triglyceride levels and reduce inflammation adequately to treat arthritis symptoms. Good sources of marine omega-3 fats include salmon, sardines, sole, herring and trout, plus cold-water oysters and mussels. Sardines, canned wild salmon and herring are the healthiest and least expensive sources.

While seafood provides many benefits, one of the concerns related to its consumption is mercury intake. Fortunately, many marine foods high in omega-3 fats are low in

mercury. Follow these two rules: Cold-water fatty fish are high in omega-3 fat; large-mouth fish are high in mercury. Thus, keep tuna, grouper, snapper, and bass to <2-3 servings a month and avoid swordfish, kingfish and shark to eliminate most of the excessive intake of mercury.

Fish oil supplements are convenient though expensive. Most brands are free of heavy metals, but many inexpensive brands are rancid, resulting in foul burping, and by increasing lipid peroxide levels pose theoretical harm that has not yet been assessed in clinical trials. To ensure low rancidity, consumers can poke a needle in the first capsule from each bottle and taste the contents; fish oil should be palatable.

One caution with fish oil is that dosages >2 gm daily mildly increase bleeding risk. In particular, patients scheduling surgical procedures should stop high fish oil dosing at least one

week prior, and those being treated with anticoagulation (such as warfarin) should avoid consuming >2 gm daily.

#6: Vitamin K

Vitamin K is a fat soluble vitamin derived from plant sources and is commonly deficient in American women. Vitamin K1 (phylloquinone) comes from plant sources. Vitamin K2 (menaquinone) comes from fermented soy products. The RDA dosage was designed to prevent excessive hemorrhaging (90 mcg females/ 120 mcg males) yet this level of deficiency is rare and usually related to severe intestinal diseases with malabsorption. Much more clinically important than clotting, vitamin K plays a critical role in bone and vascular health[ix].

Vitamin K1 at a dosage of 1,000 mcg daily, the dosage found in one cup of cooked greens, spinach and kale will increase osteoblast bone building greatly by increasing carboxylation of osteocalcin. In Japan, randomized controlled trials with Vitamin K have shown decreased fracture rates and increased bone density (similar to biophosphonates but with no reported adverse events)[x]. Although less well studied than biophosphonates, this is a secondary treatment option for patients at elevated fracture risk.

Vitamin K also activates Matrix Gla-Protein (MGP) thereby blocking vascular calcification. Low vitamin K intake is associated with hypertension and calcification of the arterial media[xi]. Vitamin K supplementation improves arterial elasticity in humans. The bottom line is that ensuring adequate vitamin K intake with one cup of cooked greens daily appears to help keep calcium in the bones and out of artery walls.

#7: Iron

Iron deficiency is the most common nutrient deficiency impacting growing children and menstruating women. Fatigue is the predominant symptom. Iron sulfate (a salt) is inexpensive and readily available but often causes GI distress. Better absorbed would be amino acid or protein bound iron; although more expensive, it is much better tolerated and absorbed[xii].

Ironically, a much more clinically important problem worth noting isn’t iron deficiency, but iron excess in post menopausal women and in men. Excess iron intake, frequently caused by supplements containing iron after menopause, is associated with increased CVD and cancer risk as iron in excess acts as a powerful oxidant.

Safety First

As a physician, recommending a supplement to meet nutrient needs is challenging as the quality of supplements is often inconsistent. Aim to recommend brands that have the U. S. Pharmacopoeia (USP) or Good Manufacturing Process (GMP) logo for better quality.

Summary

Ensuring optimal intake of fiber, vitamin D, magnesium, calcium, fish oil, vitamin K, and iron will play a major role in preventing the most common diseases in American today. Family physicians are ideal for educating Florida’s women.

Steven Masley, MD is a fellow certified family physician, nutritionist, the president of the Masley Optimal Health Center, author of Ten Years Younger, and volunteers as faculty at USF. For more information visit www.tenyearsyounger.com.