If your arteries are inflamed long term you may suffer from heart attacks and strokes. An inflamed brain may lead to Alzheimer’s disease and memory loss. If your joints are inflamed you may have aches and pains and with time develop arthritis. Increased inflammation also increases your risk for cancer. Since fish oil supplements decrease inflammation, it should not surprise you that taking fish oil reduces your risk for heart attacks, strokes, and memory loss.

Both my parents have advanced arthritis, and in my late 50s, I’m aware of my own arthritis too. The good news is that my arthritis symptoms have dropped considerably since I added fish oil, curcumin, and glucosamine sulfate to my multivitamin regimen–now I take a multivitamin pack with arthritis support every day.

To clarify if you have signs of early arthritis and increased inflammation, look for:

• Joint stiffness (especially in the morning)
• Joint swelling, usually mild and subtle
• Joint pain, especially after pounding activities

A useful blood test to measure inflammation is the high sensitivity C-reactive protein (hs-CRP) level. A normal hs-CRP level is <1.0, borderline is 1-3, and high cardiac risk is >3. Keep in mind that a recent infection causes substantial inflammation and your CRP level can jump to 10-20 after a bad infection.  This value typically returns to normal within 4-6 weeks.

A recent study has shown that fish oil supplements containing long chain omega-3 oils  lower CRP levels by 40% (Kamran et al, Clin Lipidol, 2011;6:723-729). Subjects took a fish oil supplement with 1,275 mg of EPA and 300 mg of DHA for 8 weeks to show a 40% drop in CRP levels.

If you aren’t sure how much fish oil you need, there are new blood test kits designed to measure omega-3 blood levels, ensuring your dosage gives you an optimal level of these critical nutrients. We have recently added these kits at the Masley Optimal Health Center.

Tips to Lower Inflammation Levels

1. Add fish oil daily, depending upon your health and symptoms, from 600 to 1,300 mg of EPA daily. (EPA provides the best anti-inflammatory activity of all the fish oils but you also need the DHA form as well.) To clarify high quality fish oil products, please see my article on Fish oil.
2. Take Curcumin, 500 to 1000 mg daily. As curcumin is poorly absorbed from Turmeric, see my article on Curcumin for details.
3. Avoid sugar and refined carbs, as sugar spikes prompt a jump in inflammation. Saturated fats from fatty dairy and fatty meats also increase inflammation levels.
4. Keep your body fat controlled, fat cells produce compounds that increase inflammation. Let us know if you need help achieving your weight and body composition goals.

Wishing you a life without pain and excess inflammation!

Steven Masley, MD, FAAFP, CNS, FACN

The answer is SLEEP! Far too many people are not meeting their sleep requirements. They either don’t get enough, or it is poor quality sleep. Inadequate sleep worsens multiple aspects of hormonal health, lowers metabolic rates, increases appetites, and diminishes brain performance.

Having just returned  from a family trip to SE Asia with major jet lag, I was extra sensitive to this topic this week when several of my patients were suffering from obvious sleep deprivation.

Most people need 7-8 hours of sleep nightly, although 5-10% of people may do well with only six hours per night, and likely 5-10% of folks need 8-9 hours nightly. If you are getting enough quality sleep, you should be able to wake up and feel rested without an alarm in the morning, you don’t need extra caffeine to get and keep going, you don’t have afternoon or evening fatigue, and you feel mentally sharp all day long.

Here are seven tips to improve your quality of sleep.

1. Same sleep time: Aim to go to bed and go to sleep at a similar time each night and rise at a similar time each morning, ideally within one hour. Staying up late on the weekends and sleeping in and then getting up early all week decreases the quality of your sleep all week long. If you are exhausted, then take an extra hour in the morning on the weekends, but more important is to make sure you get to bed at a reasonable time.
2. Caffeine and alcohol: Don’t overdo caffeine during the day, or alcohol in the evening. It takes 6-7 hours to remove each cup of coffee from your system. Having more than two servings daily guarantees you go to bed with caffeine in your blood stream. You might fall asleep exhausted, but after 3-4 am the caffeine kicks in and you can’t stay asleep. Drinking alcohol before going to bed ensures your alcohol levels will drop during the night, potentially awakening you with a startle. If you have 1-2 glasses of wine with dinner at least two hours before going to bed, that is ok, but your body can only remove about one serving of alcohol per hour and if you go to sleep with excess alcohol in your system, likely you will feel a startle when the alcohol leaves your system, waking you up during the night. Typically this occurs around 2-3 am in the morning.
3. Exercise: Add daily exercise. Exercise improves sleep waves, burns off tension from the day, and helps your body to feel physically tired, improving sleep. One caveat is to avoid exercising 2-3 hours before bedtime as exercise initially revs up your mental alertness, a good thing during the day.
4. Keep your room cool, dark, and quiet. Most people sleep best in a room between 68-72 degrees F (about 20-22 degrees C). Here in Florida, many people try sleeping at 78 degrees F with high humidity and they wake up sweating during the night. Your room should be cool enough so you can enjoy covering with a comforter and if your feet are cold, wear socks. Ideally your bedroom should be dark, but if not you can easily wear eye blinders to keep out the light. City life can be very noisy at night, disrupting your sleep multiple times. Ear plugs can help, but better yet consider a bedroom window upgrade with sound proof (better insulation and safety too) to keep out the traffic and city sounds. Be sure to keep pets out of your bedroom as they can wake you up multiple times each night; the same applies to children, although obviously exceptions are made for children who are ill or nursing.
5. Limit your bedroom to sleep, relaxation, and romance. Don’t watch TV or work/play on the computer within 1-2 hours of going to sleep. TV and computer screens change brain waves and activate deep brain centers, making high quality sleep elusive. Ideally unwind before going to bed. Read, relax, use prayer or meditation, and spend time with loved ones. Additionally, keep  your office activities out of the bedroom. You don’t need a workstation to distract you from good sleep.
6. Certain foods help you sleep. The brain needs serotonin to relax and your body makes serotonin from tryptophan. It shouldn’t be a surprise that your grandmother suggested you have a snack before bedtime, in particular warm non-fat milk, turkey, bananas, and peanut butter are all high in tryptophan. But if you suffer from heartburn, eat these foods at least two hours before bedtime. Warm herbal brews, such as valarian can be helpful.
7. If you have problems falling asleep, then try meditation or listen to a relaxation recording to help calm your soul before falling asleep. If you can’t fall asleep, avoid watching the clock. Even better would be to get out of bed and read for a while, select something soothing, even boring, then return to bed.

If none of these optimize your quality of sleep, then talk to your medical provider about herbal agents for occasional use, such as valarian or ashwagandha and to clarify that medical issues are not disrupting your ability to sleep. For a short term crises, a minimal-habit forming sleeping medication can be used; however please keep in mind that if used long-term, all sleep medications disrupt normal sleep architecture and make it harder to sleep without the medication.

Wishing You Sweet Dreams!

Steven Masley, MD, FAAFP, CNS, FACN

Let me share seven quick secrets to ensure you benefit from your next Japanese restaurant experience. A Japanese meal has multiple courses designed to stimulate most of our senses and add vitality to your life. Six to seven courses seem essential  for a complete meal, although we were served a sixteen course meal with fortunately many small portions.

Here are my  suggestions to a healthy, delicious meal. Keep in mind Japanese portions are typically modest and sometimes tiny.

1. Start with a soup.  Traditionally, a noodle or seafood soup would be the first course and Miso would actually be served towards the end of the meal. In an American Japanese restaurant, Miso is typically served first, so look at other options.  Miso is a soy based broth with a few slivers of tofu, seaweed, and green onion; it is very light and satisfying with delicate flavors after the main meal.
2. Next order edamame, fresh soy beans. Edamame with a tiny dash of rice vinegar and soy sauce is packed with protein, calcium, and many anti-aging compounds and has been a staple food in Japan for centuries.
3. A small salad comes next. My favorite is a mixed seaweed salad with wonderful flavor and texture, but if seaweed isn’t your thing, go for the green salad with the light Japanese dressing, often with ginger and rice vinegar.
4. Either sushi (rice rolled with seaweed and fish, cooked shrimp, and/or vegetables) or sashimi (raw fish) comes next. The quality must be fresh and excellent, or select the cooked shellfish option. Typically, sashimi is served as two small pieces, or one roll is split between two people. Although ahi tuna is one of my favorite foods, be cautious eating this type of big mouth fish often as it is very high in mercury.
5. A grilled or broiled entree is next, the most substantial part of the meal. Typically this is fish, shellfish, meat, or poultry served with white rice. From a health perspective, brown rice would be a much better choice, but white rice represents purity–fortunately it comes in a tiny bowel. My favorite entrees are unagi, (river eel) and unaga (sea eel) which are typically served over rice with a lovely sauce.
6. A mixture of pickled vegetables is next, adding  sour and bitter to complete a nearly full palate and aid in digestion. Various types of vinegar are used to pickle food. Cabbage is commonly included, and be sure to look beyond the pickled ginger that comes with  your sushi. Adding vinegar (acid) at the end of a meal is medically smart as acid improves digestion, nutrient absorption, and helps to prevent heart burn after a meal.
7. Last is fresh fruit and a cup of tea. During the dinner regular green tea is served, but the final cup will usually be something special, like Matcha (made from a special green leaf powder). If you enjoy alcohol with your dinner, then typically a lager beer or cold sake goes best with Japanese food. Although most Americans order warm sake, cold sake is usually much better quality and has a more delicate flavor suited for a Japanese meal. Fruit could be sliced mango, papaya, or strawberries.

This seems like a great deal of food, but the portions are small, and the flavors are complex and satisfying. The Japanese are not only one of the healthiest cultures on the planet, but they enjoy their food immensely, and despite their national wealth, they remain trim. We would all benefit from eating Japanese food more often.

Bon Appétit!

Let me ask a few questions to clarify if our conversation would be  important to you:

• Do you sometimes over eat, to the point you feel uncomfortable?
• Do you eat out of control, when you know you shouldn’t?
• Do you eat when you are mad, stressed, or tired but not  hungry?
• Do you make a healthy eating plan, and then can’t resist junk foods that you carefully intended to avoid?
• Do you find yourself sneaking food so others won’t notice?

If you answer yes to these questions, then you are not eating mindfully.  If you don’t eat mindfully, then you risk overeating, eating foods you don’t want to eat, and feeling worse after you eat than you did before you took the first bite.

Over the holidays, we are surrounded by excessive amounts of food, often the nutrient quality of food is poor, and our  schedules are jammed-packed, making meal planning more chaotic.

Here are my four suggestions to eating mindfully over the holidays: 

Step 1: Ask yourself prior to eating, “Are you hungry?” Are you about to eat because you need fuel, because is it socially required, or because you are upset or stressed out? It doesn’t mean you can’t/shouldn’t eat, but be very clear “why” you are eating, or you risk uncontrolled eating, and subsequently regret. If you are not hungry, select a small portion.

Step 2: Declare your space for eating. Plan a place to sit (not in front of the television, not in the car, not in front of the computer, and not at your desk), and if you are lucky, sit with a loved one you want to spend time with. Before you take a bite, look at your food and your surroundings.

Step 3: To eat mindfully, be sure you visualize, smell, taste, and feel the food in your mouth, including each and every bite. Look at the presentation of your food. Is your plate colorful, and is it the right amount to match your appetite? As you slip your first bite across your lips, how does the food taste? Hopefully it tastes delicious, if not, before taking a second bite, ask yourself, do you really want more, or would you like something else? Can you smell the food as you eat it? What is the texture like in your mouth? Switch from one item on your plate to another, and appreciate the difference between each bite.

Step 4: If you are eating with another person, then talk about the food you are enjoying.

This style of eating reflects mindful eating. If you practice mindful eating, very likely you will eat less, enjoy your food more, and make better choices. In contrast with mindless eating, (such as eating in front of the television) you may not taste or smell your food clearly, you may over eat—perhaps to the point you will be uncomfortable, and you may eat foods you would not have normally chosen.

Practicing mindful eating over the holidays will allow you to enjoy your food at a new level, and help you to make excellent food choices.

I wish you a wonderful and meaningful holiday season, filled with love and happy memories, and of course, wonderful food.

Bon Appétit!

Steven Masley, MD, FAAFP, CNS, FACN

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%

The brain is an incredible network of neurons and connections–giving us memory, processing capacity, and our many senses. Your brain function depends not only upon your genetic makeup, but also on how you nourish and care for it. Ironically, the memory center of the brain, called the hippocampus, is the most sensitive brain region susceptible to damage and aging.

Below are five simple secrets that will empower you to slow memory loss and enhance your brain speed and function:

1. EXERCISE: Aerobic exercise is critical for optimal brain function. Studies have shown that people with regular exercise have a much lower risk of developing Alzheimer’s disease.  A recent randomized clinical trial showed that in elderly adults who where sedentary, their brain’s memory center decreased in size, while in adults who were active daily, it grew. We have published information at the Masley Optimal Health Center showing that the fitter you are, the faster your brain functions. Our data shows that adding 30-60 minutes of aerobic activity 5+ days per week improved executive brain function an astounding 25-30%. Keep in mind that daily exercise is also the best predictor of weight loss and and not gaining it back.  Now, isn’t that worth getting in motion!
2. GET YOUR FISH OIL: Many studies have shown that people who eat more fish rich in long chain omega-3 oils (such as salmon, sole, trout, and sardines) have a lower risk of Alzheimer’s disease and dementia. Other recent trials show that brain function quickens with regular intake of these precious oils. To benefit, you need at least 2-3 servings of cold water oily fish three times per week. If you don’t eat these types of fish this often, then fish oil capsules can have the same benefit. Not only is fish oil good for your brain, it also helps prevent heart attacks and strokes, and decreases joint pain too. Unfortunately, many cheap sources of fish oil are rancid, don’t contain adequate EPA and DHA, and many may even be harmful, so I strongly encourage you to pick your fish oil carefully. For tips on finding good quality fish oil:  click here for more on fish oil.
3. MANAGE YOUR STRESS: If you don’t manage your stress, it can hurt you in many ways, especially your brain. Prolonged high stress raises the blood level of a hormone called cortisol, which causes your brain’s memory center to shrink. When stressed out, typically you don’t think sharply. Keys to managing your stress are to:
• Enjoy regular exercise, preferably 5-7 days per week with a mixture of strength training and aerobic activity.
• Get enough sleep. Most people need at least 7-8 hours per night.
• Don’t overuse alcohol and/or caffeine. Keep your intake to 0-2 servings per day, not more.
• Add regular relaxation routines such as massage, yoga, meditation, and/or prayer.
4. LOWER YOUR INFLAMMATION: As renowned neurologist, David Perlmutter, MD points out, inflammation sets your brain on fire. Several factors increase brain inflammation, including excess body weight, eating refined carbs and bad fats, and inactivity. There are several simple things you can do to lower brain inflammation:
• Keep your figure trim (For help with weight loss, click here for more)
• Take fish oil daily (see fish oil for details)
• Enjoy eating my Sweet Sixteen Vitality Foods daily
• Avoid refined carbs and bad fats
• Take curcumin. Curcumin is an incredible spice that slows  memory loss and lowers inflammation (see Curcumin for details)
5. AVOID MERCURY TOXICITY: Mercury is a neurological toxin, and with testing in my clinic, 30% of my patients have elevated mercury levels. Big mouth fish are clearly the greatest source of mercury today, in particular tuna, grouper, snapper, bass, swordfish, and shark. See my article on mercury symptoms, testing, and treatment for details. If you eat these types of fish more than 2-3 times per month, consider checking your mercury level.

The truth is, not only can you improve your brain speed with these five simple secrets to optimal brain function, but you will help to prevent memory loss as well.

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.

Despite its obvious importance, most Americans don’t meet their calcium requirements. Adequate calcium intake helps promote bone health, prevent osteoporosis and osteopenia, improve blood pressure control, and even seems to help with weight loss and fat loss. For more details on how much calcium you need and what type of calcium to take, please see my Bone Nutrition article for details.

Similarly, most Americans do not meet their need for magnesium. Good sources of magnesium are nuts and seeds, green leafy vegetables, beans and whole grains. Sadly, these are foods that many Americans fail to eat and enjoy. See my magnesium food content table for details.

Magnesium has many important health benefits:

• It is good for bone health
• It improves bowel function and helps prevent constipation, especially since calcium supplements when given without magnesium can cause constipation
• It improves blood sugar control
• It improves blood pressure control
• It is involved in hundreds of anti-aging enzyme reactions
• It helps prevent sudden cardiac death. Low magnesium levels have been clearly shown to cause cardiac arrhythmias that can cause major health problems and even death.

So now you get it. Magnesium is important and we don’t get enough. But what does this have to do with calcium?

Calcium blocks the intestine from absorbing Magnesium

Calcium inhibits magnesium from being absorbed in the gastrointestinal track. (In contrast, magnesium does not block calcium absorption.) If you have adequate magnesium intake (400 mg daily, see table above), then you’d be fine taking calcium alone, but very few people get this much magnesium from their diet.

The Solution: If you take Calcium, be sure to take it with Magnesium.

Most experts recommend a 2:1 or 3:1 calcium to magnesium intake. So if you take 800 mg of a calcium supplement daily (usually taken as 400 mg  of calcium divided into twice daily dosages), take 260 to 400 mg of a magnesium  supplement daily too (usually taken as 130 to 200 mg of magnesium divided into twice daily dosages).

What type of Magnesium should you take?

The worst form of magnesium to take is magnesium oxide because it is a gastrointestinal irritant. Magnesium citrate is better and less irritating, but clearly the best form is protein bound (chelated forms of magnesium). Not only is protein bound magnesium easy on your stomach and tolerated nicely, but it has much better absorption than most other magnesium forms.

A good calcium-magnesium combined supplement is OsteoForce, which comes with 200 mg of calcium and 75 mg of magnesium per pill, plus it has extra vitamin D and vitamin K. If you are looking just to add a protein bound form of magnesium, then I’d recommend magnesium malate chelate.

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.

Tomatoes with garlic and herbs don’t just smell wonderful when simmering, but they are outstanding for your health too. The orange-red pigment (lycopene) has cancer and heart disease fighting properties, plus vitamin C and potassium. Most traditional tomato sauces remove the peel and the seeds, which are the most nutritious part of the tomato.

Roasting tomatoes provides a complex flavor worth savoring and saving. Keep in mind, this sauce is chunky, not smooth and pureed. This is the time of year to make a large batch of tomato sauce and freeze or can for future occasions.

INGREDIENTS

12 medium vine-ripened tomatoes, (optionally may be peeled)

3 Tbsp extra virgin olive oil

3 medium onions, diced

2 tsp Italian herbs (or fine herbs)

1/1 to 1 tsp Sea salt

6 cups mushrooms, sliced (I prefer mixed wild varieties, but any type will suffice)

3 Tbsp fresh basil, chopped

18 medium garlic cloves, diced

1/2 cup red wine

DIRECTIONS

Set oven on bake at 400 degrees F.

To skin tomatoes (not required and keep in mind that the skins are packed with nutrients) dip them in boiling water for 1-2 minutes and peel once cooled.

Meanwhile, heat a large saute pan over medium high heat, add oil, then  add onions with dried herbs and salt. Saute for 2 minutes, stirring occasionally, then add mushrooms and heat another 2 minutes.

While the onions and mushrooms are cooking, slice tomatoes, and place into two oven-proof casseroles. Add  saute and roast in the oven. As the sauce begins to thicken (about 30 minutes) add garlic, fresh basil, and red wine. Allow to simmer in the oven another 30 minutes. Turn off the oven heat and let sauce simmer in the oven for another 20 minutes, serve and transfer extra sauce to containers for storing.