The Flex Diet – It Bends, So You Don't Break.

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Doctors have supported the heart-health benefits of omega-3s for years. They noticed that people who ate diets high in fish — which often contain omega-3s — were found to be less likely to develop heart disease. Research shows that fish oil not only improves your cholesterol numbers, but increases blood flow to exercising muscles. This results in more efficient metabolism of fat during exercise. So not only can fish oil reduce your risk of heart disease, but it can help you look better, too!

The major types of omega-3 fatty acids include:

• EPA (eicosapentaenoic acid) and DHA (docosahexanoic acid), found in fish oil and fatty fish, like salmon and mackerel
• ALA (alpha-linolenic acid), found in plant sources, like walnuts, flaxseed, canola oil, and soybean oil

Getting omega-3s from fish itself is what I tend to recommend. And the American Heart Association recommends eating fish at least twice every week. Eating more fish means you can also cut back on eating other foods that might be less healthy.

If you find it challenging to eat fish so frequently, a fish oil supplement is another option. Check the Environmental Defense Fund (www.edf.org ) to find supplement brands that meet safety standards. As with every supplement, it’s very important to clear it first with your doctor. Fish oil can increase the risk of bleeding, particularly in people taking blood thinners. Newer preparations are lower on the fishy after-taste. And many people find that storing fish oil capsules in the refrigerator helps them go down easier. You might find it interesting to have your doctor check your cholesterol before and after you increase your omega-3 intake. You’ll soon be motivated by the improvements!

How do you make sure you and your family are getting a healthy dose of omega-3s every week?

Many of us are getting our lipid profiles checked more regularly these days, even in the absence of significant risk factors for heart disease. Prevention is the best treatment, and learning more about your cholesterol and triglyceride levels can motivate you to make some healthy changes in your diet. Eating healthier can push those numbers in the right direction (by 20% or more). And research shows that this alone can reduce your risk of heart disease, even in the absence of medications.

Not sure where to start? Remember the Four F’s; four dietary components to consider while making your way to the path of more cholesterol-friendly eating:

1. Fish: Not only does fish provide a healthy alternative to processed meats and those higher in saturated fats like beef or pork, but fish also provides omega-3 fatty acids that actually raise your good cholesterol (HDL) and help lower your bad cholesterol (LDL) and triglyceride levels. Some doctors recommend taking fish oil supplements to take the guesswork out of it. But the American Heart Association recommends eating fish at least twice a week. And go for fresh or frozen fish over fast food or fried fish.

2. Fruit: Eating more fruits — and vegetables, as well — will help you get your cholesterol down, partially by increasing your fiber intake, but also by replacing some of the refined starches and high-fat snacks that are currently a part of your diet. In addition, eating a few pieces of fruit every day has also been associated with weight loss!

3. Fiber: As I’ve mentioned in previous posts, Americans generally get about half the daily amount of recommended fiber. Fiber is so helpful because it lowers your LDL while keeping you satiated. You don’t need to obsess over counting your fiber grams. But make a conscious effort to steer yourself towards fiber-rich foods like oatmeal for breakfast, higher fiber breads and cereals, beans, and again, fruits and veggies.

4. Fats: Fats are key. Remember that not all fats are created equal. Your goals should be to stay away from saturated fats, to avoid trans fats like the plague, and to cozy up to unsaturated fats, like those you’ll find in fish, almonds, avocados, and foods fortified with plant sterols. Switch out your cooking oil du jour for olive oil and help boost your HDL while lowering your LDL in the process.

The Four F’s make for easy substitutions to less healthy options, and can help improve your lipid profile when included in your diet.

Phrases like “game-changer” or “magic bullet” are thrown around a lot in medical circles, when doctors and researchers dream about changes in the medications we use to treat our patients.  For example, one of the most elusive targets in our quest to prevent heart disease is a medication that will safely raise HDL cholesterol and reduce the risk of future heart attacks.  But score one for medical research with the recent FDA approval and cost-effectiveness analysis for Dabigatran.

Dabigatran is a medication designed to thin the blood and reduce the risk of blood clots and strokes in individuals with atrial fibrillation, a common heart rhythm disorder which affects millions of Americans.  In addition to concerns related to symptoms of palpitations or less efficient heart function with increased heart rates, atrial fibrillation can increase the risk of strokes considerably – particularly in people who are at baseline higher risk.  For years, we have used warfarin (also affectionately known as “rat poison”) to thin the blood and reduce stroke risk.  However, warfarin is a challenging medication to take.  It requires some dietary modifications and regular blood testing.  It takes several days to wash out of your system, which can be challenging in the setting of bleeding or the sudden need for surgery.

Previous attempts at a substitute for warfarin have been complicated by dangerous side effects.  So with recent FDA approval of Dabigatran for stroke prevention in individuals with atrial fibrillation, we at least have a base hit.  And with the newest data suggesting that Dabigatran may even be more cost-effective than warfarin, it’s looking more like a home run.

One of the challenges of introducing a new medication into the health care system is that being effective is only part of the picture.  If a new drug works well but will bankrupt patients, it’s not going to work out.  This is why a recent study from Stanford allows patients and physicians to breathe a sigh of relief.  Researchers decide that a medical intervention (medication, procedure, or treatment) if it costs less than $50 000 per quality-adjusted life-year (QALY) gained.  In the case of Dabigatran, the number falls somewhere in the neighborhood of $45,000.  This assumed a daily cost of about $13 for the medication, although it has been recently reported that wholesale price will actually be closer to $6.75 – this would make Dabigatran significantly more cost-effective than the recent study would suggest.  Grand slam?

As you can tell, I’m pretty excited about Dabigatran.  I have no relationship to the company that makes it, but do have hundreds of patients who take warfarin, many of whom ask me at every visit when there might be a safe and effective alternative.  It’s looking like the time has come.

Ralph Macchio and I share an early November birthday. I remember discovering this as a kid, and being pretty psyched. Because, like any socially awkward pre-teen in the 1980s, I considered “The Karate Kid” to be a defining coming-of-age cinematic experience — a close second to “The Goonies” and maybe “The Breakfast Club.” And now? Even 20 years later, I still use a few of Mr. Miyagi’s tricks to help me take better care of my patients.  No waxing involved.

One of the concepts that Daniel-san took to the Mid-Valley All-Regional Championships was the idea that when you are facing an opponent, focus your energies beyond him. Sounds like a physics conundrum, but it works. Fighters know that you’ll maximize your impact if you strike a point just behind your opponent rather than use him as the point of impact. Doing this will push your momentum right through him. I realized after watching the movie a few dozen times that this was not only a great way of fighting, but an interesting strategy for approaching any problem. Focus your energies beyond the challenge, and maintain your momentum as you pass through it.

So what does this have to do with heart disease? Lots. When I sit with a patient who is contemplating a ridiculously invasive procedure, a 5% chance of death, multiple days in the hospital, and possibly months of recovery, it helps to think beyond the problem at hand. One way to do this is with simple visualization. I ask patients to try to picture themselves on the other side of the experience. I ask them to think about how good they will feel, how happy they will be that they went through with it. Once they find themselves at their destination, then it’s just a matter of getting there. Focusing energy on the destination makes the trip easier to contemplate. Because if you’ve already arrived there in your mind, that means that the journey is actually possible.

In the immortal Mr. Miyagi’s words – “Better learn balance. Balance is key. Balance is good … everything good.”