Your Health Checkup: Hope for People with Heart Failure: Get a Second Opinion

“Your Health Checkup” is our online column by Dr. Douglas Zipes, an internationally acclaimed cardiologist, professor, author, inventor, and authority on pacing and electrophysiology. Dr. Zipes is also a contributor to The Saturday Evening Post print magazine. Subscribe to receive thoughtful articles, new fiction, health and wellness advice, and gems from our archive. 

Order Dr. Zipes’ new book, Bear’s Promise, and check out his website www.dougzipes.us.

Last week a friend from long ago asked for advice after he developed heart failure. I told him that such dramatic changes have occurred in the care of patients with heart disease that locating an expert familiar with the new approaches might prolong his life.

Sir William Osler, a famous Canadian physician and co-founder of Johns Hopkins Hospital, once said that the young physician begins his life using twenty drugs to treat one disease while the old physician concludes his life with one drug to treat twenty diseases. This aphorism is no longer applicable, if it ever was, since the choice for treating most heart problems has expanded beyond the capability of any one drug or even one cardiologist unless they specialize in that particular area. While the choice may not be twenty drugs for one disease, but more than one is often the rule and not the exception.

Thus, my advice to patients questioning their care is to seek a second opinion from a cardiologist specializing in the area of their problem. Do not be afraid of hurting the feelings of your present doctor. Any physician truly interested in your wellbeing values a second opinion from another specialist that may help direct your care.

Finally, do not let the present pandemic prevent you from seeking appropriate medical support. Delaying needed treatment will only adversely affect your health.

Featured image: Oleh Slepchenko / Shutterstock

Your Health Checkup: Creating a “Neighborhood Watch” for Your Heart

“Your Health Checkup” is our online column by Dr. Douglas Zipes, an internationally acclaimed cardiologist, professor, author, inventor, and authority on pacing and electrophysiology. Dr. Zipes is also a contributor to The Saturday Evening Post print magazine. Subscribe to receive thoughtful articles, new fiction, health and wellness advice, and gems from our archive. 

Order Dr. Zipes’ new book, Bear’s Promise, and check out his website www.dougzipes.us.

Twenty years ago, when I was president of the American College of Cardiology, I wrote a president’s page commentary about the terrible toll inflicted by out of hospital cardiac arrest (OHCA), still responsible for almost 1,000 deaths daily in the U.S. I envisioned a Neighborhood Heart Watch Program I called Save A Victim Everywhere (SAVE) that would rely on citizen responders to be called and arrive first on the scene to administer lifesaving cardiopulmonary resuscitation (CPR) and/or apply a shock from an automated external defibrillator (AED). These are the two most important approaches to increase the appallingly low survival rate (5-8 percent) from OHCA in most places in the U.S. I also suggested that AEDs be made as available as fire extinguishers and be placed in readily accessible locations.

SAVE is based on the concept of a good-neighbor policy — similar to volunteer firemen and neighborhood watch programs — that could have a major impact on this scourge of modern civilization. I envisioned ordinary citizens trained to perform CPR and apply an AED and suggested that the number of such trainees could be increased if we taught such skills to high school students in public safety or health classes. When a cardiac distress call came into the 911 dispatch center, it would immediately be shunted to both the paramedics (EMS) and the nearest AED-equipped and -trained neighbor. This could increase the number as well as decrease the time-to-application of bystander applied AED shocks, the latter presently occurring in less than 10 percent of OHCAs. If necessary, drones could be used to deliver the AED to the OHCA site.

Such programs exist today in several places. For example, in Denmark, as noted in a recent publication, over a period of one year, citizen responders located about one mile from the OHCA victim were dispatched by cell phone to begin CPR or retrieve and apply an AED. Investigators noted that citizen responders arrived before EMS in 42 percent of 438 cardiac arrests, almost doubling the odds for bystander to begin CPR and more than tripling the odds for bystander application of a shock from the AED. They did not report clinical outcome.

Investigators in Germany compared outcomes for mobile rescuer-initiated CPR (94), EMS-initiated CPR (359), and lay bystander-initiated CPR (277) in 730 OHCAs. They found that mobile rescuers arrived in four minutes versus seven minutes for EMS. Outcome was also better for mobile rescuer responders with higher hospital discharge rate (18 percent) compared with EMS (7 percent). Better neurological outcomes were seen in 11 percent of mobile-rescuer patients compared with 4 percent of EMS patients (not statistically significant).

A recent review of community first responders found that such interventions resulted in increased rates of CPR or AED shocks performed before EMS arrival. However, the authors concluded that it remained uncertain whether this translated into significantly increased rates of overall patient survival and suggested that further study be performed.

Despite that cautious conclusion, since numerous studies have shown that time to first application of CPR and/or application of an AED shock are absolutely critical and that earlier application is associated with improved survival, it would seem to me that if such an outcome could be achieved with a good neighborhood heart watch policy, it would help save lives.

Citizen leaders interested in creating such a program should contact local authorities and, in collaboration with health care leaders, consider crafting SAVE for your neighborhood.

Featured image: Platoo Fotography / Shutterstock

Why Heart Disease Needs More Than Modern Medicine

The heart bestows life and death. It also instigates metaphor: It is a vessel that fills with meaning. The heart has always been linked to bravery. Even the word courage derives from the Latin cor, which means “heart.” A person with a small heart is easily frightened. Discouragement or fear is expressed as a loss of heart.

The richness and breadth of human emotions are perhaps what distinguish us most from other animals, and throughout history and across many cultures, the heart has been thought of as the place where those emotions reside.

The idea that the heart is the locus of emotions has a history spanning from the ancient world. But this symbolism has endured. If we ask people which image they most associate with love, there is no doubt that the valentine heart would top the list.

The heart shape, called a cardioid, is common in nature. It appears in the leaves, flowers, and seeds of many plants, including silphium, which was used for birth control in the early Middle Ages and may be the reason why the heart became associated with sex and romantic love (though the heart’s resemblance to the vulva probably also has something to do with it). Whatever the reason, hearts began to appear in paintings of lovers in the 13th century.

Later, heart-shaped ivy, reputed for its longevity and grown on tombstones, became an emblem of eternal love. This association between the heart and different types of love has withstood modernity. When Barney Clark, a retired dentist with end-stage heart failure, received the first permanent artificial heart in Salt Lake City, Utah, on December 1, 1982, his wife of 39 years asked the doctors, “Will he still be able to love me?”

Today we know that emotions do not reside in the heart per se, but we nevertheless continue to subscribe to the heart’s symbolic connotations. Heart metaphors abound in everyday life and language. To “take heart” is to have courage. To “speak from the heart” conveys sincerity. We say we “learned by heart” what we have understood thoroughly or committed to memory. To “take something to heart” reflects worry or sadness. If your “heart goes out to someone,” you sympathize with his or her problems. Reconciliation or repentance requires a “change of heart.”

Over the years, I have learned that the proper care of my patients depends on trying to understand (or at least recognize) their emotional states, stresses, worries, and fears. There is no other way to practice heart medicine. For even if the heart is not the seat of the emotions, it is highly responsive to them. In this sense, a record of our emotional life is written on our hearts.

Fear and grief, for example, can cause profound myocardial injury. The nerves that control unconscious processes, such as the heartbeat, can sense distress and trigger a maladaptive fight-or-flight response that signals blood vessels to constrict, the heart to gallop, and blood pressure to rise, resulting in damage.

In other words, it is increasingly clear that the biological heart is extraordinarily sensitive to our emotional system — to the metaphorical heart, if you will.

Perhaps more than any other area of medicine, cardiology has been at the forefront of technological innovation and quality improvement over the past 50 years. This golden period has witnessed a barrage of life-prolonging advances, including implantable pacemakers and defibrillators, coronary angioplasty, coronary bypass surgery, and heart transplantation. Preventive health initiatives, such as smoking cessation and cholesterol and blood pressure reduction, have supplemented these biomedical advances. The result has been a 60 percent drop in cardiovascular mortality since 1968, the year I was born. There are few stories in 20th-century medicine that have been as uplifting or far-reaching.

For a while it appeared that cancer would replace heart disease as the leading cause of death in the U.S., but no more. The rate of decline in cardiovascular mortality has slowed significantly in the past decade. There are many reasons for this. The fall in smoking rates has leveled off. Americans have become more overweight. Diabetes cases are projected to nearly double in the next 25 years. But I believe there is another reason, too. Cardiology in its current form might have reached the limits of what it can do to prolong life.

The law of diminishing returns applies to every human enterprise, and cardiovascular medicine is no different. For instance, ever since coronary thrombosis was shown to be the cause of most heart attacks, cardiologists have taken it as an article of faith that more rapid treatment of such thromboses improves patient survival. “Time is muscle,” goes the operative mantra, and the shorter the delay, the better. Yet a study of nearly 100,000 patients published in 2013 in The New England Journal of Medicine found that shorter “door-to-balloon” times — the period from a patient’s hospital presentation to inflation of a balloon to restore coronary blood flow — did not improve in-hospital survival. The median door-to-balloon time dropped to 67 minutes, from 83, in the period studied, but short-term death rates did not change.

There are several plausible explanations for this result. Perhaps heart attack patients who are healthier and at low risk for death are already getting expeditious treatment, and those who are at higher risk are experiencing the most delays. Perhaps the follow-up time in the study was too short, and if we waited a bit longer, a survival benefit would be seen. Or perhaps there is another reason. Mortality after a heart attack has already dropped tenfold, from 30 percent to 3 percent, since Mason Sones invented coronary angiography in 1958. Can the tweaking or speeding up of existing procedures possibly yield any significant additional benefit?

There are other examples of such diminishing returns. In my specialty, heart failure, medications such as beta-blockers and ACE inhibitors have profoundly improved survival since their advent in the mid-1980s. Yet recent studies of newer agents — endothelin blockers, vasopressin antagonists — have shown little benefit. Today, patients’ risk factors, such as hypertension and high cholesterol, are better controlled.

It is getting harder to improve on existing successes. No doubt we should celebrate the rise of high-tech medicine. For example, more than 90 percent of patients who present directly to hospitals that do angioplasty have door-to-balloon times today of less than 90 minutes, with a median time of approximately 60 minutes, a major improvement from only a few years ago. However, this means that the bar is continually being set higher for every new treatment.

I believe that cardiovascular medicine in its current form, focusing on investigating minor iterations of commonly used drugs or add-on therapies or optimizing existing procedures, will increasingly produce only marginal advances in the years ahead. We will need to shift to a new paradigm, one focused on prevention — turning down the faucet rather than mopping up the floor — to continue to make the kind of progress to which patients and doctors have become accustomed. In this ­paradigm, psychosocial factors will need to be front and center in how we think about health problems. Despite the centuries-old association of the heart with emotions, this is still a domain that remains largely ­unexplored.

However, today it is increasingly clear that chronic diseases like hypertension, diabetes, and heart failure are inextricably linked to the state of our neighborhoods, jobs, families, and minds. Heart disease has psychological, social, and even political roots. To treat our hearts optimally will require interventions on all these fronts. This is much easier said than done, of course. Psychosocial “repair” is just as prone to unexpected consequences, difficult trade-offs, conflicting values, and diminishing returns as any medical treatment. We cannot even agree on what should be repaired. But we will have to find ways, as Peter Sterling, the neurobiologist, has put it, to “reduce the need for vigilance and to restore small satisfactions,” such as our contact with nature and with one another. For some, this will require city-planning initiatives to encourage walking or bicycling, for example, instead of more sedentary lifestyles. Others will require fortification in more social realms, such as the enhancement of public life. For still others, cardiovascular benefits will come from more individualistic pursuits, such as yoga and ­meditation.

Whatever the case, it is increasingly clear today that the biological heart is inextricably linked to its metaphorical counterpart. To treat our hearts, we must repair our societies and minds. We must look at not only our bodies but also ourselves.

Sandeep Jauhar, M.D., Ph.D., is the director of the Heart Failure Program at Long Island Jewish Medical Center. He is the author of Doctored and Intern and writes regularly for The New York Times.

This article is featured in the January/February 2020 issue of The Saturday Evening Post. Subscribe to the magazine for more art, inspiring stories, fiction, humor, and features from our archives.

Featured image: Shutterstock

Your Health Checkup: 7 Steps to Reduce Risks of Heart Disease

“Your Health Checkup” is our online column by Dr. Douglas Zipes, an internationally acclaimed cardiologist, professor, author, inventor, and authority on pacing and electrophysiology. Dr. Zipes is also a contributor to The Saturday Evening Post print magazine. Subscribe to receive thoughtful articles, new fiction, health and wellness advice, and gems from our archive. 

Order Dr. Zipes’ new book, Damn the Naysayers: A Doctor’s Memoir.

The sheer volume of new information about heart health inundates us every day, threatening to addle our brains with warnings to “drink this health smoothie,” “swallow that vitamin,” or “eat this new and improved dietary supplement.” My wife complains that, adding to the confusion, the material often changes from week to week, and she is right. As her husband/cardiologist, I have to sift through the chaos of advice to highlight what she should believe and how she should respond.

Wouldn’t it be nice if we could distill all that information down to a pocket-sized list so we could easily remember the essentials of what’s important, do what’s needed, and be responsible for it?

The American Heart Association has tried to accomplish that with what they call “Life’s Simple 7,” or LS7, a synthesis of behavioral activities that reduce the burden of heart disease.

The LS7 includes not smoking, exercising, and controlling diet, body mass index (BMI), blood pressure, cholesterol, and glucose. Previous research supports the conclusion that adherence to LS7 reduces the risk of heart disease.

However, LS7 represents an ideal lifestyle that many of us are unable to attain. Mastery of all seven components would be great, but what would happen if you could control only several and which would be most important?

A recent study tried to answer that question in a Dutch population that included 37,803 participants from the EPIC-NL (European Prospective Investigation Into Cancer and Nutrition–Netherlands) cohort who were about fifty years old and three quarters women. An LS7 score was calculated by assigning points for each component to create an overall ideal score (11 to 14 points) that was present in about a quarter of the participants, an intermediate score (9 or 10 points) in about a third, and an inadequate score (0 to 8 points) in the rest.

Over fifteen years, the investigators found that, compared with an inadequate LS7 score, having an ideal LS7 score was associated with a 55 percent lower risk of heart failure, and having an intermediate score was associated with a 47 percent risk reduction. Importantly, intermediate and ideal scores for glucose, smoking, BMI, and blood pressure were all significantly associated with decreased heart failure incidence compared with inadequate levels.

When should you begin to adhere to LS7?

It turns out that the impact of life style on heart disease begins at an early age. In a study of 36,030 participants followed for 17 years, those having an elevated “bad” cholesterol (LDL) greater than 100 mg/dl at age 18-39 years had a 64 percent increased risk for coronary heart disease compared to those participants with an LDL less than 100 mg/dl, independent of later adult exposures. Similarly, having a systolic blood pressure exceeding 130 mm Hg was associated with a 37 percent increased risk for heart failure compared with a systolic blood pressure less than 120 mm Hg. This study concluded that exposure as young adults to components of LS7 was associated with increased cardiovascular risks in later life, regardless of exposures later in life as adults. Thus, awareness of risk and life style changes should begin in the young.

To paraphrase the conclusion in my last column, take control of your own health by controlling your LS7 components, and become your own best cardiologist. Do it now to avoid the consequences later.

Featured image: Shutterstock.com

Your Weekly Checkup: New Dangers Found in a Common Pain Reliever

“Your Weekly Checkup” is our online column by Dr. Douglas Zipes, an internationally acclaimed cardiologist, professor, author, inventor, and authority on pacing and electrophysiology. Dr. Zipes is also a contributor to The Saturday Evening Post print magazine. Subscribe to receive thoughtful articles, new fiction, health and wellness advice, and gems from our archive. 

Order Dr. Zipes’ new book, Damn the Naysayers: A Doctor’s Memoir.

I have previously called attention to the cardiovascular risks of taking nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin, ibuprofen, naproxen, celecoxib , acetaminophen, and diclofenac. Available in prescription strength and (for some medications) over-the-counter, NSAIDs interfere with the production of chemicals in the body called prostaglandins that reduce inflammation and pain and can increase the risks for developing heart attacks and strokes.

In a recent study that was the largest analysis ever conducted of cardiovascular risk associated with NSAIDs, diclofenac surfaced as the NSAID with the highest risk for causing adverse cardiovascular outcomes. Because diclofenac is a very popular and frequently used NSAID, its negative impact on cardiovascular outcomes becomes even more important.

For this study, the authors used the Danish health registry to analyze 1,370,832 people who started using diclofenac, 3,878,454 who started using ibuprofen, 291,490 who started using naproxen, 764,781 who started using acetaminophen and 1,303,209 who took no NSAIDs. The results for diclofenac were pretty damning.

They found that the 30-day adverse event rate for major cardiovascular events among people who started taking diclofenac increased by 50% compared with those who didn’t take the drug, by 20% compared with acetaminophen or ibuprofen users, and by 30% compared with naproxen users. The relative risk of major adverse cardiovascular events was highest in people with low or moderate baseline risk (that is, diabetes mellitus), while the absolute risk was highest in people with high baseline risk (that is, previous heart attack or heart failure). Diclofenac users in the highest risk group had up to 40 excess cardiovascular events per year per 1,000 people – about half of them fatal – that were attributable to starting the medication.

The increased risk was observed for those with heart rhythm problems of atrial fibrillation or flutter, stroke, heart failure, heart attacks, and cardiac death; both sexes of all ages; and even at low doses of diclofenac.

Diclofenac also increased the risk of upper gastrointestinal bleeding at 30 days, by approximately 4.5-fold compared with no use of any NSAIDS, 2.5-fold compared with use of ibuprofen or acetaminophen, and to a similar extent as naproxen.

The authors concluded that the treatment of pain and inflammation with NSAIDs may be worthwhile for some patients to improve quality of life despite potential side effects. However, considering the cardiovascular and gastrointestinal risks associated with diclofenac use, there was little justification to initiate diclofenac treatment before trying other traditional NSAIDs that had lower cardiovascular risk. When diclofenac was used, it should be accompanied by appropriate warnings of its potential cardiovascular risks.

Try to avoid NSAIDs if you can. Consider acupuncture, meditation, stretching, or other methods to relieve common aches and pains. If you need to take NSAIDs, try to keep the dose as low as possible, and take the NSAID as infrequently as possible.

Your Weekly Checkup: Psychological Distress Can Have Physical Consequences

“Your Weekly Checkup” is our online column by Dr. Douglas Zipes, an internationally acclaimed cardiologist, professor, author, inventor, and authority on pacing and electrophysiology. Dr. Zipes is also a contributor to The Saturday Evening Post print magazine. Subscribe to receive thoughtful articles, new fiction, health and wellness advice, and gems from our archive. 

Order Dr. Zipes’ new book, Damn the Naysayers: A Doctor’s Memoir.

Many people are distressed — maybe at work performing a job they don’t like or working for a boss who doesn’t like them. Or maybe they are stuck in a marriage that is on the rocks or struggling with misbehaving or uncontrollable children.

All of us, at one time or another, deal with stress in our lives. For most, the stress is transient and ultimately resolvable. But for some, the stress is longer lasting, even constant, severe, and insoluble.

These are the people I worry about because they are at increased risk for heart attacks and strokes. A recent study analyzed information from almost a quarter of a million participants with no history of heart attack or stroke. The investigators calculated and ranked psychological distress, such as fatigue, anxiety, depression, and hopelessness experienced by each participant within the previous four weeks.

When the study started, 16.2% of participants had moderate psychological distress while 7.3% had high or very high psychological distress, greater in women than men. Over the next 4.7 years, 4,573 heart attacks and 2,421 strokes occurred. The higher the degree of psychological distress, the higher the absolute heart attack and stroke risk among the participants. In men aged 45 to 79 years, those with high or very high psychological distress had a 30 percent greater risk for heart attack compared with those with lower psychological distress. The risk was less among men 80 and older. However, male sex added to the effects of the psychological stress. Among women, those with high or very high psychological distress had an 18% greater risk for heart attack compared with those with lower psychological distress and did not change with age.

The stroke risk also increased. Among those aged 45 to 79 years, high or very high psychological distress was associated with a 24% increased risk for stroke in men and 44% increased risk in women. Therefore, in woman, the magnitude of the effect of psychological distress appeared greater for stroke than for heart attacks. The reason for this is not known.

The results from this study — one of the largest of its kind — make it very clear that psychological stress has a strong, dose-dependent association with heart attacks and strokes in men and women, despite adjustment for a wide range of confounders.

How might the head impact the heart or brain to cause a heart attack or stroke? A recent study showed that patients who had post-traumatic stress disorder (PTSD) after a heart attack exhibited enhanced inflammatory responses to psychological stress. This observation provides a potential link — inflammation — between PTSD and adverse cardiovascular outcomes as well as other diseases associated with inflammation.

What can distressed people do? In some instances, antidepressant drugs can reduce the risk for cardiac events. In 300 patients with depression following an acute coronary syndrome, a 24-week treatment with an anti-depressant, escitalopram, compared with placebo resulted in a lower risk of major adverse cardiac events after a median of 8.1 years.

If you are distressed or depressed, seek professional help. Much can be done to relieve the stress to make you feel better and reduce the risk for a heart attack or stroke.

Your Action Plan for a Healthy Heart

mediterranean dish on a plate
Thirty percent of heart attacks, strokes, and deaths from heart disease can be prevented by switching to a Mediterranean diet.

Soon after Stan Hattaway woke from the fog of quadruple bypass surgery, he vowed to forever change his old eating and lifestyle habits. “It used to be that I never saw a cheeseburger I didn’t like, and if there was barbecue, well, just bar the door,” says Hattaway, who runs a marketing and advertising agency with his wife, Cathy, in Scottsdale, Arizona.

“Now, I just don’t have the desire to eat like that anymore. I exercise regularly and am probably in the best shape of my entire life.” Indeed, since suffering a heart attack and undergoing the ensuing surgery in October 2011, Hattaway has stuck closely to a plant-based diet rich in beans, vegetables, and fruits. He typically exercises every day of the week, and takes a coenzyme Q10 (CoQ10) supplement, which has been shown to benefit heart patients, plus a low-dose prescription statin.

Hattaway’s situation has prompted him to take what some may view as drastic measures in his quest to reverse heart disease, and new research affirms that many elements of his approach have relevance for anyone seeking to keep heart disease at bay, ward off a heart attack, or reverse the effects of heart disease.

And plenty of people fit the profile. Heart disease is the number one killer in the United States. The Centers for Disease Control and Prevention estimates that each year 715,000 Americans suffer a heart attack, while heart disease kills about 600,000 people annually, accounting for 25 percent of all recorded deaths. The CDC estimates the total annual price tag for coronary heart disease in the U.S. at $108.9 billion.

Though the statistics are daunting, there is also guarded optimism. Past generations were armed with only sketchy information about how to prevent heart disease, but now we live in an era in which highly advanced research is capable of providing new insights into how factors such as inflammation, diet, exercise, stress, sleep, and even a positive outlook might impact heart health. What is emerging is an increasingly clear blueprint for living a heart-healthy lifestyle.

For the five major (and simple!) steps to improving your heart health and reducing the risk of heart disease, pick up the Jan/Feb 2014 issue of The Saturday Evening Post on newsstands, or

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12 Foods That Are Part of a Healthy Lifestyle

Some of your favorite foods can help you stay young and healthy. Preventive nutrients in the following ingredients can lower your blood pressure and decrease your risk of heart attack and diabetes. Ellie Krieger, registered dietician and host of Food Network’s Healthy Appetite, shares two full-flavored, rejuvenating recipes.

1. Monounsaturated fats in olive oil are associated with lower rates of heart disease and colon cancer, and reduced risk of diabetes and osteoporosis.

2. Quercetin in onions is one of the most powerful flavonoids (natural plant antioxidants). Studies show it helps prevent cancer.

3. Rich in carotenoids, carrots may help lower cholesterol, regulate blood sugar levels, and protect against coronary heart disease and certain cancers.

4. An excellent source of potassium and manganese, zucchini provides your body with vitamins C, B1, and B6.

5. Several population studies associate an increased intake of garlic with a reduced risk of cancers, including stomach, colon, esophagus, pancreas, and breast.

6. Processing makes the cancer-fighting compounds in tomato paste more available to your body because heat breaks down the plant’s cell walls.

7. The type of soluble, cholesterol-lowering fiber found in chickpeas is not only heart-healthy, but helps stabilize blood sugars—particularly important for people living with diabetes.

8. Fresh basil boasts a healthy dose of blood-clotting vitamin K, and its oils and extracts are said to possess antibacterial and antioxidant properties.

9. Omega-3 fatty acids found in salmon promote heart, skin, and joint health. A study in the British Journal of Ophthalmology suggests omega-3s could also protect against age-related macular degeneration (AMD).

10. Data from a study published in Diabetes Care reported that a dietary pattern incorporating more low-fat dairy products may lower the risk of type 2 diabetes in middle-aged or older women.

11. According to a USDA Human Nutrition Research Center on Aging in Boston report, blueberries may improve motor skills and reverse the short-term memory loss that comes with aging.

12. A limited study at the University of Memphis Exercise and Sports Nutrition Laboratory found honey to be one of the most effective forms of carbohydrate gels to ingest prior to exercise, also functioning well in post-workout recuperation.

Salmon with Chickpea Ragu

Salmon with Chickpea Ragu

(Makes 4 servings)

Heat oil in large skillet over medium-high heat. Add onion and cook until soft, about 3 minutes. Add carrot, zucchini, and garlic and cook, stirring, until carrots are firm-tender, about 4 to 5 minutes. Add tomato paste and stir. Add chicken broth and chickpeas and bring to boil. Reduce heat to low and cook, covered, until liquid thickens, about 10 minutes. Remove skillet from heat, add 1 cup basil and ¼ teaspoon each of salt and pepper. Stir and cover to keep warm.

To cook salmon: preheat broiler. Season with remaining salt and pepper. Broil fillets for 8 to 10 minutes per inch thickness, turning once. Serve with 1 ½ cups chickpea ragu in shallow bowl. Garnish with basil.

Per serving: 1 salmon fillet and 1 1/2 cups chickpea ragu

calories: 460

fat: 17 g (saturated: 2.5 g; monounsaturated: 7 g; polyunsaturated: 5 g)

protein: 46 g

carbohydrate: 30 g

fiber: 6 g

cholesterol: 95 mg

sodium: 550 mg


Ellie’s Blueberry Blast Smoothie

Blueberry Blast Smoothie

(Makes 1 smoothie)

Put all ingredients into blender and process until smooth.

Per serving: 1 smoothie
calories: 195
fat: 1 g (saturated: 0 g; monounsaturated: 0 g; polyunsaturated: 0 g)
protein: 10g
carbohydrate: 40 g
fiber: 4 g
cholesterol: 5 mg
sodium: 134 mg

Spice Things Up!

Krieger says spices such as turmeric (found in curry) and ginger provide anti-inflammatory effects—an observation especially important for anyone suffering from rheumatoid arthritis or inflammation-related ailments.