How Can I Shake the Salt Habit?

Q: I know too much sodium is bad for me, so are there any alternatives I can cook with that will add a similar flavor boost and be healthier for me?

A: You are absolutely right—we eat far too much sodium in this country, and cutting back on sodium intake is a wise nutrition move. In fact, the American Heart Association dietary and lifestyle recommendations suggest we keep our intake of sodium under 2,300 mg per day (that’s the amount of sodium chloride found in about 1 teaspoon of salt) and under 1,500 mg for middle-aged and older adults, African Americans and those with diagnosed hypertension. Why worry about getting in too much salt—even if your blood pressure is normal? A high sodium diet has been linked to excessive loss of calcium from bones, an increase in kidney stone formation, reduced vitamin D and an increased risk of stroke, to name but a few of the adverse health effects linked to sodium overload.

Here are a few tips to help you shake the salt habit:

• Most of the salt in our diet comes not so much from the salt shaker but from processed and restaurant foods. Therefore, make an effort to choose less processed, natural whole foods. Be sure to read the nutrition facts label with the knowledge that 2,400 mg/day is your upper limit.
• If you dine out frequently, order the least processed menu options and add your own seasoning at the table. A salad bar is a great way to start your meal with a splash of heart-healthy olive oil, balsamic vinegar and a touch of lemon juice . . . and practically salt-free (but beware of pre-made salad dressings—notoriously high in salt).
• When cooking, learn to cook salt-free by using antioxidant-rich herbs and spices to give your food a surefire flavor boost. One of my favorite ways to flavor vegetables like broccoli or spinach is to sauté fresh garlic in extra virgin olive oil; add in the vegetable, then sprinkle with a touch of fresh lemon juice, yum! Dill is another one of my favorite herbs. I chop fresh dill and garlic, spread it on salmon and roast until done. Sprinkle with fresh lemon juice and you’ll never miss the salt!

Why Are Nuts Important In a Woman’s Diet?

Q: Why are certain foods like Brazil nuts important in a woman’s diet? What are some others?

A: It is important for all women to eat a heart-healthy diet to protect themselves against heart attacks and stroke (cardiovascular disease)—the leading cause of death and disability in American women—and nuts are a highly nutritious, heart-healthy food that should be a daily addition to one’s diet. Nuts contain a treasure chest full of nutrients such as protein, fiber, antioxidants (such as vitamin E and selenium), cholesterol-lowering plant sterols, and “good” fats such as the omega-3s and monounsaturated fats.

One caveat regarding nuts is that nuts are not created equally. The FDA has allowed a heart health claim for only seven types of nuts: almonds, walnuts, hazelnuts, peanuts, pecans, pistachios and some pine nuts. This is because these nuts all contain less than 4 grams of saturated fat per 50 grams of nuts. Notice that Brazil nuts did not make the cut. Brazil nuts are a nutritious food, exceptionally high in selenium and magnesium, but are also among the types of nuts that are high in saturated fat. Saturated fat is the most potent cholesterol-raising substance in our diet, so we need to cut way back on our intake. Thus, these nuts would not be your best bet.

Just remember not to go too nuts for nuts, as they are a very concentrated source of calories (due to their high fat—albeit good fat—content). Try and get about 1.5 ounces of nuts (about a handful) daily from one of the “magnificent 7” to help keep the cardiologist away!

How Can I Prevent Cramping While Exercising?

Q: How can I prevent cramping while exercising?

A: No doubt about it, muscle cramps hurt! So what are they and how can we prevent them? A muscle cramp (aka a “charlie horse” if it occurs in the leg) is an involuntary, sustained and forceful muscle contraction that can last a few seconds to what seems like a lot longer! Skeletal muscles are the type of muscles that are most likely to cramp, with calf, thigh and muscles in the arch of the foot as notoriously common spots. Although the exact cause of muscle cramping during exercise is unknown, four major contributing factors have been identified:

• Dehydration.
• An imbalance in the electrolyte level of the body fluids (most notably sodium and potassium).
• Lack of a proper warm-up and cool-down.
• Muscle fatigue.

The best way to prevent muscle cramps is to prevent the four major contributing factors:

1. Drink lots of fluid before, during and after your workouts. A good rule of thumb to determine how much fluid to drink during your workout is to gauge your “sweat rate” and try to match fluid loss with fluid intake. There are calculations to determine your exact sweat rate, with the average person losing roughly 25 to 50 ounces of sweat per hour. Drinking at least 8 ounces of fluid every 15 minutes would cover you if you lose approximately 32 ounces of fluid per hour.
2. Eat a healthy plant-based diet naturally rich in potassium (bananas, potatoes, papayas and spinach are all high-potassium foods), and do not restrict sodium in the diet directly before a long exercise bout in the heat.
3. Make sure to warm up before exercising by performing a slow version of the same exercise that you will be doing during your exercise bout, and cool down by decreasing intensity until your heart rate returns to normal
4. Follow a regular aerobic exercise training program, gradually increasing in intensity and duration from week to week, which is the best way to train your muscles to resist fatigue.

Diet or Fitness to Moderate High LDL?

Q: I am in my early 30's and was told by my primary care physician that my LDL cholesterol level was a little too high, but not at risk. Should I focus more on my diet or my fitness level to moderate my LDL?

A: Great question, as this is a topic very dear to my own heart! Considering that cardiovascular disease (CVD), which includes heart disease and stroke, is far and away the leading cause of death and disability in American men and women (killing as many people each year as all forms of cancers, lung disease, diabetes and accidents combined), it would behoove all Americans, young and old, male and female, to live a heart-healthy lifestyle. This involves fine-tuning both your diet and your exercise habits, which together favorably impact your LDL, or “bad,” cholesterol level.

The first step in preventing CVD is to sit down with your personal physician and assess your risk factors. LDL cholesterol is the most established risk factor for CVD. You and your doctor will come up with your personal LDL goal, as your LDL goal really depends on your risk status: the higher your risk, the lower your goal. According to the American Heart Association, the “optimal” goal for LDL cholesterol—for the prevention of heart disease—is less than 100 mg/dL. An LDL of between 100 and 129 mg/dL is defined as “near or above optimal.”

If your LDL is too high, what should you do? Because lifestyle changes (diet and exercise) remain the foundation for cardiovascular disease prevention and cholesterol control, the answer to your excellent question is to focus on both diet and exercise to lower your LDL cholesterol level. In my book, Cholesterol DOWN, I provide a simple diet and exercise plan that includes nine “miracle foods” and 30 minutes of walking a day that can lower your LDL cholesterol by as much as 47% in just 4 weeks.

Is the Acai Berry as Good as They Say?

Q: I have heard about the ORAC value of the açaí berry. Is it as high in antioxidants as they say?

A: ORAC, short for “oxygen radical absorbance capacity,” is a chemical test scientists use to measure the antioxidant potency of a particular food. There are actually a variety of tests that scientists can use to test the antioxidant capacity of foods. What must be understood, however, is that the antioxidant capacity of a specific food determined in the lab does not necessarily translate to the antioxidant capacity of that food in the human body. That said, to strengthen our body’s defenses against highly destructive free radical damage, we should try to eat a variety of plant foods (high on the ORAC scale) daily. The easiest way to do that is to consume a rainbow of colors throughout the day. In 2007, scientists at the USDA published a list of ORAC values for 277 foods. Some of the foods highest on the USDA ORAC scale include red wine, English walnuts, oregano, cocoa and gingerroot.

The açaí (pronounced ah-sigh-EE) berry is the fruit of a type of palm tree (Euterpe oleracea) that grows near the Amazon River of Brazil. Açaí is consumed in beverages and food products, and yes, it has been found to exhibit an exceptional antioxidant capacity in the lab. A recent study, published in the Journal of Agricultural and Food Chemistry (Seeram et al., 2008), ranked the antioxidant potency of several commonly consumed beverages in the United States. Pomegranate juice led the pack followed by red wine > Concord grape juice > blueberry juice > black cherry juice > açaí juice > cranberry juice > OJ, iced tea and apple juice.

The bottom line: don’t be misled by claims of one particular food’s superior antioxidant activity, which may or may not be based on accurate testing. Eating a variety of antioxidant-rich foods, on a daily basis, is your best strategy for harnessing the disease-fighting antioxidant potential of the mighty plant kingdom.

What Are Some Healthy Breakfast Ideas?

Q: What would be some alternatives for a healthy breakfast rather than my regular bowl of whole-grain cereal?

A: Nothing beats a bowl of whole-grain oatmeal for breakfast, the first step in my 10-step Cholesterol DOWN plan. I would say that eating a bowl of oatmeal made with light soy milk, some ground flaxseeds and maybe some cranberries and topped off with chopped almonds is about as good as it gets for starting the day off right. That said, if you are tired of the same old whole-grain cereal for breakfast, then why not try something new? After all, variety is the spice of life! I have some excellent, heart-healthy breakfast recipes in my book, Cholesterol DOWN, that you might enjoy.

How about Mia’s veggie omelet (named after my daughter Mia)? It is made with egg whites, lots of colorful veggies and topped off with a touch of soy cheese. Serve it up with 100% whole-grain toast spread with some plant sterol-containing margarine and you have a delicious breakfast that provides you with antioxidant-rich vegetables, soy protein and whole grains—and it lowers your cholesterol, too. Another breakfast favorite of mine that I often make for my own family on Sunday mornings is almond oat pancakes. Made with oatmeal, almonds, flaxseeds and soy milk; spread with plant sterol-containing margarine; sprinkled with powdered sugar; and served with warm Vermont maple syrup . . . these pancakes are delicious, nutritious and contain 5 of the 10 cholesterol-lowering steps in my book. It doesn’t get much better than that!

How Often Should I Workout?

Q: Is it better to work out more days per week for shorter intervals or fewer days per week for longer intervals?

A: The answer to your question really depends on your personal preference and the type of exercise. When patients ask me what’s the best kind of exercise, my answer is always: “Whatever type of exercise that you will do on most days of the week.” In a nation of couch potatoes, suggesting that people find whatever kind of exercise works for them is sound health advice.

Major health agencies such as the Centers for Disease Control and Prevention and the American College of Sports Medicine (ACSM) recommend that for good health and to reduce risk of chronic disease, adult Americans should participate in moderate-intensity aerobic (or cardio) exercise (such as brisk walking) for at least 30 minutes on 5 or more days of the week or vigorous-intensity cardio at least 3 days of the week. So the frequency really depends on the intensity that you choose to gauge your exercise bout. What’s more, research has shown that the 30 minutes can be cumulative, meaning it will be just as effective if you choose to divide the 30 minutes up into 10-minute bouts.

Aerobic exercise is not the only type of exercise that you need to try and fit in. The ACSM also recommends weight training exercise (8 to 10 different exercises and 9 to 12 repetitions of each exercise) 2 days a week. Weight training exercise is essential for enhancing muscular strength and endurance, helping to prevent the decline of muscle mass (and metabolic rate) that accompanies aging, and promoting bone health.