Coenzyme Q10 (CoQ10) is rising to the top of the list of nutritional supplements that may promote longevity and well being. Along with omega-3 fish oil and vitamin D, CoQ10 appears to be especially beneficial for individuals with cardiovascular risk factors like high cholesterol, high blood pressure or diabetes.

But what is CoQ10 and what does it do? If you think back to your high school biology class, you may not remember CoQ10, but you probably studied mitochondria at some point. These are the little power plants where our cells generate and store nearly all of the energy needed to power our bodies. CoQ10 is a key enzyme used in the mitochondria. The brain, heart and muscles, be­cause of their high en­ergy requirements, are especially dependent upon adequate levels of CoQ10 for optimal function.

CoQ10, through its antioxidant activities, also helps protect the body from free radicals, which are dangerous compounds that tend to oxidize (rust) everything from DNA to cholesterol. That’s what predisposes us to premature aging and disease.

CoQ10 is incorporated into the mitochondria where it facilitates the chemical conversion of fats and sugars into energy. An increasingly convincing body of scientific evidence indicates that supplementing your diet with CoQ10 may support health energy production in the mitochondria and positively impact your overall health and well-being.

In the process of normal aging, we tend to decrease our production of CoQ10 by up to 70 percent or more. After age 45, particularly for those who remain very physically active, this can start causing age-related problems with muscle, brain, and heart function.

Importantly, statin drugs, such as simvastatin or atorvastatin, particularly at higher doses, can also reduce the body’s ability to manufacture CoQ10 by another 40 percent. Statin drugs lower cholesterol levels by inhibiting an enzyme in the liver, which not only reduces the production of cholesterol, but also low­ers levels of coenzyme Q10.

This can mean individuals taking a statin, particularly at higher doses, may experience muscle aching, weakness, and fatigue. Therefore, it may be especially important to supplement your diet with CoQ10 if you are:

- Over age 45;
- Physically active; or
- On a statin drug.

Additionally, CoQ10 is often used as a nutritional supple­ment for a wide variety of heart-related issues such as high blood pressure, high cholesterol and heart failure.

CoQ10 may help replenish youthful CoQ10 levels promoting cellular energy production. Thousands of research studies suggest possible roles for CoQ10 to: maintain normal blood pressure levels; support healthy im­mune system function; support the normal function of brain and nervous system; and promote healthy heart function.

This nutrient is very difficult to absorb and thus only one percent of the CoQ10 found in many formulations is actually absorbed into the bloodstream. I developed CardioTabs Ultra CoQ10 as a highly absorbable supplement. Talk with your doctor about whether you might benefit from this nutritional supplement, especially if you take a statin drug, and be sure to look for a CoQ10 in a highly absorbable formulation.

In Good Health,

James O'Keefe, MD

Nine Steps Toward a Hunter-Gatherer’s Diet:

1. Thrive on the earth’s natural bounty. Eat whole, natural, fresh foods; avoid highly processed foods.

2. Consume a diet high in fruits, vegetables, nuts and berries, and low in refined grains and sugars.

3. Increase consumption of omega-3 fatty acids from fish, fish oil, and plant sources like walnuts, canola oil, greens, soybeans, and flaxseed.

4. Avoid trans fats entirely. Eliminate fried foods, hard margarine commercial baked goods, and most packaged and processed snack foods. Also eliminate consumption of fatty meats and high-fat dairy.

5. Increase consumption of lean protein such as skinless poultry, fish, game meats, and whey protein. Eat only lean, fresh cuts of red meat and limit consumption of saturated fats, including: fatty, salty processed meats like bacon, sausage and deli meats.

6. Incorporate olive oil or canola oil into your diet. Avoid corn, safflower, sunflower, and vegetable oils.

7. Choose purified water, tea, nonfat unsweetened dairy or soy milk, and red wine. Avoid soft drinks, fruit juices, high-fat dairy, and sports drinks. Even 100 percent fruit juices are still loaded with too much sugar and should be considered off-limits. However, low sodium vegetable juices are very nutritious.

8. Use your body as it was designed and programmed over the millennia and engage in daily exercise from a variety of activities that incorporate aerobic and strength training as well as stretching exercises. Outdoor activities are ideal.

9. Develop and maintain relationships that provide social support (e.g., spouse, family, friends, neighbors, community, etc.) Try to also include some activities that involve altruism and nurturing.

In Good Cardio Health,

James O'Keefe, MD

Photo Credit Woodlouse via PhotoPin CC

An interesting and provocative Kansas City based study, involving 137 mummies from four antiquated cultures found evident signs of atherosclerosis, a hardening of the arteries, in 34 percent of the mummies they examined.

When fatty material known as plaque collects along artery walls atherosclerosis is occurring, and as it thickens increased pressure is put on the heart and artery walls to pump blood throughout the body. In order to diagnosis the mummies with atherosclerosis, researchers used Computed Tomography (CT) scans to measure calcium and plaque buildup that had accumulated on artery walls.

A conclusion drawn from the study was that changes we make in our diets and lifestyles don’t have as great an impact on heart disease as we think. Lead author and Saint Luke’s Cardiologist, Dr. Randall Thompson was quoted as saying, “People who propose you can prevent this disease by eating a certain way or living a certain way are overselling their point of view. Maybe we have less control over this than we might think.”

I am fascinated by the findings, but undaunted in my conviction that regardless of the calcified plaque, we can control the occurrence of arterial disease. Following diets similar to the Hunter Gatherer and especially, the Mediterranean Diet, which has received a lot of press of late, are ideal in combating the spread of atherosclerosis. This means consuming lots of vegetables, fish and seafood with little red meat, olive oil, fruits, nuts and berries, legumes, and moderate amounts of red wine with the evening meal.

These ancient cultures had campfire smoke, daily life and death stresses, and all sorts of other nutritional issues to deal with that likely caused inflammation in arteries. However, few survived long enough to die from it, so atherosclerosis didn’t exert strong selective pressures. We modern humans aren’t natural selected to be resistant to arterial plaque and its ravages.

As I told the local press who contacted me about the study, if we live long enough, calcified arterial plaques may be unavoidable regardless of the century in which we lived, but heart attacks and cardiovascular deaths resulting from those plaques are entirely avoidable in the 21st Century. Now we just have to avoid the mummies’ fates of falling into a glacier crevasse or getting shot in the back by an enemy arrow!

In Good Health,

James O’Keefe, MD

Photo Credit Brooklyn Museum via PhotoPin CC

Seventy years ago, a visionary scientist named Dr. Ancel Keys, while vacationing in Pioppi, Italy, noted that people of this small village to the south of Naples, seemed to be vigorous, healthy and exceptionally long-lived. Indeed, Dr. Ancel Keys, who lived to be 102 years of age himself, decided that the Mediterranean Diet was playing a large role in the exceptional health of the cultures. After decades of subsequent research showing benefits of various components of the Mediterranean Diet, the medical world has come to embrace this eating style.

Unfortunately, when the average American thinks of the “Mediterranean Diet”, he or she visualizes pasta or pizza. While these foods are consumed in small quantities by some of the traditional Mediterranean peoples, they are not the central features of this diet, nor the ones that promote health and longevity. Instead, the most important components of the Mediterranean Diet are lots of vegetables, fish and seafood with little red meat, olive oil, fruits, nuts and berries, legumes, and moderate amounts of red wine with the evening meal.

Sadly, this cardio health focused Mediterranean Diet is being abandoned by the people famous for inventing it. Recent reports indicate that Italy is the ‘fat man’ of Europe now with the highest rates of obesity on the continent. Obesity is particularly common in the young people where up to 36% of 12-16 year-old Italians are now overweight or obese.

The “Industrial Global Diet” is the new term for what we use to call the old standard American diet. When a country’s standard of living rises, the population tends to abandon its traditional eating patterns and instead adopts a diet of processed foods, fast foods, and high calorie fare. Italy,Spain,Greece, and Crete young people are abandoning the Mediterranean Diet and in all of these places, and their rates of obesity are skyrocketing.

In America during the 20th century, the rates of heart attack, diabetes, and cardiovascular death rose steeply for the first three-fourths of that century. The only time periods when these rates fell were during the two World Wars when rationing of meat, sugar, white flour, butter and gasoline, forced people to walk more and rely on home grown produce and locally caught fish.

Unfortunately, fast food, and high calorie processed food such as hamburgers, french fries, chips, candy bars, sweetened sodas, etc. are inexpensive and widely available. On the other hand, foods that make up the traditional Mediterranean Diet such as fresh vegetables, fruits, olive oil, fish, nuts, and berries tend to be more expensive. Some people complain that these days it helps to be wealthy if you want to eat like a poor Mediterranean peasant from centuries past.

Bottom line, now more than ever, it is important to follow a cardio healthy diet. One example of this is the traditional Mediterranean Diet. Try to eat at least two different colors (deeply hued vegetables and fruits are ideal) with each meal. Additionally, eat a small portion of lean protein such a fish, chicken breast, non-fat dairy with each of your three meals. For dessert, choose berries or other fruit. A glass of red wine with the evening meal is a good idea if you can limit it to never more than two glasses. Drink water, tea, coffee, or non-fat milk, and try to avoid foods that are processed. The closer you keep your diet to nature, the more vigorously you will thrive and the longer you will live.

A Typical Mediterranean Meal:

- Grilled salmon with grilled red, green and orange bell peppers tossed with olive oil before cooking.

- Spinach salad with tomatoes, dressed with olive oil vinegar. Ice water with a slice of fresh lemon.

- One glass of red wine, and or decaf coffee or tea.

- Berries for desert.

In Good Health,

James O'Keefe, MD

Photo credit via PhotoPin CC Marcel Germain 

The life expectancy of Americans has approximately doubled over the last century. The average American today lives seventy-eight years; males typically make it to age seventy-four, and females to age eighty. Scientists estimate the maximum potential human life span at 120 years, and in fact the longest well-documented human life was 122 years.

Longevity has been assumed to be mostly a matter of being born with the right genes, but experts tell us that only about one-third of aging is attributable to genetics. You have much more control over the aging process than you probably have imagined. Of course, you will age more gracefully if you exercise daily, maintain a healthy weight, eat right, and don’t smoke or abuse alcohol. But learning how to effectively cope with and avoid stress is also a major factor in living a long and vigorous life.

Among the strongest predictors of who will live to advanced ages are traits like optimism, volunteerism, and an ability to work through problems and still maintain enthusiasm and love of life. A recent study showed that people who live a century or more have several traits in common:

• A positive, yet realistic attitude

• An adventurous love of life

• A strong will

• Spiritual beliefs

• An ability to renegotiate life when necessary

• An insistence on aggressive medical care when necessary

• A sense of humor

The real beauty of these findings is that many of the same things that make life pleasurable - an ability to laugh, having faith, a happy outlook, a love of adventure, curiosity, and loving relationships - are the very same factors that will keep you alive and well for 100 years. Other characteristics of centenarians like strong will, the flexibility to renegotiate life, and willingness to find expert medical help when needed are crucial to overcoming the mental and physical maladies that we all develop sooner or later.

About 80 percent of chronic serious medical conditions like heart disease, cancer, arthritis, Alzheimer’s, diabetes, and so on are preventable with the right diet, lifestyle, attitudes, and medical care. Today more than ever, staying healthy is not a matter of fate, genes, or luck, but rather a function of your lifestyle and diet and how well you monitor your health and respond to the problems that will inevitably appear.

In Good Health,

James O'Keefe, MD

Sad but true, some of the most dangerous threats to your life are disguised as comfy furniture and electronics for passive entertainment. Even if you are good about getting daily exercise, and don’t smoke, a habit of prolonged sitting every day can be expected to shave about two years from your life expectancy, according to a study in the British Medical Journal in July 2012, which followed 167,000 people for about a decade.

Both Joan and I have always had a difficult time sitting still for more than a few minutes. Slouching in a chair in front of a computer and keyboard, or sitting and staring at a TV screen for a prolonged period of time makes us both miserable. Seated inactivity just feels uncomfortable to us. For Joan, it’s hard to even sit down to dinner for more than a few minutes at a time.

Just several hours of physical inactivity can cause an immediate drop in the levels of an enzyme that clears fat from the bloodstream, which causes the blood levels of triglycerides (fats) to rise, in turn triggering a surge in free radicals that cause inflammation and dysfunction in the brain, heart, blood vessels, and liver. In essence, too much sitting results in inflammation throughout your system, and eventually increases risks for obesity, depression, diabetes, high blood pressure, heart attack, stroke and Alzheimer’s dementia.

More TV = Less Life

A landmark study of Australians showed every hour of TV viewing could be expected to shorten a person’s life by about 22 minutes. This means that if the average adult person watched no TV, he or she would probably live about 1.5 to two years longer.

According to this large study, watching TV for more than four hours a day (compared to watching less than two hours of TV daily) increased chances of dying from any cause during the follow-up period by 50 percent, and increased the risk of dying from cardiovascular disease by 80 percent. And this doesn’t even take into account the fact that all those extra hours freed up might be better spent in activities that bring meaning and vitality to life, such as time spent cultivating relationships with family and friends, pursuing hobbies, being active outdoors, traveling, etc.

And sitting too much can also predispose to cancer. Shockingly, the numbers of Americans developing malignancies linked to obesity and physical inactivity, such as cancers of the pancreas, esophagus, kidney, and uterus, have risen every year from 1999 through 2008. One recent study reported that individuals who have worked 10 years or more in jobs that required them to be physically inactive had twice the risk of colon cancer compared with people who had never worked sedentary jobs.

Benefits of Standing or Strolling. Prolonged sitting causes problems even for those who exercise regularly. An eight-year study that followed a quarter-million American adults correlated daily activity levels with their long-term general health. One of the best predictors of survival and overall health was the amount of physical activity they did on a daily basis: the more the better.

Although regular physical exercise somewhat diminished the health and mortality risks caused by prolonged sitting, even those who exercised for seven hours or more a week but spent at least seven hours a day in front of the television were more likely to die prematurely, than the people who exercised at least seven hours weekly and watched less than an hour of television daily. In other words, it’s not enough to just get your 30 minutes of physical activity during the day. You should try to be on your feet at least, and moving, even if at a slow pace, as often as you can. 

Exercise. Try this experiment; check your blood pressure when you are feeling tense or upset. Then go out for a 30-to 60-minute brisk exercise session. Re-check your blood pressure about 30 minutes after you cool down; it will almost certainly be substantially lower.

Meditation, prayer, relaxation breathing. Although prayer comforts many people, you can also lower your blood pressure by simply meditating quietly, especially if you take slow deep breaths, and focus on prolonging the exhalation phase (breathing out) longer. Relaxation breathing is easy to do: breathe in for the count of four, hold your breath for the count of seven, and breathe out slowly for the count of eight. Even doing just four to eight cycles of this relaxation breathing will lower your blood pressure and reduce your sense of anxiety.

Sleep. When you are sleep deprived, your blood pressure is substantially higher. Shoot for at least seven to eight hours per night. If you have a hard time falling or staying asleep, take one 81 mg aspirin and 3 mg of Melatonin at bedtime. Getting enough sleep keeps your hormones in the ideal ranges, which makes it easier to have a narrow waist and nice low blood pressure.

Diet. The average American consumes 4,000 mg of sodium per day - almost 10 times as much as we need. Avoid processed food as much as possible; it’s generally loaded with salt.

In Good Health,

James O'Keefe, MD

- Find activities that you truly enjoy. Your chances of sticking with an unpleasant program for the long term are not good.

- Increase your workout time and intensity not more than about 10 percent per week.

- Listen to your body. If a joint or muscle begins to hurt, ease off or find another activity to do instead for a few days. If you feel strong, go a little further or harder.

- Find an exercise partner. A dog is ideal, but a friend or family member will do fine as well. My husband James routinely writes prescriptions to his patients to walk their dog as a motivator for them.

- Stay well hydrated.

- Get advice from a pro. Hire a personal trainer to give you pointers on what is best for you. Even if it is for only an occasional hour to receive tips and a fresh workout routine, professional input can really keep you on track.

- Cross-train. This is one of the most important features of a ideal exercise routine. Different activities will prevent injuries and burnout and keep you enthused and optimally fit.

- Start your exercise slowly, with five or ten minutes at a low-level intensity warm-up pace. Save the stretching for after the exercise session.

- Set goals and reward yourself when you achieve them. Sign up for a race or an active vacation for which you will need to train.

In Good Health,

Joan O'Keefe, RD

Cultivate healthy habits. Nothing else will so reliably create vitality, happiness, and 

A keystone habit, according to Charles Duhigg, is a fundamental routine that is crucially important because it has the power to start a chain reaction, which can shift other patterns and eventually transform our lives. Keystone habits influence how we eat, think, play, work, and live. A keystone habit can trigger a process that, with time, can trans­form everything. So, pick one of these five keystone habits that is not yet in your daily routine and focus on making it a priority to do this regularly until it becomes automatic. Eventually if you can ultimately establish most or all of these five keystone habits in your day-to-day routine, your health and your life will be radically altered for the better.

Five Keystone Habits

1. Sleep seven to eight hours nightly.

2. Exercise at least 20 to 30 minutes daily.

3. Eat two colors and one healthy protein at each meal.

4. Take omega-3 and vitamin D each day.

5. Think of three blessings for which you are grateful each night before dozing off or upon awakening in the morning.

In Good Health,

James O'Keefe, MD

If you wanted to be blessed with remarkably good health and exceptional longevity, what one change would you make to your daily diet? The answer is to include a generous daily inta

When I was a kid, the only lettuce we had in our household was iceberg lettuce. When Joan and I were first married we ate romaine lettuce, then we moved to red leaf lettuce. But for the past 20 years, we have been huge fans of the real stars of health and longevity—leafy greens like baby spinach, kale, broccoli and arugula. These are the most nu­trient-dense foods on the planet. Kale, a cross between cruciferous vegetables and a leafy green, may be the best of best!

A large meta-analysis of more than 200 long-term ob­servational studies concluded that raw vegetables showed a stronger protective effect against cancer than any other type of food. Leafy greens in particular also provide potent protection against macular degeneration—the leading cause of blindness in adults. A low level of carotenoids in the macula of the eye (the highly sensitive center of your field of vision where your visual acu­ity is the best) predisposes to macu­lar degeneration and blindness.

If you can make sure you are eating leafy greens like kale and spinach at least five times weekly, your risk of developing macular de­generation falls by 86 percent! Joel Fuhrman, M.D., advises his patients to tape a sign on their refrigerator door that says: “The SALAD is the MAIN dish!”

The base of your salad should be hearty greens like spinach or kale, not iceberg lettuce. Then add two more colors—your choice; red, green, or orange bell peppers, or broccoli, or carrots, or onions, or cel­ery, or mushrooms or snap peas, or better yet—all of the above. Be creative, indulge your vegetable passions, and dress it with extra-virgin olive oil and wine vinegar or fresh lemon juice to enhance your body’s ability to absorb the cornu­copia of potent nutrients present in these vegetables.

Now just add a modest serving of protein, like boiled peel-and-eat shrimp, or a chicken breast, and perhaps add a bowl of raspberries for dessert. It can be simple to create an ideally nutri­tious meal that is also wonderfully delicious!

In Good Health,

James O'Keefe, MD

Since 1937, the Harvard Study of Adult Development has closely followed one entire class of Harvard students for more than 70 years, through college, careers, marriages, divorces, illnesses, and for many participants, even death. The study focused on how different behaviors are linked with various outcomes in terms of health, hap

When the physician direc­tor of the Harvard Study was asked what this unique and comprehen­sive database revealed he replied, “The only thing that really matters in life are your relationships to other people.” Truly, our interpersonal relationships dwarf every other factor in our lives for predicting the quality and quantity of our life. In other words, family and friends are much, much more important to our physical and emotional well being than money or anything else. For instance, recent studies show that belonging to a social group that meets even just once a month, has the same positive effect on your sense of well-being as doubling your income.

In his brilliant new book “Stresscraft” (an e-book available on amazon.com), my good friend Frank Forencich writes about how today’s focus on the individual, rather than family, community, and tribe is unprecedented in human history. During the vast majority of human existence on Earth, people identi­fied powerfully with their “group.” Ubuntu (pronounced oo-Boon´-too) is a traditional philosophy of the Bantu tribe from southern Africa that believes a connection exists between people, and it is through this bond that we discover our iden­tity and our purpose in life.

Ubuntu holds that, “I am what I am because of who we all are.” The worldview of ubuntu speaks about belonging, about compassion, about being a valuable part of something bigger than each of us. In this way of life, when someone is degraded or hu­miliated, we are all diminished. Ac­cording to Frank, “Ubuntu is not just idealistic Afro-hippie talk. It’s solidly supported by the latest findings in social neuroscience and interperson­al neurobiology. The philosophy of ubuntu is practical, intelligent, and functional.” This attitude that we all need each other gives us resilience, strength and assurance to persevere in the face of daunting hardships. 

In Good Health,

James O'Keefe, MD

Amby Burfoot, winner of the Boston Marathon in1968 and editor-at-large for Run­ner’s World, in a recent in­terview for that magazine asked me, “So even if there are possible risks associated with marathons and other excessive endurance exercise; lots of bad things might happen to us when we get out of bed in the morning. Is this any different?”

I wrote back to Amby: Firstly, the host of bad things that can hap­pen when one gets out of bed in the morning are nothing compared to the dreadful things that tend to hap­pen to the person who stays in bed. My friend and colleague Dr. Mike Main tells his hospitalized patients, “Nearly everyone who dies in the hospital, dies while lying in bed. Don’t let this happen to you. Be ac­tive, to the extent that you are able.” The typical American sits at a desk or behind a wheel for the vast majority of his or her workday and then goes home and watches, on average, four to five hours of TV daily! Sitting and lying around are very dangerous activities.

Of all the risk factors for premature death, perhaps the most malignant is low cardio-respiratory fitness—being “out of shape.” Con­versely, a daily exercise habit is the single most powerful therapy for im­proving both the quality and quan­tity of your life (that is something that adds years to your life and life to your years). Getting just 30 minutes daily of moderate or vigorous physi­cal activity per day can cut your risk almost in about half for premature death, diabetes, Alzheimer’s disease, depression, and heart attack. People who regularly engage in physical exercise have markedly lower rates of disability, and an average life expectancy that is about seven years longer than sedentary people.

Dr. Chip Lavie, my close friend and research collaborator, and I ran together in Minnesota in rain, sleet or snow while we were training to be cardiologists at the Mayo Clinic 25 years ago. Both of us have been passionately interested in exercise, personally and profes­sionally, ever since. I continue to do a wide variety of physical activities for about an hour daily; this includes running not more than two to three miles with my two canine running partners three or four times weekly. I also swim, bike, lift weights, do yoga, skate, snowboard, hike, etc.

Research shows that the potential health benefits are not the main motivation for most regular exercisers and fitness buffs; rather, it is the mental benefits and improve­ment in their perceived quality of life. For me, vigorous exercise be­stows a state of focused relaxation, stress reduction, joy and gratitude for life - which wears off in about a day; which is why I work out at least once every 24 hours.

The last thing we want to do is give the average American another lame excuse to continue his or her favorite exercise - couch surfing while watching television. Our paper on the potential dangers of exces­sive endurance exercise is meant to shed light on a largely underappreci­ated risk of extreme exercise such as marathons, and ultra-marathons. Over years to decades, this type of prolonged strenuous running can take a toll on cardiovascular health, in essence causing premature aging, scarring, stiffening, thickening of the heart and blood vessels.

The benefits of exercise are analogous to a powerful drug; indeed, if we had a pill that does everything that exercise does, most cardiologists would go out of busi­ness. Still, like any potent drug, an ideal dose exists: enough to get the full benefit but not so much as to cause dangerous side effects. The lat­est data from our studies and others strongly suggests that the ideal dose of daily vigorous exercise is about 30 to 60 minutes. Heck, you can get the majority of improvements in cardio­vascular risk and longevity with a mere 20 to 30 minutes of walking per day. Indeed, if you do more than 60 minutes of strenuous exercise daily, you start to lose some of the health benefits seen with lesser amounts of physical activity. So ask yourself; why am I running marathons? If you are doing it for your health, you can do better by not overdoing it. I tell people who ask me about the advisability of running a marathon, “If you really want to do a marathon, go ahead and train up for it and do one…then cross it off your bucket list and get into exercise patterns that are more ideal for promoting overall health and longevity.”

If you listen closely to your body, you may feel some ill effects (such as palpitations, irregular heart­beats, chronic fatigue, and slower recovery) after overdoing exercise, especially as you get into middle age. Honestly, our own personal in­sights regarding this issue were part of the impetus that stimulated Chip and me to investigate the poten­tial downsides of chronic excessive strenuous exercise. Neither of us is any less enthusiastic about our love of daily exercise - we are just trying to be smart about doing everything we can to cross the finish line of life with a strong heart. . .at age 100. 

In Good Health

Could eating eggs regularly be as harmful to your health as smoking?! A Canadian study published online July 31, 2012 in the journal Atherosclerosis reported this finding, though I have real doubts about the validity of their conclusions. These researchers sent questionnaires to 1,200 men and women (average age about 61) who were followed regularly in a preventive heart clinic. The study showed that regular egg yolk consumption was linked with plaque progression in the carotid (neck) arteries.

Surprisingly, eating as few as three egg yolks per week seemed to predispose to an increase in plaque development. A larger and more impres­sive analysis of the egg dilemma came from the Physicians Health Study, which has been following 21,300 male doctors for 20 years. This study found that men who ate seven or more eggs per week were about 25 percent more likely to die from any cause compared to men who ate fewer than seven eggs weekly. Importantly, six or fewer eggs per week was not linked with in­creased risk of heart trouble or death. The cardiovascular risk of eating eggs seems to be higher in diabetics, probably because they are at such high risk for arterial plaque development, and thus are very sensitive to excess choles­terol in their diet.

Egg whites are a wonderfully healthy, cholesterol-free and lean source of high-quality animal protein. Eating an egg white omelet with veg­etables like tomatoes, spinach, mushrooms and onions is about as nutritious as food gets. The USDA recommends limiting cholesterol intake from diet to less than 300 mg daily. A single yolk contains about 200 mg of cholesterol. I personally don’t miss the yolks at all, but if you do, try to limit yourself to not more than three yolks per week, and look for organic eggs that are high in omega-3 fats.

Father Jim is a friend and patient who raises chickens for eggs. I buy these free-range brown eggs from him every chance I get. He treats his chick­ens as if they were his children. Just before dark, he checks to see that they are all safely nestled into their roosts for the night. He worries about owls and other predators getting his beloved hens if they are left outside when darkness falls. If any of the birds have been chased up into the tree branches, Jim (a spry 75-year-old) props a tall ladder against the tree, and climbs up to rescue the stranded birds. He gently scoops up the chicken and shoos it into the safety of its coop for the night. To my vegan friends who shun all animal products because they cannot condone eating animals raised in inhumane conditions, I direct them to an egg producer like Father Jim.

These eggs come from hens who are nurtured with tender loving care, have the run of acres of chicken paradise, and wander about during the day feeding on bugs, seeds and other natural food sources. His chickens are about as happy and healthy as birds can be, and their eggs are loaded with wholesome protein that is ideal for rebuilding the tissue that is constantly being torn down in the course of day-to-day living. By adding ideal, clean protein, like organic fresh egg whites to your diet, you improve your health in many ways. Finally, eat locally grown food whenever you can. It tends to be fresher.

 In Good Health

Turkey:
You can’t go wrong with this healthy source of lean protein.

Mixed Green Salad:
I like to mix baby greens, spinach, hearts of palm, cucumbers, tomatoes, anything to add color into a salad. Drizzle the salad with light vinaigrette (olive oil and balsalmic vinegar), sprinkle with fresh parmesan cheese and garnish with pimento.

Fruit Salad:
Another easy way to add color, not calories to your meal. Slice fresh, colorful fruits like strawberries, blueberries, grapes, pineapples, cantaloupe, even apples and bananas (the more color the better) and serve chilled.

Green Beans Almondine:
Again, simplicity is key. I simply use chicken broth in the steamer instead of water and steam green beans as usual, when done toss with Benacol and sliced almonds.

Sweet Potatoes:
My kids have never been fans of sweet potato casseroles, but baked sweet potatoes sprinkled with cinnamon is a healthy option.

Cranberries:

While festive, most cranberry sauces have far too much sugar. I recommend making your own, but only using 1/3 the sugar from the recipe on fresh cranberry packages – try adding some sliced apple to tame the tart.

Whole Grain Rolls:
We serve these warm, on the side, and not before the meal!

Pumpkin Pie:
We do serve the traditional pumpkin pie, but I use only nonfat condensed milk and a lowfat pie crust. Just remember – portion control!

Alcoholic Drinks:
For the adults, of course. With one drink per day, heart protection is highest and the risks for alcohol-related health problems are at their lowest. People who drink one or two drinks daily have a 25% to 50% lower risk of heart attack, a 40% lower risk of stroke, and about a 33% reduction in the risk of developing diabetes.

Thanksgiving and the holiday season is a time to celebrate and with food being a large part of the celebrations, remember to keep moderation in mind.

Just as important during this time is maintaining healthy numbers, be it triglyceride, cholesterol, blood pressure etc. See how to keep your health numbers in check here.

In Good Health,

Photo credit: bennthewolfe

Omega-3 fats were plentiful in our natural food chain. Countless generations before us ate a high omega-3 diet of wild game, leafy greens, nuts, and especially fish. Unfortunately modern food manufacturers have squeezed the omega-3s out of our diet and replaced them with harmful saturated and trans fats.

Salmon swimming in the frigid waters of the Arctic Ocean are perfectly soft and supple even though their body temperature is just a few degrees above freezing because the lipids in their cell membranes are mostly omega-3 fats. These fats remain liquid even down to temperatures below the freezing point of water (32 degrees Fahrenheit). Imagine you raised these fish in a warm farm pond in Florida and fed them nothing but French fries, stick margarine, doughnuts, and other foods high in trans fats. If you then transported them to the Arctic, upon release they would be transformed to the rigid consistency of a stick of margarine floating in ice water.

The melting point of trans fats and saturated fats are much higher and thus they are solid at room temperature. When you eat a diet high in these lipids your cell membranes become stiff and dysfunctional. You may not notice the hardening as dramatically as the salmon in our story because you have the advantage of being warm-blooded. But the type of fat incorporated into your cell membranes profoundly affects your tissues, especially the electrically sensitive ones like your brain, eyes, and heart. To support healthy tissues, provide them with the preferred fats to incorporate into their cell membranes.

In Good Health,

Dr. James O'Keefe

11 Tips for a Healthy Halloween:

 - Do not buy Halloween candy in advance.  The day before at the earliest to avoid temptation of eating the candy and having to buy more before Halloween comes.
 - Increase exercise the week of Halloween. Make sure you are getting plenty of lean proteins and fruits and vegetables too.
 - Fill up your kids with a healthy snack before trick-or-treating to help prevent them from gorging throughout the Halloween festivities.
 - Make sure the kids and parents walk when they go trick or treating vs. driving them around or using golf cart, etc.
 - Darker chocolate options for candy is better - more antioxidants.
 - Make sure to have a full dinner before going trick or treating.
 - Allow only a few pieces of Halloween candy to be consumed that day. Do not allow the kids to stash the candy in their rooms.
 - Get involved with a pumpkin carving party or go for an outing at a pumpkin maze. It's healthy Halloween fun for adults and kids alike.
 - Host a Halloween party. In supplement to or in lieu of trick-or-treating, try hosting a party where you control what foods are consumed. Include such healthy snacks as vegetables and dip, apples and peanut butter or even whole grain bread and lean meats for sandwiches. Not only is it a healthier option, but good way to bond with your neighbors and other parents.
 - As the night is coming to an end, watch a Halloween movie with your kids instead of allowing them to acclimate with their new found goodies which could lead to unhealthy blood sugar levels.
 - Donate the candy the next day to a local charity or church.  If you have to dump it, dump it, and don't feel guilty - after all it's your family's health we are talking about.

In Good Health,

Becky Captain, RN, FNP-C

Erectile Dysfunction (ED), the ability to retain and maintain an erection sufficient to allow sexual intercourse, has been estimated to affect, at least to some degree, about 50% of men ages 40-70 years.  ED can be a marker of vascular disease elsewhere, for example the coronary arteries.  Risk factors for ED are essentially the same as those for coronary disease:   high blood pressure, diabetes, smoking, high cholesterol, depression and known disease of the blood vessels (such as previous heart attack or stroke).

But exercise and sex, can be dangerous, as well.  They are both among the most common acute causes of heart attack and sudden cardiac death.  This is especially the case in sedentary people or “weekend warriors.”  To minimize the risk of cardiovascular problems with exercise or sex, it is best to stay fit, exercise on a regular basis, and avoid extreme physical exertion. Viagra and Levitra are both highly effective options for improving ED.  These appear to be safe drugs, especially Viagra, which has a long and reassuring track record.

It should come as no surprise now that the ways to keep your heart and love life in good shape  do overlap:  don’t smoke, keep your blood pressure, cholesterol, and weight under control, and exercise regularly.

In Good Health,

James O'Keefe, MD

As one of the most popular health supplements and one of the most extensively studied, omega-3 has benefited the lives of millions of people.  However, a new meta-analysis from Greece compiling randomized controlled studies appeared this week in The Journal of the American Medical Association and noted no significant reduction in mortality from omega-3 consumption.

Numerous major news and media outlets are interpreting these results to show that omega-3 is ineffective as a supplement without also presenting the limitations and deficiencies in the analysis itself.

The item of greatest contention for me, and some fellow physicians, was that the study actually showed a statistically significant reduction in cardiovascular mortality. In addition, borderline significant reductions were seen in all-cause mortality and sudden death. The researchers focused on the lack of statistically significant reduction in all-cause mortality, which led the media to report that omega-3 is not beneficial.  However, as noted in the illustration below, the reduction in cardiac death was significant (if the confidence interval line does not cross the 1.0 line the result is by usual standards deemed statistically significant).

Examples of the limitations in the meta-analysis:

- The dose of omega-3, specifically the beneficial DHA and EPA fats, was less than 1 gram daily, which is not optimal for conferring maximal benefits, especially for lowering triglycerides and reducing inflammation.
- Many of the studies included in this analysis did not have a long enough follow-up. The average follow-up was only 2 years when prevention studies involving heart and stroke patients typically span 5 years.
- Researchers picked twenty of the thousands of studies on this topic, as many studies vary with types of patients and the doses of fish oil studied. Omega-3 is nearing the top of the list for most studied substances in modern medicine.
- Many of the studies covered participants who were already sick, not accounting for the wide range of effects their medications could cause. Heart patients are often prescribed a multitude of drugs, from beta-blockers to diuretics, creating a significant challenge in determining omega-3 effectiveness. 
- Many of the studies didn't test to see if people were starting out with diets very low in fatty fish and therefore omega-3s. If one is consuming a high daily dose of omega-3 in his or her diet, the benefits of an omega-3 supplement for that person are likely to be less apparent or maybe even nonexistent.

The Prayer Study, conceived by friend and colleague William Harris, PhD, was a randomized, controlled trial to answer the question, “Does intercessory prayer (praying for someone else) really make a difference in making people well again?”

About 1,000 patients who were admitted to the Heart Institute’s Coronary Care Unit over a one-year period were randomly assigned to either prayer or no prayer. Those in the prayer group were prayed for individually for about twenty-eight days by groups of five volunteers. A total of seventy-five people in fifteen groups from a variety of denominations did the praying during the study. The patients were not aware of the study, nor were their doctors or other caregivers. The study was conducted silently and diligently, with the help of the chaplain’s office at Saint Luke’s Hospital in Kansas City.

At the end of the trial, those who were randomly assigned to the prayer group did significantly better and experienced 11 percent fewer adverse events and a 10 percent shorter stay in the CCU than those in the control group.

This was a scientifically sound, rigorously conducted trial that produced statistically significant benefits in favor of the people who were prayed for. The benefits might have been the result of chance alone, and other similar studies on intercessory prayer have produced mixed results. It seems unlikely that science will even definitively settle the issue of whether God answers prayer, or even exists. Nonetheless, if you find yourself beset by worries or feeling beleaguered and hopeless, try praying. It surely won’t hurt, and it very well might help. Faith may not move mountains, but it certainly can help to bolster your spirits and rally your defenses to defeat illness.

It is said that God helps those who help themselves. Perhaps the most powerful advantage that prayer confers is a sense of optimism and strength. Turning a problem over to a higher power somehow unburdens you, enabling you to effectively mobilize the forces lying within your soul. Good old-fashioned faith and state-of-the-art medicine and are not incompatible. In fact, these two different strategies are synergistic. When used in tandem they provide a formidable defense against threats to your health and well-being—yet another example of the antiaging power of taking the best from both worlds.

In Good Health,

James O'Keefe, MD

Linked to type 2 diabetes, inflammatory diseases, heart disease, Alzheimer’s dementia and more, excess abdominal (belly) fat is a health problem with which millions of Americans struggle.

Green tea is among the most commonly consumed beverages in the world, and has been found to confer many health benefits.  Two studies just published showed some impressive results regarding green tea’s ability to burn off belly fat and reduce excess weight. 

The first study was a randomized controlled trial (the gold standard for scientific studies) conducted in China and published in the Journal of Functional Foods. A total of 118 obese Chinese participants were randomized to 1 cup daily of tea that was catechin-enriched (a moderately high dose of green tea anti-oxidants were added to the tea). After 12 weeks those drinking green tea every day showed statistically significant improvements with loss of belly fat and body weight.

Catechins are flavonoid compounds that are considered potent antioxidants. Flavonoids are also found in fruits and vegetables; diets rich in these natural inflammation fighting molecules are are connected to improved heart and brain health.  Green tea and its potent anti-oxidants, when combined with exercise and a healthy diet, may aid in your efforts to burn off excess belly fat.

Another study demonstrating the potential benefits of green tea was published in the Journal of Nutrition, Health & Aging and linked green tea to not just a healthy loss of weight, but a reduction in waist circumference as well. This study focused on 45 elderly participants with metabolic syndrome, which is a pre-diabetic condition that consists of high blood pressure, increased blood sugar levels, excess waist circumference, high triglycerides and low HDL cholesterol, and people with this problem are at higher risk for heart disease.  

Half of the group was instructed to drink 3 cups of green tea a day, and the other half drank a beverage that looked and tasted like green tea but had none of its usual antioxidants.  After 60 days the researchers found a statistically significant improvement in weight for the green tea group compared to the control group.  While both groups showed improvements in body mass index and waist circumference, the control group’s results were not as significant.

The researchers stressed green tea’s polyphenol anti-oxidants as the catalyst which crank up the body’s metabolism in a safe fashion and supports the health of blood vessels, the heart and brain.  

I drink about 4 cups of green tea daily, or a take a tea supplement. I encourage you to incorporate green tea into your diet as well—it’s about the healthiest beverage on the planet in my opinion.  

In Good Health,

James and Joan O'Keefe

A study of twenty patients with mild high blood pressure who were treated with chocolate was published in the July 2005 issue of the journal Hypertension. This study reported that 100 grams (about three ounces) of dark chocolate daily for three weeks caused a twelve-point reduction in their systolic (top) blood pressure with a 13 percent drop in the bad cholesterol level. White chocolate showed no benefit in this study. Additionally, dark chocolate improved the health of the blood vessels by making the arteries more relaxed and responsive. Finally, measurement of insulin sensitivity (predisposition to diabetes) was also improved in the patients who received the dark chocolate, but not in patients who received the white chocolate.

These benefits were attributed to the presence of high levels of beneficial antiaging flavonoids in dark chocolate.

The type of chocolate makes all the difference. Milk chocolate is high in sugar and milk fat and low in antioxidants, and it will expand your waistline, not your arteries. White chocolate is not chocolate at all, and the instant cocoa mixes you find at the supermarket contain only low levels of antioxidants and may include saturated fats from palm oil. Cheaper brands of chocolate are mostly sugar and often substitute toxic hydrogenated vegetable oils for cocoa butter.

 If you want health-food grade chocolate, look for a product that is at least 60 percent cocoa solids by weight. The first ingredient in a high-quality chocolate bar should be cocoa solids, cocoa mass, cocoa, cacao, cocoa butter, or chocolate liquor.

 Baking chocolate is 100 percent cocoa and is practically inedible, and most people find chocolate bars with greater than 85 percent cocoa too bitter to enjoy. We prefer chocolate that is 70 to 75 percent cocoa and find that a small chunk (or square) can be savored for a few minutes. Good-quality dark chocolate is high in calories, so you have to limit yourself to not more than about twenty grams (two-thirds of an ounce or 100 calories) daily. Dark chocolate–covered nuts are a highly nutritious (but high-calorie) treat; limit yourself to not more than about ten per serving. 

In Good Health,

James and Joan O'Keefe

Photo credit: MarcelGermain via PhotoPin CC

Just one dose of vitamin A twice a year can reduce child mortality by 24%. Imagine, just one dose can give an at-risk, nutritionally deficient child, the chance to lead a full and nourished life. That is why for every CardioTabs Daily Multivitamin purchase we’ll donate 25 cents to Vitamin Angels, that’s all it takes to reach one child for an entire year!

At CardioTabs, we are working to curtail vitamin deficiency in America, and the rest of the world, which causes cancer, reduced immunity, heart disease and more. Healthy levels of vitamin A can drastically reduce the effects of undernutrition and malnutrition in children. Vitamin Angels’ program offers infants and children at-risk the nutrients they need to grow up healthy, bolstering their immune system and helping them lead meaningful and productive lives.

It’s a great feeling to know what an impact we are making on these children. In 2011, Vitamin Angels connected essential nutrients with 24,846,893 at-risk infants and children in 41 countries around the world, including the U.S. For 2012, our shared goal is to connect 25 million children with essential nutrients.

Be an angel and help us reach that goal!

In Good Health,
James and Joan O’Keefe

For those of us who just don’t want to look older, avoiding sun damage is the number one way to stay wrinkle-free. That means wearing your sunscreen every time you’re outdoors. The body actually makes its own vitamin D from sun exposure, but wearing sunscreen cuts vitamin D production almost entirely. So, what’s a wrinkle-phobe like me supposed to do? Take a Vitamin D supplement. I take at least 2,000 IU per day.

I’m going into this aging thing kicking and screaming. Here are 6 simple, sometimes surprising, things that you can do to make sure that you age gracefully:

1. Don’t smoke. In addition to ruining your heart and lungs and increasing your risk for almost every disease, smoking also causes nasty wrinkles and makes you look far older than your years.

2. Wear your sunscreen. 

3. Eat plenty of brightly colored fruits and vegetables. The antioxidants in fruits and vegetables fight inflammation and its aging effects. Having all of those antioxidants on board is like an internal sunscreen. It basically decreases inflammation and can help fight the inflammation caused by eating the wrong things. I eat LOTS of fruits and vegetables.

4. Avoid sugar and white flour. I avoid them like the plague! They cause inflammation that comes out in the skin in the form of wrinkles. I have a lot of really skinny friends, but I can tell in a nanosecond just by looking at their skin if they’re eating the right things. If not, they look 10 years older than they actually are. If I’m going to eat something sweet, I go with dark chocolate covered almonds—I’ll have three (you can get them at Costco). Never milk chocolate, always dark chocolate. If you’re going to do the wrong thing, remember: think of your skin, and use my 3-bite rule.

5. Water. You must drink it. Your skin LOVES to be hydrated from the inside out. You can use all of the expensive moisturizers and creams you want, but skin loves to be hydrated with water. At least 6-8 glasses a day–I don’t care how you twist it. You just have to do it!

6. Eat prunes, or dried plums (Ha ha! We all know it’s a prune, but they’re trying to improve the image and have started calling them dried plums—but, we all know a prune is a prune and it’s good for you). Really! Not only will prunes keep your digestive system running well, but they may also help keep your skin soft and supple.

In Good Health,

Joan O'Keefe, RD

Photo credit: CarbonNYC via PhotoPin CC

Important research hot off the press: a study published in the July 2012 issue of The New England Journal of Medicine found that vitamin D, when taken in higher doses- between 800 and 2000 IUs per day – substantially reduces the likelihood of broken bones in both men and women. This was a meta-analysis of 11 individual randomized controlled trials all of which focused on  the effect of vitamin D supplementation in those over age 65. Among the 31,000 seniors who were taking between 800 to 2000 IU of vitamin D, they found a 30 percent decrease in the risk of hip fractures with a significant decrease in risk of fractures of other bones as well. However, the researchers found no significant reduction in fracture risk for doses of vitamin D less than 800 IUs daily.

Based on this study and a growing body of research we recommend that you consume about 2000 IU of vitamin D3 per day. Many individuals need more than this to keep their blood levels of vitamin D in the ideal range of 40 to 60 ng/mL. Vitamin D is not only critical for bone strength - as this important new research shows, but it may also reduce risks for many of the most common serious diseases including diabetes, high blood pressure, cancer, heart disease, and autoimmune disorders. Alarmingly, vitamin D deficiency is an epidemic in America, with up to 2 out of 3 of us having suboptimal levels of this critically important compound (that is actually more of a hormone than a vitamin). Some experts been estimated that up to a third of cancer cases might be avoided if we all consumed adequate amounts of vitamin D on a daily basis.

You do not need to worry that 2,000 IU will be an excessive dose. When you go outside in a bathing suit and bask in the summer sunlight, your skin will make about 10,000 IU to 20,000 IU of vitamin D per hour with no chance of creating vitamin D toxicity. Additionally, studies indicate that vitamin D supplements at doses of up to 10,000 IU daily seem to be safe—although we don’t recommend taking these high doses unless your vitamin D blood levels are being monitored. One more point: to ensure maximal absorption, try to consume your vitamin D with a meal that contains some healthy fat like olive oil, fish oil, nuts and avocados.

For information on vitamin D and immunity support see here.

In Good Health,

James O'Keefe, MD and Joan O'Keefe, RD

Photo credit: Eduardo Amorim via photo pin cc

Even if you are not up for epic adventures into the wil­derness, make a habit of taking at least a few minutes to get outside for some nature therapy at least once or twice daily. There is virtually no weather that keeps me indoors; it’s just a matter of dressing appropriately. And here in the middle of the USA, we get a wide variety of weather during four distinctly different seasons, which I find imbues life with a reassuring natural cyclical rhythm.

Taking a brisk walk in a nearby park, or just along a tree-lined street can provide ben­efits, both immediate and long-term, to your health and happi­ness. Getting outside in any natural environment can be restorative, even if it is nothing more than small green space in the middle of an otherwise drab, bustling urban asphalt and concrete metropolis.

The key is to move your body once you find a natural sanctuary. Green exercise—walking, running, biking, swimming, gardening, stretching, etc. in an outdoor natural setting, will boost your mood and self-esteem, and, over time, can dramatically improve your physical and mental health and well being.

9 Techniques to Enhance Your Life with Green Therapy: 

• - Try to incorporate some outdoor nature time in almost every day area that has trees and grass along your route.
• 
  
• - Visit a nearby park, or any green space, during breaks in your workday, over lunch hour for example, or during coffee breaks, or immediately after finishing work.
• 
  
• - Plant a garden and nurture plants in your yard and inside your home.
• 
  
• - Take vacations to naturally beautiful locations.
• 
  
• - Take your dog outside for walks regularly.
• 
  
• - Eat outside whenever you get the chance.
• 
  
• - Sit or work by a window with a view of a natural setting whenever you get the opportunity.
• 
  
• - Instead of always meeting indoors, occasionally go for an outdoor walk with a colleague or co-worker while you discuss an issue.
• 
  
• - Make a point of appreciating and commenting upon natural splendor such as a gorgeous sunset, a majestic oak, a beautiful garden, or a brilliant moon.

In Good Health

James O'Keefe, MD

Photo credit: dhilung via photo pin cc

As part of my duties as a cardiologist, I read thousands of Cardioscans, CT scans that screen for calcified plaques in the arteries supplying the heart. While looking at the images, I often point out to the residents and cardiology fellows how some people with “hardening of the arteries” due to extensive amounts of coronary atherosclerosis have more calcium in their coronary arteries than in the bones of their spine. When you are young and healthy you have soft, supple arter­ies and sturdy, strong bones. The development of soft bones and hard arteries is an ominous sign. 

About two out of three Ameri­cans do not meet the Recommend­ed Daily Allowance for calcium, which partly explains why osteo­porosis or osteopenia (inadequate bone density) affects the majority of post-menopausal women and is increasingly common in men. For that reason, next to multivitamins, calcium pills are the most commonly consumed daily over-the-counter supplement. Unfortunately, re­cent studies suggest that calcium supplements might increase risk of heart attack in women, probably by accelerating calcified plaque build-up in your coronary arteries. On the other hand, meeting your calcium requirement by getting it from your food and beverages appears to be perfectly safe, both for your bones and your heart.

Get Calcium from Dairy and Bones; Not Pills

The traditional focus in nutrition on supplementation of single isolated nutrients may be especially mis­guided in the case of calcium. A diet supplemented with calcium, as a mono-nutrient pill, is not ideal for promot­ing bone health and may instead accelerate arterial plaque calcification and increase cardiovascular risk.

A diet rich in plants such as leafy greens, colorful vegetables and fruits will make your system less acidic, which is conducive for strong bones. However, plants are relatively poor sources of calcium compared to animal sources. Non-fat or low-fat dairy products such as skim milk and Greek yogurt are excellent sources of calcium, but many adults do not tolerate dairy due to lactase deficiency or milk allergies.

Adult human hunter-gatherers for millennia acquired most of their calcium by consuming animal bones, where it is found in a matrix of bone-building nutrients including magnesium, phosphorus, protein, and osteo­calcin. I know—eating bones during your meals is currently inconvenient and socially impolite, yet it may be a key to strong bones and soft supple arteries. Make stews using bones, letting them slow cook for hours. And if you like sardines, look for those with the skin and bones intact, packed in water with no added salt.

Consum­ing plenty of high-quality protein like egg whites, whey protein, lean red meat and fish, when combined with adequate calcium and magnesium intake and regular strength training (like weight lifting), is a sure-fire recipe for strong, sturdy bones that will hold up for a century.

In Good Health,

James O'Keefe, MD

Photo credit: Grump Puddin via photo pin cc

 A large study of women found that those who ate several servings of nuts weekly had an astound­ing 74 percent lower risk of cardiovascular disease, such as heart attack and stroke. Other studies show that regular consumption of nuts will lower your chances of developing Alzheimer’s disease, diabetes, and breast cancer.

Walnuts are highest in the beneficial omega-3 fats, and pecans are loaded with anti-oxidants. Brazil nuts are the single best dietary source of seleni­um—a powerful mineral for warding off chronic diseases like diabetes. Almonds are especially high in fiber and calcium and have been shown to lower cholesterol and blood sugar. Pistachios are rich in anti-oxidants and raise your good or “HDL” cho­lesterol, while sunflower seeds help to lower bad cholesterol. Among the nuts, chestnuts are lowest in calories and fat, yet high in fiber. Cashews are rich in copper and zinc, but not quite as healthy as other nuts. Peanuts are actually a legume not a nut, so the health benefits of peanuts do not measure up to the “tree nuts” mentioned above. Still, lightly salted pea­nuts, as an occasional snack are okay. And, peanut butter dabbed on banana slices is a favorite item on the O’Keefe breakfast menu.

Nuts are high in calories, so if you have a weight issue you need to be careful about sticking to about one serving (approximately one quarter cup) of nuts per day. However studies show that people who eat two or more servings per week actually have lower rates of obesity than those who rarely eat nuts. A serving of nuts will increase satiety for hours, pre­venting cravings for junky snacks and thus may help to prevent overeating. Shoot for about one small handful of mixed nuts daily, preferably unsalted or lightly salted. If you are an athlete and burn lots of calories by exercising vigorously, nuts are a great way to increase your intake of healthy calories.

In Good Health

James and Joan O'Keefe

The latest vitamin to flame out in a large randomized trial was vitamin E. As an essential nutrient, and antioxidant, that promotes heart and cell health, when used in low doses, a large trial found a very small, but statistically significant increased risk of prostate cancer in men who took a 400 IU vitamin E daily for 7 years.

While the study was well conducted, this prostate cancer finding was used via a reductionist approach, meaning researchers made this conclusion purely from vitamin E and its reaction with the body. When researchers combined vitamin E with selenium, the risk was reduced to a non-significant level. As a typical composite in multivitamins which include a cohort of supporting nutrients such as vitamin A, D, B, C, folic acid, zinc and more, isolating vitamin E may not be the most appropriate way to study its effects. Vitamin E reacts with other compounds producing effects dissimilar to how it singularly reacts with the body.

Although a separate supplement of vitamin E is not a good idea, the modest vitamin E amount of about 75 IU or less found in multivitamins appear to be harmless and might even provide some benefits for individuals who are not eating an ideal diet.

In most of the largest and best done trials, mega-dose vitamins in healthy populations tend to not be beneficial to health and longevity, and in some instances, may even cause harm. But here’s a key point to understand: supplementing with an essential nutrient to increase an already normal level to a super-normal (very high) level generally doesn’t provide health benefits.  On the other hand, taking a supplement to bring an abnormally low level of an essential nutrient, such as omega-3 fats or vitamin D - which most Americans are deficient in, into a normal range typically provides wide-ranging and powerful benefits to health and longevity.

I recommend that you get at least 33IU of vitamin E daily, if possible through nuts, extra virgin olive oil, avocados,  1,000 mg daily of DHA and EPA (the 2 most important omega-3 fats), and at least 2,000 IU daily of vitamin D3.

In Good Health,

James O'Keefe, MD

Photo credit: cosmo flash

In general you want to avoid multivitamins with mega-doses—these unnaturally high doses have not been shown to improve cardio health and longevity and in some cases, like high dose vitamin E (above 400 IU per day), they may be harmful. Look for a “Multi” with about 100% of the Daily Value for most of the essential vitamins and minerals.

The one exception is Vitamin D—the critically important nutrient that is in many ways more correctly labeled a hormone rather than a vitamin. Most Americans are deficient in Vitamin D, predisposing them to a host of disorders including muscle and bone weakness and pain, diabetes, obesity, high blood pressure, diabetes, heart disease, stroke and cancer.

The Daily Value for Vitamin D is just 600 IU, but most experts in the field feel that this is way too low to get most people’s vitamin D levels into the ideal ranges. Unless you live south of the latitude line extending from Atlanta to Los Angeles, and are outside for hours a day, you probably need to take at least 2,000 IU to maintain normal vitamin D levels. Ideally, look for a multivitamin that has 2,000 IU of Vitamin D3, along with about 100% of the Daily Value for the other nutrients.

Most multivitamins have more iron than you need, as the Daily Value for this nutrient is 18 mgs, which is at least twice as much iron as most men and post-menopausal women need. And this can be a problem, because excess iron can build up in your tissues and organs throughout your body, predisposing to oxidative stress—which is a scientific term for rusting from the inside out. Chronically high iron stores can cause many serious problems like premature aging, heart disease and cancer.

Bottom Line: for most people a daily multivitamin is a good strategy for improving your long-term health and vitality. Just be smart about it and look for a Multi that has what you need. Make sure that the brand you use independently tests its products to verify that what is on the label is actually in the pill; a recent report from ConsumerLab found that over 25% of multivitamin brands (including some of the most popular and widely used) contained either too much or too little of some of the ingredients listed on the label.

In Good Health

James  O'Keefe, MD

For additional information on health supplements and health supplement products see our company at cardiotabs.com

About 3 hours into the trans-Atlantic crossing, the pilot announced, in a tone that did not convey the confident reassurance that one comes to expect from an airliner captain, "We have a medical emergency, if there is a medical doctor on board, please report to the back of the plane.” Joan looked at me, raised her eyebrows and then glanced back over her shoulder.

I quickly made my way to the back of the cabin to find a very pale, cold and clammy, middle-aged man in severe distress who looked as though he was about to lose consciousness. I had him lay down on the floor immediately, and found out that he was a Dutchman named Johan who felt somewhat unwell before boarding the plane.

As we ventured out across the wide ocean, he was now clutching his belly and complaining of “the worst pain in his life”. I quickly examined him, and though I just barely touched his abdomen, he writhed in agony pushing my hands away. His belly was as tight as a drum, and as I listened with a stethoscope, I heard no bowel sounds.  Johan had an “acute abdomen”, which is a potentially life-threatening emergency, often necessitating urgent surgery. Except we were thousands of miles away from the nearest hospital, and Johan was looking “shocky”, with a pulse of 110 and a blood pressure of only 70/40.  I placed an intravenous line and administered fluids, but had no other therapies with which to treat him; specifically the emergency medical kit contained no morphine or antibiotics. I did my best to comfort Johan, but both he and I understood the unspoken reality: we were “between the Devil and deep blue sea”.

I discussed our predicament with the captain over the phone, and he explained that we could circle back to Iceland or forge ahead to the northeastern Canada, but either option was about 3 hours away. I told him that wherever we land, we would need an ambulance waiting, and a nearby hospital. A moment later, we heard the engines roar to full-throttle as the plane’s nose tipped upward—climbing to a higher altitude that would allow for faster speeds. As we hurtled towards North America Johan soldiered on, patiently and silently enduring the ordeal, as I knelt on the galley floor next to him. Though the intravenous fluids had stabilized his blood pressure the bag was nearly empty now, his pain was worsening again and now he was also developing shaking chills. The thought occurred to me that maybe this was an example of Einstein’s Theory of Relativity: the faster we flew the slower time seemed to be moving.

After what felt like an eternity, we approached our destination: Goose Bay Airport—a remote airstrip surrounded on one side by the rocky Labrador coastline, and one the other three sides by hills densely forested with tall evergreens. Blustery winds from a ‘Nor’Easter’ were howling off the Altantic Ocean, and as we circled overhead, the Captain jettisoned fuel to drop some weight from the plane to make the landing safer. Goose Bay, an airport built during World War II was never designed to accommodate a fully loaded modern jumbo-jet airliner. In fact, the runway was about 30% shorter than what was usually required for a jet of this size. The plane pitched wildly as the captain fought the cross winds and finally broke through a very low cloud ceiling, setting the 767 down hard on the tarmac, and slammed on the brakes.

We offloaded Johan by stretcher into a 1960’s vintage model ambulance, and I gave report to a local paramedic who spoke in a strange thick Scottish-sounding dialect that was barely recognizable as English. I laid one hand on Johan’s shoulder, and with the other I gently squeezed his hand and told him that he was stable and that a physician was waiting for him just up the road at an emergency room. He looked up at me as his eyes welled up and said, “Thank you doctor.” I scampered up the stairs to the plane and stood there watching the ambulance pull away, bound for the little hospital in Happy Valley; I turned to notice that the sun was already setting—at about 4 in the afternoon. After the plane was refueled and de-iced, we sat at one end of the runway, waiting for what seemed to be a very long time. When we did take off I looked down and saw the runway disappear from under our wings just a few seconds after we were airborne; I was guessing that the captain’s blood pressure at that moment was at the other end of the spectrum from Johan’s—probably about 200/100.

I heard from Johan a few days ago—he had a large kidney stone blocking the flow from one kidney, resulting in so much pain and inflammation that it also caused a bowel obstruction. After a surgical procedure he was recovering well, and was expecting to be discharged from the hospital soon. The episode reminded me how grateful I am to be in a healing profession. The opportunity to make a positive difference for a person in trouble is by far the most rewarding part of my job. A person might make a living from what they get, but I believe you make a life by what you give.

In Good Health

James H O'Keefe, MD

Your system is a machine that will run smoothly and efficiently when you feed it the fuel for which it has been designed by nature. All of the energy necessary for you to move, to think, to grow, and to stay alive comes from your metabolic engine - which resides collectively within the mitochondria - the mi­croscopic power generators, within each of your 100 trillion cells. Those little mitochondrial furnaces burn only two fuels - glucose and fatty acids, and the “smoke” that comes off from that metabolic fire needs to be tightly buffered and neutral­ized because otherwise it can cause big trouble. This metabolic smoke consists of free radicals or pro-ox­idants that, if not neutralized, will cause you to “rust from the inside out,” leading to premature aging and disease.

Just like throwing too much wood and kindling on a fire all at once will make it burn out of control causing toxic amounts of smoke to billow through the air, the “metabolic smoke” from eating a high-calorie, fast food meal will billow through your cells and pol­lute your system. After you gulp down a cheese­burger, large fries and a Coke, this massive slug of calories is digested almost immediately, leading to dramatic spikes in your blood sugar and fats.

This fuel “floods your en­gine,” causing the metabolic fires to churn out massive amounts of smoke in the form of free radicals like super-oxide anions. These toxic molecules oxidize your DNA which leads to premature aging and can­cer, and oxidize your blood choles­terol, which leads to inflammation and disease in your arteries, heart and brain. Additionally, these spikes in glucose trigger correspond­ing spikes in insulin, which directs your body to store a lot of those extra calories as belly fat; causing a downward spiral because excess abdominal fat churns out inflamma­tion and leads to hormonal disrup­tions that predispose to even higher spikes in glucose and triglycerides after eating.

Contrast that to what happens after a meal consisting of steamed broccoli, a salad of spinach and tomatoes drizzled with extra-virgin olive oil and vinegar, a modest serv­ing of lean protein (skinless chicken breast or baked fish for example), with water and/or tea for your beverage, and berries for desert. This straight-from-nature food has several advantages:

1) It is going to take much longer to eat than processed food because you are going to have to do a lot more “food-processing” (chew­ing) yourself, and an even longer time to digest.

2) The calories from this meal will trickle into your bloodstream never causing your blood glucose or blood triglyc­erides to rise above 100, and your metabolic engine will burn those calories cleanly as they arrive, rather than storing them in belly fat. 

3) Furthermore, all of those natural pigments from the colorful plants are ANTI-oxidants that will bind to and neutralize the oxidants (smoke) thrown off by your engine as it burns the glucose and fats from the meal.

In reality your body’s metabolism is mind-bogglingly complex and breathtakingly intelligent in its design and function, yet it can be simplified down to a practical take-home message: your machine will run best when you feed it only the natural fuel for which it’s de­signed. Fill the gas tank of your car with jet fuel and it will run poorly, and eventually this high-octane kerosene will ruin the engine. Eating modern, refined, processed, high-calorie foods will do the same to your body.

I cannot overemphasize the funda­mental and critical importance of this concept - if you want to stay youthful and healthy, you must avoid these post-meal spikes in glucose and fats. The 5 step strat­egy to do that will sound familiar:

1) Eat only whole, natural foods (that contain no more than one or two ingredients)

2) Balance your calories consumed with calories burned each day

3) Keep your waist size to half your height in inches

4) Exercise daily

5) Get seven to eight hours of sleep each night

In Good Health,

James O'Keefe, MD

 The article concluded that, “Among patients with new hemodialysis grafts… fish oil improved... graft patency, rates of thrombosis, and improved CV event-free survival.” This well-done study of patients with severely diseased kidneys who had recently undergone surgical placement of an arterio-venous shunt for chronic vascular access for hemodialysis found that those individuals who were randomized to high-dose Omega-3 (4 capsules) fared significantly better with reduced clotting of the new graft during follow up and a reduced chance of a cardiovascular event (such as heart attack, stroke, or cardiac death) compared to those who received a placebo.

 Omega-3 has been shown to help aid in anti-inflammatory and anti-thrombotic activities in previous studies, and this controlled, randomized double blind study involving over 200 stage 5 chronic kidney disease patients is another high-quality trial to add the already impressive body of data indicating that Omega-3 helps substantially improve long-term cardiovascular health.  

See the JAMA abstract here. 

In Good Health,

James O'Keefe, MD

Whey protein is a source of pure, natural dairy amino acids that make up about 20 percent of the protein in milk and is one of the highest quality proteins you can consume. It is found in the whitish translucent liquid that is separated from milk during the cheese-making process. If you use a clean and pure whey protein product, you will get the benefits of a high-quality protein rich in branched chain amino acids that will help you support a healthy body weight, promote a healthy immune system as well as keep you filled up.

Whey protein confers 7 distinct benefits that will support you in accomplishing your health goals.

1. Whey contains a high level of cysteine, an essential amino acid that stimulates the body’s antioxidant production and thus supports a healthy immune system.

2. Whey is an excellent source to help build muscle protein because it is uniquely rich in all the essential amino acids.

3. Whey increases satiety, thereby lowering your daily intake of calories and supporting a healthy life expectancy as well as promoting a healthy loss of weight.

4. When substituted for other protein sources, whey reduces the load of toxic pro-aging and potentially carcinogenic substances found in meat, fish, and poultry.

5. Whey protein may help with emotional stress because it is high in tryptophan—an amino acid that supports a healthy mood and sleep quality in some individuals.

6. Whey protein, when added to a high-carbohydrate meal, supports healthy blood sugar levels, as reported in the July 2005 issue of the American Journal of Clinical Nutrition.

7. The amino acids in whey protein are the building blocks your body needs, promoting skin, hair and nail health.

In Good Health,

Dr. James O'Keefe

It appears that the human genome contains only 25,000 genes, or about one third more than the lowly roundworm. Geneticists were initially surprised that something as complex as a human being could be built from such a limited blueprint. However, it is also becoming increasingly clear that gene regulation is far more important than simply the number of genes. Each gene can function in a variety of different ways depending upon how it is regulated. Perhaps the single most powerful way to regulate your genetic expression is with regular exercise.

Over half of all of your genes are modified by regular physical activity. This means when you exercise regularly you literally change your genetic makeup and favorably alter almost every aspect of your being, including your appearance, body composition, mood, memory, sleep, blood pressure, hormones, and longevity. Exercise changes your genetic function, which in turn sends chemical signals that remake you into the lean, powerful, energetic, and optimistic person you were designed to be.

Many of the cardio health problems blamed on aging are actually symptoms of deteriorating fitness and waning strength caused by idleness and apathy. Fortunately, getting back to a very physically active lifestyle will send growth and repair signals throughout your body and brain, allowing you to grow younger.

Even those of us who study physical fitness professionally have been surprised at the power of daily exercise. The fact is, it may be the single best “drug” for many health problems. It will improve cholesterol profiles by lowering the bad fats and raising the protective HDL (good cholesterol) level. Exercise will lower blood pressure and is the most effective weapon against obesity. Studies show that permanent weight loss is almost impossible without regular exercise.

With an appropriate regimen of physical activity and diet some patients with high blood pressure are able to discontinue their medications. Recent studies showed that an aerobic and strength-training exercise program, coupled with a healthy Mediterranean diet, was effective in preventing two out of three cases of diabetes.

Regular physical activity not only improves your physical strength and appearance, it also makes you feel good. A recent study tracked 174 previously sedentary men and women between the ages of sixty and seventy-five who participated in a supervised walking and stretching program. After exercising at least three times a week for six months, the participants showed significant improvements in self-esteem and reduced rates of depression. Six months after completing the program, participants who went back to a sedentary lifestyle showed deterioration in self-esteem and mood.

In Good Health,

Dr. James O'Keefe

Omega-3 fats nourish the cells of the skin, hair, nerves, brain, heart, and virtually all of the tissues and organs. You are what you eat. This overused cliché is literally true when we are talking about the type of fats we consume. The membranes of the cells throughout your body are mostly composed of lipids (fats).

Omega-3 fats were plentiful in our natural food chain. Countless generations before us ate a high omega-3 diet of wild game, leafy greens, nuts, and especially fish. Unfortunately modern food manufacturers have squeezed the omega-3s out of our diet and replaced them with harmful saturated and trans fats.

Salmon swimming in the frigid waters of the Arctic Ocean are perfectly soft and supple even though their body temperature is just a few degrees above freezing because the lipids in their cell membranes are mostly omega-3 fats. These fats remain liquid even down to temperatures below the freezing point of water (32 degrees Fahrenheit). Imagine you raised these fish in a warm farm pond in Florida and fed them nothing but French fries, stick margarine, doughnuts, and other foods high in trans fats. If you then transported them to the Arctic, upon release they would be transformed to the rigid consistency of a stick of margarine floating in ice water.

The melting point of trans fats and saturated fats are much higher and thus they are solid at room temperature. When you eat a diet high in these lipids your cell membranes become stiff and dysfunctional. You may not notice the hardening as dramatically as the salmon in our story because you have the advantage of being warm-blooded. But the type of fat incorporated into your cell membranes profoundly affects your tissues, especially the electrically sensitive ones like your brain, eyes, and heart. To support healthy tissues, provide them with the preferred fats to incorporate into their cell membranes.

In Good Health,

Dr. James O'Keefe

Just one dose of vitamin A twice a year can reduce child mortality by 24%. Imagine, just one dose can give an at-risk, nutritionally deficient child, the chance to lead a full and nourished life. That is why for every CardioTabs Daily Multivitamin purchase we’ll donate 25 cents to Vitamin Angels, that’s all it takes to reach one child for an entire year!

At CardioTabs, we are working to curtail vitamin deficiency in America, and the rest of the world, which causes cancer, reduced immunity, heart disease and more. Healthy levels of vitamin A can drastically reduce the effects of undernutrition and malnutrition in children. Vitamin Angels’ program offers infants and children at-risk the nutrients they need to grow up healthy, bolstering their immune system and helping them lead meaningful and productive lives.

It’s a great feeling to know what an impact we are making on these children. In 2011, Vitamin Angels connected essential nutrients with 24,846,893 at-risk infants and children in 41 countries around the world, including the U.S. For 2012, our shared goal is to connect 25 million children with essential nutrients.

Be an angel and help us reach that goal!

In Good Health,

James and Joan O’Keefe