Selecting safe seafood is no simple matter.  How can you get enough omega-3s without ingesting too much mercury?  What’s the difference between farm raised and wild caught?  Is foreign seafood safe for consumption?  Which types of fish are safest overall?  I was simply overwhelmed (as you may be), so I scaled the literature to catch the bottom line.

Health Benefits of Fish

Seafood is an excellent, lean source of protein and can contain high levels of heart healthy omega-3 fatty acids.  There’s no one best fish overall.

Farmed or Wild Caught?

Wild caught seafood is exactly that.  One minute, Nemo is swimming around without a care in the world and before he knows it, he’s dinner.  Wild caught fish is more expensive but often worth the price.   Farmed fish, especially from abroad, is often packed with contaminants, pesticides and antibiotics.  Fish farms can be nasty places that expose workers (and fish) to scary chemicals.

What’s the Deal with Mercury?

Technically a heavy metal, high dietary levels of mercury can build up in your system, cause memory loss and other neurologic problems.  Very large wild fish such as salmon or swordfish can contain large amounts of mercury.  Limit these varieties to once a week.

Does Country of Origin Matter?

YES!  In 2005, the FDA began requiring country of origin labeling for imported foods.  Seafood farming is big business in developing countries like Vietnam and Thailand.  You may think the US government is watching these imports closely, but it’s estimated they’re only inspecting 0.5% of all imported seafood.   Contaminants like PCBs (think rusty old refrigerators festering at the bottom of a riverbed) can be present in high levels.  Antibiotic and pesticide use is rampant and unregulated.  While imported shrimp from Vietnam may be low in price, it may have a tremendous cost to your family’s health.

The Sushi Story

Consuming uncooked seafood poses significant health risks.   Mild gastrointestinal symptoms frequently result from a sushi bender.  The good news?  You’re unlikely to eat large quantities of seafood in your tuna roll.   If you’re worried about food-borne illness, select cooked varieties like smoked salmon or shrimp.

What Should I Do?

1. Eat fish 2-3 times per week.
2. Vary the types you consume so you can avoid high levels of any one contaminant.
3. Buy wild caught fish if possible.
4. Pay attention to country of origin.  Supporting US fisherman is good for our economy and healthier overall.  Avoid fish from developing countries like Vietnam, China and Taiwan.
5. When eating out, ask the chef for details about the fish.  In more expensive restaurants, chefs often personally select their fish.  Steer clear of seafood at chain restaurants like Long John Silver’s or Appleby’s; these low priced items are poor choices.
6. Make informed choices at the grocery.  Most fish has been frozen (often within minutes of being caught) and then defrosted in your local market.  Be sure to ask about country of origin and to pack your selection on ice.

Best Bets from the United States

Are you regular?  Do you fit within the definition of normal bowel health?  You might be surprised to learn that daily bowel movements aren’t the norm!  Adult males should have 3-4 BMs per week and women 2-3.  I see patients every single day who struggle with chronic constipation.  If you have lifelong constipation, you’re at increased risk of bloating, hemorrhoids and diverticular disease.  Here’s my advice for keeping things moving along.

Drink More Liquid

Any liquid will do.  Don’t let yourself become dehydrated; the more fluid your bowel gets, the softer your stool will be.  To figure out how many ounces per day you need, divide your body weight in pounds by 2.

Increase Fiber Intake

The average American eats less than 10 grams of fiber per day.  The daily goal for bowel health is 25-35 grams.  Fiber rich food pulls water into the intestine and bulks up the stool, allowing for softer, more frequent passage.    Gradually increase your fiber intake over 2-3 weeks

GOOD CHOICE: Bran

Wheat bran, oat bran and rye bran are excellent sources of fiber.  As it turns out my mother was right on this one! Find bran in breakfast cereals or sprinkle it on top of yogurt.  The coarser the grind, the better it works.

GOOD CHOICE: Beans

All beans contain fiber and are good sources of protein.  Some can cause gas.

GOOD CHOICE: Fruits with Skins

Fruits are a sweet, delicious, simple way to increase your fiber intake.

BAD CHOICE: White Fiber

“High Fiber” processed foods (bars, cereals, cookies) are a terrible idea.  Food manufacturers add naturally occurring fibers such as inulin or pectin in order to amp up the nutritional content.  THIS IS USELESS.  It won’t help constipation and causes gas in everyone.

BAD CHOICE: Sugar Alcohols

Processed foods often contain low-calorie sweeteners such as maltitol, lactitol and sorbitol   They cause gas and may have a mild laxative effect.  Curiously, prunes naturally contain sorbitol, which explains why they work for constipation (but also cause gas).

The BOTTOM Line

Are doing enough to keep your bowels in tip top shape?  Know what’s normal for your body and pay attention if you have a change in color, caliber or frequency of your bowel movements.  Call a doctor right away if you see blood in your stool.  Drink plenty of fluids and gradually increase bran, beans and fruit into your diet.

Perhaps it’s my penchant for chaos, or maybe I’m simply a masochist. I am adamant that we eat as a family every night.  If you regularly read my blog, you’ve  heard about my persnickety children and picky husband (who tells the kids he’s allergic to strawberries and spinach (he’s not)).  My kids burped, farted, gagged and hollered.  It wasn’t dinnertime bliss at the Frank household; it was WAR.

I like control and I like organization.  So, I got to thinking: if everyone is clear on the rules, no one would piss me off.  Then I could enjoy my gourmet fare in peace.

    Family Dinner Rules

Sit Down & Stay Seated

Everyone Tries Everything

One Meal. No Substitutions.

Everyone Helps Set Up.  Everyone Helps Clean Up.

Water Only.  Adults Have a Few Other Choices.

Be Respectful & Don’t Interrupt

 No Phones

Feel free to borrow the list or make a new one for yourself.  But make the effort to eat at home with your clan.  Families that eat together are better connected, healthier and happier.

The Bayer Company tells us to “Take it for pain.  Take it for life.” Unfortunately, the decision to take Aspirin is not that simple.  Salicylates, discovered by the ancient Greeks, were originally derived from the bark of the willow tree and found to reduce fever.  In 1900, the Bayer Company began manufacturing Aspirin (also known as Acetylsalicylic Acid, or ASA).  A century later, we’re still discovering Aspirin’s amazing powers.

Aspirin Can:

1. Reduce fever
2. Relieve pain
3. Thin the blood, reducing risk of stroke and heart attack
4. Limit the damage from a heart attack
5. Reduce inflammation
6. Prevent colitis flares

 The Dangers Of Aspirin Are:

1. Bleeding and Bruising
2. Gastritis (stomach irritation) and Ulcer
3. Allergy
4. Tinnitus (ringing in the ears)
5. Reyes Syndrome in children

Aspirin irreversibly impairs platelet function, slowing your ability to clot, thus preventing heart attack and stroke.  It can thin the blood in as little as five minutes.  On the flip side, it takes two weeks for your clotting to normalize after stopping Aspirin.

In addition, Aspirin decreases inflammation and fever by blocking prostaglandin synthesis.  Prostaglandin is important in protecting the stomach lining from acid.  As many as 2 million Americans have gastritis each year, many of whom take aspirin or similar anti-inflammatory medications called NSAIDs.  The gastrointestinal and bleeding risks of Aspirin are cumulative when it is taken with similar drugs.

Aspirin Is Risky If Taken With:

• Any blood thinners (warfarin, plavix, etc.)
• Any anti-inflammatories (ibuprofen, naproxen, etc.)
• Ginkgo Biloba (often used for memory)
• Evening Primrose Oil (often used for hot flashes)
• Fish Oil (often used to lower cardiac risk)

When Should A Healthy Person Take Daily Aspirin?

If you have multiple cardiac risk factors or have had a stroke or heart attack, you should take a daily anti-platelet drug.  See your doctor and make certain you’re taking appropriate precautions.

Which One and How Much?

For prevention, I recommend 81 mg of Aspirin daily.  This dose sufficiently thins the blood with limited risk of hemorrhage and ulcer.  Any generic Aspirin is fine.  And don’t bother with enteric-coated aspirin. The local effect of aspirin on the stomach lining is inconsequential. The effects of aspirin occur after it’s absorbed, well beyond the limits of the coating itself.

When it comes to balancing risks and benefits of a potentially dangerous drug, prevention is a tricky game.  Listen to your physician, be sure to make healthy eating a priority, quit smoking, and exercise regularly.   Taking a daily Aspirin is only one facet of your prevention strategy.

Here are my must-haves, in no particular order.  If you must buy something immediately, the links are provided!

1.    Stick Blender with Chopping Attachment

http://www.amazon.com/Cuisinart-CSB-77-Blender-Chopper-Attachments/dp/B0006G3JRO

2.    Rubber Spatula (heat resistant)

http://www.target.com/p/Michael-Graves-orange-Silicone-Spatula/-/A-13306498#?lnk=sc_qi_detailbutton

3.    Chef’s Knife (no dishwasher!)

http://www.amazon.com/Henckels-International-Forged-Synergy-8-Inch/dp/B000FMVS4A/ref=sr_1_10?s=home-garden&ie=UTF8&qid=1328289917&sr=1-10

4.    Cooking Thermometer

http://www.amazon.com/Taylor-9842-Commercial-Waterproof-Thermometer/dp/B00009WE45/ref=sr_1_4?s=home-garden&ie=UTF8&qid=1328289969&sr=1-4

5.    Rimmed Baking Sheet (Half-Sheet Size, not nonstick)

http://www.amazon.com/Sheet-Pan-Half-Size-Heavy/dp/B0001MS3P6/ref=sr_1_6?ie=UTF8&qid=1328560434&sr=8-6 

6.    Plastic Cutting Board

http://www.amazon.com/Architec-Gripper-Cutting-Board-14-Inch/dp/B002C1AVKE/ref=sr_1_24?s=home-garden&ie=UTF8&qid=1328290140&sr=1-24

7.    Fine Mesh Strainer

http://www.amazon.com/HIC-Brands-that-Cook-Essentials/dp/B00428M7HK/ref=sr_1_11?s=home-garden&ie=UTF8&qid=1328290220&sr=1-11

8.    Glass Mixing Bowls

http://www.amazon.com/Pyrex-Prepware-3-Piece-Mixing-Clear/dp/B00004SZ7H/ref=sr_1_1?s=home-garden&ie=UTF8&qid=1328290292&sr=1-1

9.    BPA Free Food Storage Containers

http://www.amazon.com/Snapware-Airtight-Plastic-Storage-Container/dp/B003TYJUA0/ref=sr_1_2?s=home-garden&ie=UTF8&qid=1328290330&sr=1-2

10. Measuring Cups (liquid and dry) and Measuring Spoons

11. High Quality Pots and Pans (nonstick ok)

http://www.amazon.com/Anolon-Advanced-Anodized-Nonstick-11-Piece/dp/B004GUTTK2/ref=sr_1_1?s=home-garden&ie=UTF8&qid=1328290525&sr=1-1

I’m taking aim at talk show nutrition experts who instruct we overfed, oversated and overweight Americans to avoid getting hungry.

Hunger is not your enemy.

From infancy, we are browbeaten into tuning out our body’s innate signals.  “Get that baby on a schedule!”  Who does this serve, really?  The exhausted mother, that’s who.  We starve our offspring to stretch out their wail-free periods in order to catch a few extra winks of sleep.  Then we wake them up and cram an unwanted bottle of formula (think about that term for a minute…formula for what?) down their gullets.  Hungry?  It’s not time to eat yet.  Sleepy?  Eat now so Mama can get some rest.

These early lessons might impact a person’s ability to recognize and act upon signals of hunger and satiety.   So, maybe it’s not entirely your fault that you overeat!  Go ahead and blame your parents for this, as well as your mullet in sixth grade.  Your Mom is used to taking responsibility for your shortcomings!

You’re an adult.  Now you’re responsible for when, what and how much you eat.

Tired?  Drink a Red Bull.  Can’t sleep?  Have an Ambien.  Sad?  Here’s a Prozac.   Have heartburn?  Get rid of stomach acid with a pill.  Dehydration headache?  Take Advil instead of drinking water.   We (myself included) are dumbed down and over-medicated, trudging through life inert to the clues our bodies give us. 

Time to tune in.

1. Eat when you’re hungry.  Don’t eat to prevent hunger later.  That’s just stupid.  Here’s a radical thought: skip breakfast!  I don’t give a rats ass about the “studies” every nutrition guru quotes.  If you’re not hungry, maybe you don’t need to eat.
2. Eat natural foods.  Recognize that all the artificial crap you’re putting into your body messes with your tastes.  McDonald’s added French Fry Flavor makes it really hard to enjoy homemade baked fries.  Splenda is thousands of times sweeter than sugar.  Instead of artificial everything, reconnect with the glory of a ripe peach.
3. Listen to cravings.  You’re unlikely to crave cauliflower, but perhaps the antioxidants in dark chocolate will be modestly beneficial!
4. Pay attention during meals.  We talk, booze it up, sit in the dark, rush or drive while we’re eating.  Stop this.
5. Full means stop.  We all know what it feels like to be overstuffed.  If you’re pants pinch, you’ve gone too far.
6. Plan ahead.  Don’t let yourself get into a desperate drive-thru situation.  You know you’re eventually going to need sustenance, so be prepared.

I’m sick of so-called nutrition experts that advocate preemptive eating.  They’re afraid that if you become ravenously hungry, you’re apt to eat a King Size Milky Way and an entire Sara Lee coffee cake.  But you’re not out of control and you have the ability to make good decisions.  Even if you eat the prescribed oatmeal for breakfast, what’s to stop you from raiding the vending machine mid afternoon?  If you routinely ignore hunger, how can you know how it really feels?

I’ll admit, I’m as guilty as you.  I’m addicted to coffee, take prescription medications, and often ignore my internal cues.  Unfortunately, the quick, easy solution to the problem isn’t always best.  Start tuning in and acting on your body’s signals.  They’re there if you listen.

In general, I’m a terrible listener.  But something miraculous happens when I step into a room with a patient.  I pay attention.  Not the kind of foot tapping, doorknob holding, thirty-second care some doctors provide, but the real, undivided kind.  I love sitting in the room with patients (most of the time), really want to get to know them as human beings, and learn what makes them tick.

Sometimes, though, I’d like to call “BULLS—“.  Patients, I am on to your shenanigans!  As a public service and a source of humor, I thought it would be a good idea to share some (very) common misrepresentations.

1. My temperature runs low.
2. I’m pretty sure I’m not pregnant.
3. I only drink one case of beer per day.
4. I quit smoking for good.  Yesterday.
5. I can quit any time I want.
6. I was completely awake during my surgery.
7. I’m allergic to every antibiotic.
8. I don’t know why I’m overweight.  I don’t eat very much at all.
9. (Regarding a healthy diet) I know exactly what to do.
10.  I don’t exercise, but I am really active.
11. I’ll schedule my colonoscopy soon.
12. Oh, and doctor, one more thing…I accidentally spilled my Vicodin down the drain.

Rather than confront patients, I usually nod sympathetically.  We doctors have neither the time nor energy to ferret out your fabrications, so TELL US THE TRUTH!  We’re not the enemy!  Our only mission is to help you lead healthier lives.  So, here are some tips to improve communication:

• Tell the truth.  We’re not going to get mad if you stopped your Zocor.
• If you don’t like a plan, tell us up front.  We’ll work with you to find another way.
• We’re concerned about prescription costs too.  It’s ok to ask about alternatives!
• Tell us about your bad habits.  We understand…we have them too!

You comprise a full 50% of the doctor-patient relationship.  Honesty and trust are paramount to its success.   And if someone happens to swipe your Vicodin, you’re out of luck.