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Get answers to your most important nutritional and fitness related questions with the help of;

Thomas Sbarra, M.D.,F.A.C.C.,F.A.H.A, Cardiologist
Wellness Program Director


Valerie Shor Oppenheim, R.D.,LNC
Integrative Nutrition Consultant

Email your questions to

Cholesterol Guru saved us....
It seems almost unbelieveable that barely 25 years ago there was still controversy raging in the medical literature about whether cholesterol played a central role in the development of heart disease. The first attempt to summarize where the science stood was the Consensus Conference on Lowering Blood cholesterol to Prevent Heart Disease in 1984. One of the chief architects was Basil Rifkin, the head of the National Institutes of Health, division of Atherogenesis who passed away this week at 73. Dr Rifkin and his pals were the first to take a stand and declare that the total evidence from a bunch of small studies and population surveys showed that high cholesterol levels were killing our people in increasing numbers. They also made the important statement that we should attempt to reduce the level of cholesterol in the blood of all Americans because even average levels in this country were way too high by historic standards. For instance they were less than half as high in Asian countries with mostly fish and vegetable based diets where heart disease was almost unheard of. They further called, rather cautiously for treating those with levels above 240 with diet and in some cases niacin and cholestyramine, the only drugs available at the time (this was some 5 years before the availability of the first statin drug).

It was a bold move at the time and was welcomed by those of us who needed support to get people to change their carnivorous and sedentary habits. We have learned a lot since then, not the least of which is that very low cholesterol levels are achievable with modern drug therapy and lifestyle change and can dramatically reduce risk of heart attack and stroke by as much as 90%!! Dr. Rifkin and the NIH deserve a lot of credit for saving a lot of us from ourselves.

Is fish oil just fishy business?
Are we being scammed again by companies trying to sell us another supplement or is fish oil better than snake oil?

It has been known for years that communities that eat fish as their primary protein source have low levels of heart disease. The problem with that kind of information is that Eskimos do a lot of other things that Cape Codders don't do and their lifestyles may be as  or more important than the fish. Recently however, several studies have shown that fish consumption in western cultures reduces risk of heart disease and stroke and that fish oil supplementation has similar effects. The American Heart Association in 2002 suggested that those with heart disease or at risk of heart disease (smokers, diabetics, those with high cholesterol and especially high triglycerides) either eat fish twice a week or take supplements. 

What about mercury and PCB's in the fish or in the fish oil? 

Pregnant women are most sensitive to these toxins but they aren't at high risk of heart disease and shouldn't be reading this.  The rest of us, beyond reproductive age for all intents and purposes might consider these suggestions.  Fish of almost any sort probably won't harm you if eaten twice a week. Despite what some of the manufacturers try to tell you, that their supplement is the only safe one, virtually all of the commercially available supplements have been scrubbed of mercury and PCB's, in part because of regulation and because removing them is fairly easy. You should be able to get supplements from many sources for around $6 a month or less. You need to take 1000-1200mg of a combination of two omega 3 fatty acids (the active ingredients) DHA and EPA. This usually requires swallowing 2 or 3 soft gel capsules about as big as jelly beans a day.

Come to the Barnstable County Fair where you can hear me talk about this and other heart matters at the community services tent on Fridays and Sunday at noon. Visit our booth there anytime for a load of heart related information and an informal chat with me or one of our knowledgeable staff.

Q: I hear nuts are so good for you but they are so high in fat. What is a good portion size?

Nuts are indeed a healthy choice since they provide the "heart healthy" monounsaturated fats, fiber, vitamin E, small amounts of protein and many minerals.

They make a good snack choice since they are portable, can be purchased dry roasted or raw and do not need refrigeration - BUT portioning is the key. Depending on the processing and the specific nut, the calories will vary, but a good portion is between ¼ and 1/3 cup which can be pre- measured into a zip lock bag. Add fruit and you will have a satisfying, blood sugar stabilizing snack. Nuts are also greats in vegetable, meat or fruit salads, yogurt, cereals, trail mix (of course), stir-frys, stews and desserts.  Avoid the open can of nuts in front of the T.V. when portioning can be a challenge. Go Nuts!

Q:  Why Should I get out of bed and exercise?

A:  The short answer is because it will save your life as you know it.  

Exercise will keep you from becoming a decrepit geezer at 70 and keep you functioning well into your mid 80’s. That extra 15 or 20 years of vitality, a quarter of your entire life,  is worth the price of getting up every day and exercising, well worth it.

We have been programmed for the last 3,000 million years or so to exercise every day or to hibernate. Only in the last 100 years have any but the ultra elite been able to avoid physical work and still survive. This amount of time is not even a blip on the evolutionary timeline and we have not adapted well. The result is that 70% of the diseases that ravage us after age 50 occur from poor nutrition (mostly ‘excess nutrition’) and lack of physical activity. We can eliminate all of the misery associated with those lifestyle related diseases by sensible eating and exercise. Start with no junk food and 20 minutes six days a week of enough exercise to make you sweaty and breathless.

Stick around to enjoy your retirement, really enjoy it with a sense of vibrancy and health that will energize you every day and enable you to leave your younger colleagues in your wake not at your wake.

Q: As summer arrives, so do food challenges with frequent parties, holidays, eating out, travel, boating, family and guests (fried seafood, ice cream, hot dogs, potato salad, eating out, alcohol, etc.) How can I avoid sabotaging my renewed efforts to eat healthfully while not feeling deprived?

A: Eliminate an "all or nothing", "good food-bad food" mindset. There are temptations and challenges all year round, everywhere you go. Be proactive by creating the food environment and choices that support your goals. Detach from external eating cues and what everyone else is doing and experiment with the following modifications to develop the diet that works for you. Chances are very good that your family and friends could improve their diet as well.

                          5 Ways to Fix the Food Challenge

  • 1. Eliminate- (chips, sweetened beverages, dips- food not really important to you)
  • 2. Decrease the Portion- split orders, doggie bags, at home : ½ plate veggies, ¼ lean protein, ¼ whole grains
  • 3. Decrease the Frequency- fried clams only once a month instead of weekly
  • 4. Substitute- for a healthier version or different choice altogether (Healthy Choice hot dogs have only 1 gm vs 13 +gms of fat for others). Read labels.
  • 5. Modify the recipe-between the internet and cookbooks, there are zillions of resources for trimming the calories off your favorite foods:

Last updated: March 20, 2013

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