Image: Salmon
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Salmon is packed with heart-protective omega-3 fats and contains low levels of mercury.
updated 9/18/2009 8:11:25 AM ET 2009-09-18T12:11:25

Before she orders fish at a restaurant, Linda Becker grills the waiter like a detective. “This isn’t farmed salmon, is it?” she’ll ask. Once she ascertains that it’s not — she refuses to eat fish that she believes swim with antibiotics, pesticides, and feces — she practically asks for the salmon’s pedigree and personnel file. Then, Becker, a 53-year-old equestrian and mother of one from Frederick, Maryland, will make her menu choice. And in the end, it will probably be the organic chicken. Becker admits that she’s a little food phobic, but with good reason. As a breast cancer survivor, she’s trying to avoid exposure to environmental chemicals.

The rest of us may not have the same excuse for our picky eating. We’re all a little food nutty, and our phobias could be affecting our health.

Blame the headlines. Soy was a wonder food last year; this year it does bubkes for you and may even cause harm. A daily glass of wine protects your heart but ups your breast cancer risk. Some experts say they’re seeing more and more people blacklisting foods with bad reputations.

“People are nutritionally traumatized,” says Lisa Dorfman, RD, a dietitian and psychotherapist in Miami. “There are just so many red and orange food alerts that you can handle before you go numb. We’ve had it.”

The truth is, some people with special risks do need to be cautious about their intake of “scary” foods such as fish, coffee, eggs, wine, and soy. The rest of us are just depriving ourselves of their significant health benefits — from reducing the odds of cardiovascular disease and cancer to preventing blindness. Here’s how to get over it.

Fear factor: pollution
Fish — or cut bait?

The good: Scientists and environmentalists agree on this: “You shouldn’t give up fish,” says Tim Fitzgerald, a researcher with Environmental Defense, which has produced a suitable-for-refrigerator posting report on seafood ( called “How Many Meals of This Fish Can I Safely Eat per Month?”

The consensus is that fish is the best source of animal protein you can get, and it is relatively low in fat. Many species pack heart-protective omega-3 fats, and those that don’t “are still better than eating a cheeseburger,” Fitzgerald says. In Harvard’s Nurses’ Health Study, which has been following more than 80,000 women for nearly 3 decades, those who ate two to four fish meals a week lowered their heart disease risk by 30 percent and stroke risk by 27 percent.

The bad: Much of the fish on American tables is contaminated with mercury, a neurotoxin that can cause brain damage, and, to a lesser extent, polychlorinated biphenyls (PCBs), industrial pollutants linked to cancer. Children, women in their childbearing years, and those who are pregnant or nursing are considered high risk and need to restrict their intake of high-mercury fish because the heavy metal can interfere with youngsters’ brain development.

Studies have found that mercury exposure even before birth can lead to deficits in language, attention, motor skills, and memory in children. Likewise, PCB-laden fish pose a risk to the tiniest bodies: In studies, children who had been exposed in the womb had persistent deficits in both motor skills and short-term memory.

The bottom line: If you don’t fall into a high-risk category, eating fish twice a week is good for you. But don’t eat the same fish twice in one week, and restrict highly polluted species you love (such as swordfish) to an occasional meal.

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“Having a variety means you’re not going to miss any of the important nutrients, but you’re not likely to get too much of something that’s bad,” says Walter Willett, MD, Fredrick John Stare professor of epidemiology and nutrition at Harvard School of Public Health and one of the leaders of the Nurses’ Health Study.

If you are at risk, the EPA recommends that you pass up the fish that top its “most contaminated” list: shark, swordfish, tilefish, and king mackerel. Get your two servings a week (up to 12 ounces) by eating low mercury seafood such as shrimp, canned light tuna, salmon, pollock, and catfish. (Albacore, or white tuna, has more mercury than light tuna, so limit yourself to 6 ounces a week.) For types of PCB-contaminated fish to avoid, check state advisories at

Fear factor: cholesterol
Eggs — incredible, but edible?

The good: There’s substantial evidence that for most people, eggs are not only harmless but healthy. “Eggs have good-quality protein with the essential amino acids; choline, which might play a role in preventing memory loss; and lutein and zeaxanthin, carotenoids that protect the eyes against cataracts and macular degeneration,” says Maria Luz Fernandez, PhD, a professor of nutritional sciences at the University of Connecticut.

In Dr. Fernandez’s study of 45 healthy men and women ages 60 and older, those who ate as many as three eggs a day didn’t raise their heart disease risk at all. After a month, 70 percent had little or no change in their cholesterol. About 30 percent saw an increase in cholesterol, but the good cholesterol (HDL) rose in proportion to the bad (LDL). And that’s good.

The bad: The signature happy-face meal of childhood — two eggs, sunny-side up, and a grin of bacon strips — is now just a memory that makes us nostalgic for the days when we could eat anything and our knees didn’t crackle like Rice Krispies. Today, the average American still eats eggs but fewer than five a week. The reason? Cholesterol. One egg yolk packs close to the daily cholesterol limit of 300 milligrams that the American Heart Association (AHA) says we should observe to avoid cardiovascular disease. You can safely have an egg a day as long as you watch your cholesterol intake from other foods (such as shrimp or pastries containing eggs). But the AHA suggests that people with heart disease or significant cardiovascular risk factors limit cholesterol to 200 milligrams a day. (One small egg has 157 milligrams; one medium, 187 milligrams.) You may be genetically predisposed to absorb more cholesterol from food.

The bottom line: Follow the AHA’s one-a-day guideline — unless you have diabetes. A Harvard study found that men and women with diabetes who ate an egg a day had 1 1⁄2 to 2 times the risk of developing heart disease as those who ate up to one per week. If you’re otherwise healthy, go ahead and order the omelet, which Dr. Fernandez’s research suggests might even help your heart. But just to make sure you’re staying healthy, schedule a cholesterol test in 2 or 3 months. If the results show you’re okay, go for it.

Fear factor: cancer
Soy — the has-bean?

The good: Soy’s days as a wonder food seem to be over, but don’t spit out that edamame just yet. On the positive side, two studies supporting soy were published 2 months after the AHA questioned soy’s cholesterol-lowering claims. One found it modestly protective against breast cancer. The other noted a cardiovascular benefit to a specific group: postmenopausal women with low estrogen and suspected heart disease whose blood chemistry made them receptive to plant estrogens from soy.

“Soy is generally very good,” agrees Frank Sacks, MD, a professor of cardiovascular disease prevention at Harvard School of Public Health who served on the AHA soy advisory panel. “There are a lot of other reasons to eat tofu and soy burgers: They contain polyunsaturated fats, are a good source of fiber, and have other vitamins. They’re a healthy substitute for saturated fats. People just shouldn’t expect them to be of any special benefit.”

The bad: Everything that was so right about soy — its ability to curb heart disease, osteoporosis, and hot flashes — seems to be wrong. Last winter, the AHA released a report by a panel of experts saying there was little or no evidence that soy independently lowers the risk of heart disease. Although promoted as a cholesterol reducer, soy only knocks down harmful blood fats by about 3 percent. “If you came to your doctor with a cholesterol level of 250 and you’d lowered it by 3 percent, he’d say, ‘Time for a statin,’” concedes Mark Messina, PhD, a soy researcher and consultant for the soy industry. The committee also cast doubt on soy’s ability to quench hot flashes and slow bone loss.

The jury isn’t in yet on whether soy, which is mildly estrogenic, may fuel estrogen-positive breast cancer. “But if you’re on medications like tamoxifen and aromatase inhibitor drugs, you may want to err on the side of caution and stay away from it,” says Karen Collins, RD, nutrition consultant for the American Institute for Cancer Research.

The bottom line: If you’ve had breast cancer but aren’t taking estrogen-curbing drugs, eat tempeh without fear. But everyone should stick to soy foods and stay far away from processed foods with added isoflavones, the plant hormones in the bean. “It’s one thing to eat tofu and another thing entirely to take supplements,” says Dr. Sacks. “We don’t really know enough about isoflavones and how estrogenic they are, so we’re concerned about people getting excessive amounts.”

Fear factor: heart attack
Coffee — serious perks?

The good: More than 2 decades of research has failed to find much wrong with drinking caffeinated coffee other than a potential for java jitters. “The major conclusion we’ve made is that it’s remarkably safe,” says Dr. Willett. Recent preliminary research suggests that coffee protects against cirrhosis of the liver and even, yes, diabetes. And coffee seems to be the most common source of antioxidants in the American diet. (Coffee is, after all, a bean.) In studies, it has lowered the risk of type 2 diabetes, liver cancer, gallstones, and even breast cancer in the particularly vulnerable: women with the BRCA1 or BRCA2 genes.

There’s also evidence that coffee increases alertness, improves athletic performance, and may preserve memory. “One study showed that elderly women who drank coffee over their lifetime tended to have better memory than those who did not,” says Michael P. McDonald, PhD, an assistant professor of pharmacology at Vanderbilt University who is an investigator at its Institute for Coffee Studies.

Coffee may even boost your mood. Vanderbilt is launching a study to find out just how much it perks us up.

Caffeine does raise blood pressure. But the Nurses’ Health Study and the later NHS II found no connection between total of more than 155,000 women.

The bad: You may want to give up coffee if you’re pregnant (some equivocal evidence suggests that caffeine may trigger miscarriage), have trouble sleeping (caffeine is a stimulant), or have heartburn or gastroesophageal reflux disease (“Caffeine loosens the valve at the end of the esophagus and can allow for the backwash of stomach acid,” explains gastroenterologist David H. Robbins, MD, of Beth Israel Medical Center in New York City). And there’s the latest caffeine jolt: A recent University of Toronto study found that people with a genetic variant that makes caffeine linger in their bodies — an estimated half of the population — were 36 percent more likely to have a heart attack if they drank 2 or 3 cups a day. That figure went up to 64 percent if they had 4 or more. “My wife told me I ruined a lot of people’s morning,” confesses study author Ahmed El-Sohemy, PhD, Canada research chair in nutrigenomics.

But there’s some good news along with the bad. In Dr. El-Sohemy’s study, even genetically vulnerable people who had just 1 cup every day weren’t at any greater risk of heart attack than those who didn’t drink joe.

The bottom line: If you love coffee, don’t give it up for health reasons, unless you drink so much you register on the Richter scale. Most experts recommend that you limit yourself to 4 cups a day. If you’re concerned that you may carry the problematic caffeine gene (there’s no test yet), stick to 1 cup. But make sure what you’re drinking is really a cup.

“A cup is 8 ounces of drip coffee, regular ground,” says Dr. McDonald. “People who go to Starbucks experience the supersize phenomenon: If it only costs you 50 cents more to go from 8 to 16 ounces, you think, ‘Why not?’ But that’s 2 cups.”

However, if you have heart disease, drink only filtered coffee and avoid that double shot of espresso or coffee made in a plunge pot. “There is some suggestion that if coffee’s not filtered, it can raise cholesterol levels and slightly increase heart disease risk,” says Dr. Willett. “Apparently, the cholesterol raising factors are caught by the filters.”

Fear factor: cancer
Red wine — the tangled vine?

The good: There’s increasing evidence that alcohol — and red wine in particular — may offer generous health benefits for heart and mind. Studies suggest that drinking moderate amounts daily — one or two servings, comprising 5 ounces of wine, 12 ounces of beer, or 1.5 ounces of 80- proof liquor — may lower heart disease risk by as much as 40 percent, possibly by boosting levels of good cholesterol and suppressing clot formation. In the Nurses’ Health Study, women who had one drink a day reduced their odds of cognitive decline as they grew older — and their risk was 20 percent lower than the teetotalers in the group.

The bad: Although early studies hint that a compound called resveratrol in grapes might inhibit tumor growth, alcohol itself has been linked to a variety of cancers, and multiple studies over the past 2 decades have found it may contribute to about 2 percent of all breast cancers diagnosed in the United States. Worse, the risk starts rising at less than half a glass of alcohol a day. Experts also point out that alcoholism has a strong genetic link. “If many of your immediate family members have a drinking problem, it’s probably not a good habit to adopt,” says Cindy Moore, RD, director of nutrition therapy at the Cleveland Clinic.

The bottom line: Most people can have an alcoholic drink a day without fear, experts say. For women who have or are at high risk of breast cancer, however, there’s some danger in imbibing.

“Though the relationship between alcohol and breast cancer is real, it’s not a powerful one,” explains Dr. Willett. “It’s not like smoking and lung cancer, where you could have a 2,000-fold increase in risk. At one drink a day, your risk is 10 percent higher than that of someone who doesn’t drink. At two drinks a day, it’s 20 percent higher. But the good news is that folic acid can mitigate the excess risk.” A 400-microgram supplement could allow you to have that glass a day again.

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