Today I read a story about a woman at the center of a controversial legal battle in Italy.

Eluana Englaro had been in a vegetative state since she was in a car accident 17 years ago. The media was calling Englaro “the Terri Schiavo of Italy,” because her case was similar to woman here in the United States. (Schiavo’s husband as legal guardian, wanted his wife’s feeding tube removed, but Schiavo’s parents fought their son-in-law for years to keep the tube in place).

Englaro’s father fought the Italian courts to remove his daughter’s feeding tube, which kept his daughter alive, saying it was not his daughter’s wish to be kept alive “artificially.”

This case sparked heated debate between parts of the Italian government and the Catholic Church, who likened the removal of the feeding tube to euthanasia, which is illegal in Italy. And the legal battle that ensued brought to light the ethical issues surrounding euthanasia and the right-to-die, as well as the legality of living wills.

This case sparked heated debate between parts of the Italian government and the Catholic Church who likened the removal of the feeding tube to euthanasia, which is illegal in Italy. And the legal battle that ensued brought to light the ethical issues surrounding euthanasia and the right-to-die, as well as the legality of living wills.

Unfortunately, the woman died before any of these legal issues were resolved, and I’m sure this is a controversial debate that will rage on among contending parties for years to come.

But one of the most interesting aspects of this story has nothing to do with lawmakers and government officials at the center of the debate. Rather, it’s the way the people in the region have taken matters into their own hands, and the ever-expanding role technology is beginning to play in the public’s interpretation of the law.

Over the weekend, some Italian citizens began creating living wills on YouTube, documenting their personal wishes with regard to “do not resuscitate” (DNR) orders, designation of health care proxies and any other modifications they feel are important, in the event they are rendered incapacitated. But the irony lies in the fact that in Italy, there is no legislation on end-of-life issues and no recognition of living wills as legal documentation of a person’s wishes.

Here in the U.S., it’s quite the opposite. As physicians, a standard question that we must ask all patients upon admission to the hospital is whether or not they have a living will. If they do, we request to see a copy of it so that it can described in detail in the patient’s chart.

But I have to tell you, in the last few years since this law was mandated, I can literally count on one hand, the number of patients that have answered yes to that question. For many of us, it’s human nature to try not to think about what could go wrong, so we often don’t take the time to plan for it.

So when I look at these people taking matters into their own hands, making a short video clip detailing what they would want done in a worst-case scenario, I’m curious about how these videos will be interpreted by the law in future ethical debates, and at the end of the day, if their wishes will be honored.

Join the discussion on my Facebook page.

Is it really better to eat a hamburger than have a piece of tilapia?

No!

There has been a lot of confusion lately due to a recent study from Wake Forest University School of Medicine concluding that “farm raised tilapia, one of the most highly consumed fish in America, has very low levels of beneficial omega-3 fatty acids and, perhaps worse, very high levels of omega-6 fatty acids.” The researchers concluded that this combination could be very damaging for patients with arthritis, heart disease, and other auto-immune diseases that are vulnerable to exaggerated inflammatory responses.  According to the study, if individuals are consuming tilapia as a method to control inflammatory diseases then they would be better off having hamburgers and pork bacon (keep in mind however that these are high fat meats full of artery clogging saturated fats.)  The study also showed that tilapia has an average of 11:1 ratio of detrimental omega 6 to omega 3 versus the 1:1 ratio in salmon or trout which is more desirable.

Now let me try to breakdown the details.  

There are two types of fat, omega-3 and omega-6, and both are essential for human health in a ratio of 2:1.  However, the typical American consumes far too many omega-6 fats in their diet while consuming very low levels of omega 3 fats with a ratio of 20:1. Omega 6 fats can be found in corn oil, safflower oil, cottonseed oil, peanut oil, and soybean oil. Omega 3 fats can be found in seafood, whole grains, beans, flaxseed oil, and walnut oil. The reason for this change is because our diet now includes huge amounts of vegetable oils used for cooking and in prepared foods.

The highest levels of omega 3’s can be found in fish.  Omega 3 in fish is high in two fatty acids crucial to human health, DHA (DocosaHexaenoic Acid) and EPA (EicosaPentaenoic Acid).  These two fatty acids are pivotal in preventing heart disease, cancer, and many other diseases.  While studies show that eating too much omega-6’s and too little omega-3’s causes blood clots and constricts arteries, increasing your risk for heart attacks and worsening arthritis, I would not recommend staying away from a very lean fish such as tilapia.

Studies have shown that excess calories lead to weight gain and an increased chance for morbidity.  Therefore, replacing tilapia with a high saturated fat beef will only cause more harm.  Beef and high fat meats such as pork, bacon, and processed meats are full of artery clogging saturated fat and have 100 calories and 8 grams of fat per ounce.  When was the last time you ate only one ounce of meat?  I can bet you that your hamburger at last Sunday’s BBQ was at least 5 ounces (which puts you at 500 calories and 45 grams of fat.)  And I’m sure that wasn’t the only thing you ate.  However, if you had tilapia for dinner, at 35 calories an ounce and 0.1 gram of fat, a 5 oz piece of fish would only put you at  175 calories and around 3 grams of fat.

 Therefore, why not enjoy your tilapia dinner and still aim to increase your ratio of omega 6s to omega 3s back to a more healthful 2:1 ratio by incorporating more seafood, whole grains, beans and other seeds, and reducing your intake of foods made with or cooked in vegetable oils.

Tanya Zuckerbrot, MS, RD is a nutritionist and the creator of The F-Factor Diet™, an innovative nutritional program she has used for more than ten years to provide hundreds of her clients with all the tools they need to achieve easy weight loss and maintenance, improved health and well-being.  For more information log onto www.FFactorDiet.com.