Almost 20% of young adults have hypertension

Many people believe that it is normal for blood pressure to rise as we age, but this is not true.  Cultures whose diet does not contain excessive added fats, animal protein and salt, and is high in fresh, whole plant foods do not experience the age-related increase in blood pressure that we see in the Western world.1,2 These age-related elevations in blood pressure are not related to age itself – instead they are due to the cumulative destructive effects of a poor diet and insufficient exercise on the circulatory system over years and years. 

Hypertension (blood pressure at or greater than 140/90) is on the rise – between 1996 and 2006, hypertension prevalence in the U.S. increased by 20%.3 Now, new results from the National Longitudinal Study of Adolescent Health have produced an estimate that 19% of young adults (24 to 32 years old) have hypertension.

Plus, more than half of these individuals were unaware that they had high blood pressure. This 19% figure is markedly higher than previous estimates, and was based on in-home measured blood pressure in 2008 in a population of over 15,000 participants.4,5 This elevated blood pressure will only progress as they continue to harm their blood vessels with salt and processed food. 

If almost 1 in 5 already have blood pressure higher than 140/90 by age 32, just imagine how much trouble this generation is in. First of all, the risk of death from heart attack and stroke begins to increase when blood pressure climbs over 115/75.6  Plus, high blood pressure is an important risk factor for hemorrhagic stroke, kidney disease, stomach cancer, dementia, osteoporosis, hardening of the arteries, arrhythmia, blindness, and enlargement of the heart.7-11

Many people in this age group, who were born between 1976 and 1984, have grown up on diets made up primarily of processed foods and fast food, and this study has revealed that their bodies are starting to show signs of the damage.  If they do not change their habits, they will be prescribed medication that they will have to take for the rest of their lives to control their blood pressure.  But this will not remove the cause of the problem, and will put them at risk for harmful side effects. And their poor lifestyle habits will continue to cause worsening of their cardiovascular disease. Of course, this outcome is avoidable with lifestyle changes.  This generation of young adults can enjoy a long, healthy life without blood pressure-lowering medication by starting to follow these guidelines now:

How to reduce blood pressure naturally

  • Avoid salt.   A population-wide 1200 mg decrease in sodium consumption has been estimated to reduce coronary heart disease cases by 60,000, strokes by 32,000, and heart attacks by 54,000 each year.  Plus, remember that salt does damage unrelated to blood pressure too.

  • Avoid added sugars.

  • Minimize caffeine and alcohol.

  • Focus preferably on plant protein rather than animal protein.12,13

  • Get plenty of minerals, phytochemicals and antioxidants by eating primarily whole plant foods. For example, flavonoids from berries have a blood pressure-lowering effect, and nuts can enhance endothelial cell function, which promotes proper blood pressure regulation. Also, a dietary pattern high in fruits and vegetables is consistently associated with healthy blood pressure levels in observational studies.14-16

  • Exercise regularly and vigorously.

  • Follow my micronutrient rich dietary program and regain a normal weight.

 

 

 

References:

1. Freis ED: Salt, volume and the prevention of hypertension. Circulation 1976;53:589-595.

2. Sever PS, Gordon D, Peart WS, et al: Blood-pressure and its correlates in urban and tribal Africa. Lancet 1980;2:60-64.

3. American Heart Association: High Blood Pressure Statistics. http://www.americanheart.org/presenter.jhtml?identifier=4621. Accessed June 2, 2011.

4. Nguyen QC, Tabor JW, Entzel PP, et al: Discordance in National Estimates of Hypertension Among Young Adults. Epidemiology 2011.

5. Neale T: 1 in 5 Young Adults May Have Hypertention. MedPage Today. http://www.medpagetoday.com/Cardiology/Hypertension/26700?utm_content=&utm_medium=email&utm_campaign=DailyHeadlines&utm_source=WC&userid=322421. Accessed June 2, 2011.

6. Lewington S, Clarke R, Qizilbash N, et al: Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. Lancet 2002;360:1903-1913.

7. Heart Disease and Stroke Statistics: 2010 Update At-A-Glance. http://www.americanheart.org/downloadable/heart/1265665152970DS-3241%20HeartStrokeUpdate_2010.pdf. Accessed January 11, 2011.

8. Sonnenberg A: Dietary salt and gastric ulcer. Gut 1986;27:1138-1142.

9. Tsugane S, Sasazuki S: Diet and the risk of gastric cancer: review of epidemiological evidence. Gastric Cancer 2007;10:75-83.

10. Go O, Rosendorff C: Hypertension and atrial fibrillation. Curr Cardiol Rep 2009;11:430-435.

11. DellaCroce JT, Vitale AT: Hypertension and the eye. Curr Opin Ophthalmol 2008;19:493-498.

12. Elliott P, Stamler J, Dyer AR, et al: Association between protein intake and blood pressure: the INTERMAP Study. Arch Intern Med 2006;166:79-87.

13. Wang YF, Yancy WS, Jr., Yu D, et al: The relationship between dietary protein intake and blood pressure: results from the PREMIER study. J Hum Hypertens 2008;22:745-754.

14. Alonso A, de la Fuente C, Martin-Arnau AM, et al: Fruit and vegetable consumption is inversely associated with blood pressure in a Mediterranean population with a high vegetable-fat intake: the Seguimiento Universidad de Navarra (SUN) Study. Br J Nutr 2004;92:311-319.

15. Fu CH, Yang CC, Lin CL, et al: Effects of long-term vegetarian diets on cardiovascular autonomic functions in healthy postmenopausal women. Am J Cardiol 2006;97:380-383.

16. Utsugi MT, Ohkubo T, Kikuya M, et al: Fruit and vegetable consumption and the risk of hypertension determined by self measurement of blood pressure at home: the Ohasama study. Hypertens Res 2008;31:1435-1443.


 

Salt increases heart attack and stroke risk, even if blood pressure is normal

Excess dietary salt is notorious for increasing blood pressure – blood volume increases, placing more stress on blood vessel walls. This forces the heart to pump harder against the pressure, and also structural changes that harden the vessel wall (this hardening is called stenosis) occur in response to these high pressures.

About one-third of all American adults and over 50% of those over the age of 55 have hypertension, and hypertension carries significant risks. Elevated blood pressure accounts for 62% of strokes and 49% of coronary heart disease. [1] Notably, the risk for heart attack and stroke begins climbing with systolic pressures (first number in the blood pressure reading) above 115 mm Hg – considered “normal” by most standards.[2] Also, dietary salt is not only dangerous to the cardiovascular system, but also contributes to kidney disease, osteoporosis , ulcers, and stomach cancer. [3]

There is new evidence that excess dietary sodium intake promotes atherosclerotic plaque development and heart disease, even in those without elevated blood pressure.

In the 1990s, it was found that the relationship between salt intake and stroke mortality was stronger than the relationship between blood pressure and stroke mortality; this suggested that salt may have deleterious effects on the cardiovascular system that are not related to blood pressure.[4] Excess sodium in the diet affects sodium concentrations in the blood, which affects the cells of the blood vessel wall and blood volume, even if blood pressure itself does not change. The eventual results are long-term changes in vessel wall structure, including thickening of the vessel wall and arterial stiffening. Excess dietary sodium prompts changes in hormonal systems and also gene expression in endothelial cells (the cells that make up the inner lining of blood vessels). These changes in turn promote excessive growth of vascular smooth muscle cells, which contributes to thickening of vessel wall, and altered production of structural proteins, such as collagen, elastin, and fibronectin, which contributes to arterial stiffening. Dietary salt has also been associated with endothelial dysfunction (the inability of endothelial cells to properly regulate blood pressure), which is one of the initiating events of atherosclerotic plaque formation. [5-8]

The study population consisted of overweight and obese individuals withoutelevated blood pressure., Their sodium intake was evaluated by measuring the amount of sodium excreted in the urine. The authors found that higher urinary sodium (indicating higher sodium intake) was associated with greater carotid artery intima-media thickness – a predictor of future cardiovascular events. Intima-media thickness (IMT) is an indicator of atherosclerotic plaque development and is established in the medical literature as an accurate predictor of future cardiovascular risk. IMT testing is a non-invasive ultrasound technique for imaging any abnormal thickening in the intima (inner lining) and media (smooth muscle layer) layers of the carotid artery. Thickening indicates atherosclerotic plaque formation, and therefore increased risk of heart attack or stroke. [9] I use this test to assess cardiovascular risk and track patients’ progress in my medical practice.

Reducing dietary salt is not only important for those who already have elevated blood pressure – limiting added salt is essential for all of us to keep our cardiovascular systems in proper working order. On top of consuming the vast majority of our calories from phytochemical-rich, unrefined plant foods, salt avoidance adds another layer of protection against heart attack and stroke. It is also important to remember that a low fat, flexitarian or vegan diet plus a low cholesterol level does not protect you from developing high blood pressure later in life from years of using too much salt; it also does not protect you against the risk of later life hemorrhagic stroke, as long as you overly salt your food.

 

 

References:

1. He, F.J. and G.A. MacGregor, A comprehensive review on salt and health and current experience of worldwide salt reduction programmes. J Hum Hypertens, 2009. 23(6): p. 363-84.
2. Lewington, S., et al., Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. Lancet, 2002. 360(9349): p. 1903-13.
3. Tsugane, S. and S. Sasazuki, Diet and the risk of gastric cancer: review of epidemiological evidence. Gastric Cancer, 2007. 10(2): p. 75-83.
4. Perry, I.J. and D.G. Beevers, Salt intake and stroke: a possible direct effect. J Hum Hypertens, 1992. 6(1): p. 23-5.
5. Simon, G., Experimental evidence for blood pressure-independent vascular effects of high sodium diet. Am J Hypertens, 2003. 16(12): p. 1074-8.
6. Sanders, P.W., Vascular consequences of dietary salt intake. Am J Physiol Renal Physiol, 2009. 297(2): p. F237-43.
7. Safar, M.E., et al., Pressure-independent contribution of sodium to large artery structure and function in hypertension. Cardiovasc Res, 2000. 46(2): p. 269-76.
8. Dickinson, K.M., J.B. Keogh, and P.M. Clifton, Effects of a low-salt diet on flow-mediated dilatation in humans. Am J Clin Nutr, 2009. 89(2): p. 485-90.
9. Lorenz, M.W., et al., Prediction of clinical cardiovascular events with carotid intima-media thickness: a systematic review and meta-analysis. Circulation, 2007. 115(4): p. 459-67.

 

That's What You Get For Eating Out In Vegas

Las Vegas.  Flickr: http2007

I have always been an advocate that you can find healthy food anywhere. I tell people this all the time when they ask if I dine at restaurants or how I handle social events involving food. Boy, did my trip to Vegas prove me wrong. 

I traveled to Vegas with hard-core meat and junk-food eating friends. Besides their affinity for foods I consider grotesquely inedible, I love these people and cherish them as my friends. They tried to please me in our restaurant choices and I figured there would be vegetable options on every restaurant’s menu, so I was initially pretty easy going about where we went to eat. I figured worst-case scenario, I could ask the chef to steam some vegetables for me. It would be no big deal, I thought.

Upon our first lunch outing, my friends chose a Japanese restaurant. I was famished and as such, agreed to eat wherever they desired. When I glanced at the menu, I was a happy girl. The menu was a treasure trove of vegan and vegetarian options, all which seemed as tasty as any home cooked meal. I ordered the Crispy Lettuce Rolls, which were to be filled with mushrooms and tofu. Can’t go wrong with that, right? Wrong.

When my meal arrived it looked delicious, so I eagerly took a big bite. What I tasted was pure salt. That’s what my meal was. Lettuce wrapped in salt. Much to my later regret, I continued to consume the meal because I was famished and as a salt-binge ingénue, didn’t comprehend the repercussions that eating this meal would entail. Throughout the day I felt perfectly fine, but by dinner time I no longer felt like my vibrant, healthy glowing self. I actually felt positively disgusting. I was bloated, very thirsty and uncomfortable in my own skin. In my state of physical lousiness, I began pondering how in the world other people could eat like this every single day and function normally. For dinner I was going to stay as far away from seasoned food as possible. My friends chose a Mexican restaurant with plentiful salad options. Okay, I figured I couldn’t go wrong with a salad. 

I was proven wrong once more. I asked for Portobello mushrooms instead of chicken on my salad and when I bit into those mushrooms they were oozing with salt and vinegar. I couldn’t eat my side order of beans, which I had attempted and failed to order salt free (they were pre-prepared), because they also tasted like a mouth full of salt. Needless to say, I wasted my money on food I didn’t consume. Apart from one evening meal at the Wynn in which I custom ordered a vegan meal of steamed vegetables (I loved the meal and Steve Wynn for going vegan!), I could not find healthy food anywhere.   It was a nutritarian nightmare. For lunch one day I ordered what appeared to be a healthy, grilled vegetable wrap, only to take a bite into a mouthful of grease. I couldn’t eat it. Just like the overflowing decorative opulence of many of the Vegas hotels, apparently all of the chefs at the Vegas restaurants assumed they should opulently season, sugar and grease their dishes. 

My memories of the trip will be of the wonderful shows and places we went to, but I will also remember how bloated and disgusting I felt after eating salted food. I guess the moral of this story is to arrive on vacations better prepared. I was too naïve and didn’t realize until it was too late that you must assume all food in restaurants are loaded with salt. I should have known to ask for plain vegetables and salads with the dressing on the side. I should have known to travel with a stash of nuts and apples or other healthy options to curtail my hunger. My father would have been saying, “I told you so!” I learned my lesson. No more veggie junk-food hangovers for me!

     

Stroke in the news: Beau Biden, Bret Michaels

BrainStroke is the leading cause of disability in the U.S., and the third leading cause of death. Almost 800,000 people in the U.S. have a stroke each year. Although stroke is usually perceived as a condition that afflicts older Americans, it occurs in people of all ages. About 25% of strokes occur in people under the age of 65, and 10-15% occur in those under age 45.1

Yesterday, at the age of 41, Beau Biden, Delaware Attorney General and son of U.S. Vice President Joe Biden, suffered what is being called a mild stroke. As of now, there is no available information as to what type of stroke he suffered. Joe Biden himself suffered from a hemorrhagic stroke due to a ruptured brain aneurysm in 1985 at the age of 45.2

Bret Michaels, of the band Poison and a contestant on The Celebrity Apprentice, suffered a subarachnoid hemorrhage (a type of hemorrhagic stroke) in April at age 47. He was released last week to a rehabilitation facility.3

What is a hemorrhagic stroke?

Most strokes, about 85%, are ischemic strokes, in which blood flow to the brain is blocked either by a clot or atherosclerotic plaque. The remaining 15% of strokes are hemorrhagic strokes, caused by bleeding in the brain due to the rupture of a blood vessel. This may be the rupture of a small, damaged artery or an aneurysm. Hemorrhagic stroke is even more devastating than ischemic stroke – the rapid bleeding into the brain compresses the neural tissue, most often resulting in permanent damage or death.1

What makes the small blood vessels of the brain susceptible to rupture?

Hemorrhagic stroke, on average, affects younger people than ischemic stroke does, and the most common cause of hemorrhagic stroke is high blood pressure.4  Elevated blood pressure places stress on the walls of the small delicate vessels in the brain, and is the foremost risk factor for both ischemic and hemorrhagic strokes. Small vessels contain a much thinner layer of muscle, or no muscle layer at all, making them more susceptible to the effects of elevated pressure.

How to protect yourself from hemorrhagic stroke: Avoid salt!

High blood pressure is the most important risk factor for hemorrhagic stroke, and Americans have a 90% lifetime probability of having high blood pressure. The most effective way to keep blood pressure in a favorable range is to avoid the huge amounts of excess salt that most Americans consume. Stroke mortality is significantly higher in Japan and exceptionally high in certain areas of China where salt intake is high, in spite of low-fat diets.5 It is also well established that Third World countries that do no salt their food are virtually immune to hypertension and strokes.

High-salt consumption may be potentially more dangerous for vegans, vegetarians, and others who have earned low cholesterol levels by eating otherwise healthful diets. Many vegans believe that their low cholesterol levels and decreased atherosclerosis risk make them exempt from all types of cardiovascular disease, but this is not the case. Unlike heart disease, cholesterol is not an important risk factor for hemorrhagic stroke. In fact, low cholesterol levels are associated with increased risk of hemorrhagic stroke. A number of studies both in Japan and in the West have illustrated that fewer animal products and a low serum cholesterol were associated with increased risk of hemorrhagic stroke.6 The plaque-building process that results in atherosclerosis and premature death may in some way actually protect the fragile blood vessels in the brain from rupture due to high blood pressure. A high-salt diet may dramatically increase the risk of hemorrhagic stroke in vegans because they can live longer than the general population and not die from a heart attack first. Of course, excess sodium increases both heart attack and stroke death in all diet styles, but in vegans, a high-salt diet may be even more dangerous. To protect against heart attacks, ischemic strokes, and hemorrhagic strokes, you must dramatically curtail salt consumption. 

Excess salt is more dangerous than most people realize. In addition to high blood pressure and stroke, salt contributes to kidney disease, heart diseaseosteoporosis, ulcers, and stomach cancer.7 Avoiding salt is an essential component of a health-promoting, disease-preventing diet.

To learn more, read my articles and newsletters about salt, hypertension, and reducing blood pressure.



References:

1. Centers for Disease Control: Stroke. http://www.cdc.gov/stroke/

American Heart Association: Stroke. http://www.americanheart.org/presenter.jhtml?identifier=4755

5. Kono S, Ikeda M, Ogata M. Salt and geographical mortality of gastric cancer and stroke in Japan. J Epidemiol Community Health. 1983 Mar;37(1):43-6.

6. Iso HM, Stampfer MJ, Manson JE, et al. Prospective study of fat and protein intake and risk of intraparenchymal hemorrhage in women. Circulation 2001;103:856.

Yano K, Reed D, MacLean C. “Serum Cholesterol and Hemorrhagic Stroke in the Honolulu Heart Program.” Stroke 1989;20(11): 1460-1465.

7. Tsugane S, Sasazuki S. Diet and the risk of gastric cancer. Gastric Cancer 2007;10(2):75-83

Hidden salt in chicken

Giant chickenThe practice of chicken “plumping” by the industry has many consumers outraged. Plumping is term used to refer to injection of salt water, chicken stock, seaweed extract, or some combination of these into chickens – this increases the weight and price of the chicken – plumped chicken can be up to 15% salt water by weight. Of course, cost is important, but even more important is that this practice can also increase the sodium content of the chicken by up to 700%. About 30% of the chickens sold in the U.S. are plumped.

Sodium is not only associated with hypertension – high sodium intake contributes to heart disease, hemorrhagic stroke, kidney disease, osteoporosis, and stomach cancer as well. Conscientious consumers or those with elevated blood pressure who are restricting salt intake to avoid these dangerous outcomes are not expecting there to be anything other than chicken in the package of chicken. The industry is taking advantage of that fact, and adding even more salt into the diets of Americans in the process. Chicken producers say that consumers prefer the taste of plumped chicken, that adding salt water increases moistness and enhances taste - of course it tastes better to most Americans – it’s full of salt!

Taking into account the popularity of chicken among most Americans, this is a serious concern – especially since reducing salt intake in the U.S. by approximately one-third has been estimated to reduce cases of heart attack and stroke by tens of thousands each year. The last thing Americans need is more salt in their diets.

Of course, I recommend minimizing animal products. But if you do occasionally eat chicken, it is simple to make sure that you are paying for only chicken and not salt water. First, remember that “100% Natural” and even “Organic” does not mean that the chicken has not been injected with salt water. Check the ingredient list and the sodium content - chicken meat contains approximately 75 mg sodium per 4-ounce serving – plumped chicken may list up to 440 mg sodium for the same serving size.

 

References:

  1. Salt-Water-Soaked Chicken Not at all Natural, Says CSPI: http://www.cspinet.org/new/201002241.html
  2. Lifescript: Is Your Chicken too Fat? http://www.lifescript.com/Body/Diet/Eat-well/Is%20Your%20Chicken%20Too%20Fat.aspx?utm_campaign=2010-03-06-46296&utm_source=healthy-advantage&utm_medium=email&utm_content=healthy-well-wise_Is%20Your%20Chicken%20Too%20Fa&FromNL=1&sc_date=20100306T000000

Salt update

On Wednesday, January 20th, about a week after NYC Mayor Bloomberg proposed his controversial salt reduction initiative, evidence was presented in the New England Journal of Medicine that salt reduction truly can save lives.

Salt shaker

Using mathematical models, the authors were able to make estimates of cardiovascular disease rates based on a population-wide 3 g decrease in salt consumption (1200 mg sodium). 

By their projections, a 3 g salt reduction would result in 60,000 fewer cases of coronary heart disease, 32,000 fewer strokes, and 54,000 fewer heart attacks each year. This is comparable to the cardiovascular benefit from smoking cessation efforts.   These estimates don’t even take into account the beneficial effects on other diseases related to salt excess, like osteoporosis, kidney disease, and stomach cancer.

Health care costs were predicted to decrease by $10 billion to $24 billion, making this type of intervention much more cost-effective than medicating people who have hypertension. With health care reform at the forefront of American politics, this study highlights the value of prevention in bringing down costs. Since about 80% of salt in the diet is already in the food when it is purchased, this intervention must occur at a national policy level rather than a personal responsibility level – hopefully, these data will not be ignored by policymakers.

A 1200 mg decrease in sodium consumption would represent a 34.3% drop in sodium consumption of average Americans, somewhat more ambitious than the 25% reduction proposed by Mayor Bloomberg. But based on the above figures even a 25% reduction is likely to bring cardiovascular benefits.

 

References:

Bibbins-Domingo K et al. Projected Effect of Dietary Salt Reductions on Future Cardiovascular Disease. NEJM. Published at www.nejm.org January 20, 2010 (10.1056/NEJMoa0907355)

Appel LJ and Anderson CAM. Compelling Evidence for Public Health Action to Reduce Salt Intake. Published at www.nejm.org January 20, 2010 (10.1056/NEJMe0910352)

 

NYC cracks down on salt!

First New York City banned trans fat, then required chain restaurants to post calorie counts, then warned about weight gain from sugary sodas, and now it’s taking on salt.

Salt shakers

 

Mayor Bloomberg has called for a nation-wide initiative to reduce sodium content of packaged and restaurant food by 25% over the next five years. The program would be voluntary for the food manufacturers and restaurant chains.

Of course, cutting sodium by 50% would be even better, but this is a respectable first step.   A reduction in sodium intake by 50%, according to a recent meta-analysis, is estimated to reduce the rate of stroke by 23% and cardiovascular disease by 17%.1

A similar voluntary salt reduction program has been in action in the U.K. since 2003, and has so far has managed to reduce the average salt consumption consumption from 9.5g (approx. 3,800 mg sodium) to 8.6g (approx. 3,400 mg sodium). This year, the U.K. has set more challenging salt reduction goals for 2012.

Salt is dangerous - I have always warned people about excess salt consumption - here are some facts:

  • The human diet, for millions of years, did not contain any added salt – only the sodium present in natural foods. This equates to less than 1000 mg of sodium per day. 
  • Today, according to the CDC, Americans typically consume 3500 mg of sodium per day.
  • Americans have a 90% lifetime probability of having high blood pressure
  • 80% of sodium in the American diet comes from processed and restaurant foods. As NYC health commissioner Dr. Thomas Farley said, “Most of the salt we consume is in the food when we buy it.”  The Center for Science in the Public Interest has found several chain restaurant meals that contain over 6,000 mg of sodium!
  • And finally, sea salt is not healthier than table salt – all salt comes from the sea, and it doesn’t matter if it’s pink or gray or white, it’s still about 98% sodium chloride. It’s salt, and it’s dangerous. 

Many people interpret public health policies such as these as the “food police” telling us what we can and cannot eat. I see it as the opposite – progress in consumer freedom. By putting a limit on the amount of salt in foods that can be sold to us, we now have the choice. We, not the corporations that sell food to us, are in control of our salt intake. We are able to purchase packaged food and eat at restaurants without consuming dangerous levels of sodium. For those who prefer to ignore the risks of high sodium intake, no one is outlawing salt shakers.

Even more troubling, others see this as an ‘insignificant’ issue compared to health care reform, the economy, unemployment, etc...

Our health and quality of life are insignificant? Heart disease, stroke, kidney disease – insignificant? I don’t think so. People who die from diseases of nutritional ignorance are not around to worry about the economy.

But won’t cutting salt make the foods bland? First, the program plans to reduce salt gradually so that foods will not appear to be bland. And actually, excess salt deadens the sense of taste - if you cut down your salt intake, your taste buds will adjust over time, becoming more sensitive to salt. By avoiding salty foods, you regain your ability to detect and enjoy the subtle flavors in natural foods.

What do you think about this new push in New York City to improve people’s diets? I think it is great.

 

References:

1. Strazzullo P et al. Salt intake, stroke, and cardiovascular disease: meta-analysis of prospective studies BMJ 2009;339:b4567 ; http://www.diseaseproof.com/archives/osteoporosis-sodium-acidbase-balance-and-bone-health.html

2. Tsugane S, Sasazuki S. Diet and the risk of gastric cancer. Gastric Cancer 2007;10(2):75-83

 

http://www.nytimes.com/2010/01/11/business/11salt.html

http://www.cnn.com/2010/HEALTH/01/11/new.york.salt/index.html

http://www.nypost.com/p/news/opinion/opedcolumnists/as_salt_on_science_t5MDuh3FqtTWpMS5bs282J 

Sodium, acid-base balance, and bone health

 

Salt shakerWe’ve known for years that excessive sodium intake contributes to hypertension, and a new meta-analysis of 13 studies has confirmed that high sodium intake is associated with increased risk of stroke and overall cardiovascular disease.1 Salt consumption is also associated with kidney disease, and a new study suggests that reduced sodium intake could benefit bone health.

Women 45-75 years old with prehyptertension or stage 1 hypertension were assigned to one of two diets.  Both diets supplied the same amount (800 mg) of calcium.  One diet was a high-carbohydrate, low-fat diet.  The other diet was a low-sodium diet (1500 mg), which included red meat but was designed to have a low acid load.2 

Western diets, generally high in animal protein, produce acid in the body, forcing the body to buffer this acid in part by the release of alkalizing salts from bone (e.g. calcium citrate and calcium carbonate) – this is associated with urinary calcium loss and is thought to contribute to osteoporosis. Fruits, vegetables, and legumes have favorable effects on acid-base balance, since the acid-forming effect of their protein content, which is lower than that of animal products anyway, are balanced by their mineral content.3-4

After 14 weeks, the women on both diets increased markers of bone formation and reduced their calcium excretion – those on the low sodium diet had a greater reduction in calcium loss. The authors concluded that this diet was protecting the mineral reserves in bone, and that this could have long-term implications for bone health. Future studies will likely measure bone mineral density and fracture incidence in response to these diets.2

The average daily consumption of sodium for Americans is around 4000mg, almost double the U.S. recommended maximum of 2300mg. The low sodium diet in this study provided a maximum of 1500mg of sodium per day, but included up to six servings of red meat per week, limited the consumption of nutrient-rich legumes to 4-5 per week, and was based on high-calorie, nutrient-poor grain products - 7-8 servings per day.5 The high-carbohydrate low-fat diet was likely based on grain products as well.

Although both of these diets had favorable effects when implemented in place of a standard western diet, they both have room for improvement. By minimizing the high-protein, high-saturated fat animal products, and replacing grain products with mineral- and phytochemical-rich vegetables, fruits, and legumes as the base of the diet, both acid load and sodium would be further reduced, presumably leading to further benefits on bone health.

 

References:

1. Strazzullo P et al. Salt intake, stroke, and cardiovascular disease: meta-analysis of prospective studies. BMJ 2009;339:b4567

2. Nowson CA et al. The effects of a low-sodium base-producing diet including red meat compared with a high-carbohydrate, low-fat diet on bone turnover markers in women aged 45-75 years. Br J Nutr. 2009 Oct;102(8):1161-70. Epub 2009 May 18.

3. Welch AA et al. Urine pH is an indicator of dietary acid-base load, fruit and vegetables and meat intakes: results from the European Prospective Investigation into Cancer and

Nutrition (EPIC)-Norfolk population study. Br J Nutr. 2008 Jun;99(6):1335-43. Epub 2007 Nov 28.

4. Massey LK. J Nutr. Dietary animal and plant protein and human bone health: a whole foods approach. 2003 Mar;133(3):862S-865S.

5. http://dashdiet.org/

 

Adjusting to a Healthy Diet - Your Body Will Detoxify

It takes time to be comfortable with the changes in your life. It is not unusual to feel physically uncomfortable as you detoxify in the process of making over your body chemistry with a healthful diet. The more stimulating or harmful your prior habits, the worse you feel when you stop them. When breaking your addiction to salt, meat, dairy, saturated fat, processed foods and other substances, you might feel headachy, fatigued, or even a little itchy or ill, but the good news is these symptoms rarely last longer than a week or two. However, if you are making the changes to nutritional excellence gradually uncomfortable symptoms should be minimized.

Some people are so addicted to stimulating food, sugary sweets, and overeating, they may even feel depressed when they don’t indulge. For example, cheese, salt, and chocolate are all addictive, and it takes a prolonged period of abstinence to beat these addictions. Sugar and caffeine, especially when mixed together, are highly addictive and create a significant amount of discomfort when stopping. Sugar withdrawal symptoms have been demonstrated to be similar to withdrawal symptoms from opiates, including anxiety and tremors.1 I have observed many individuals with a history of severe chronic headaches, who were on drugs for headache suppression, develop fever, backaches, diarrhea, and other severe detoxification symptoms when stopping medications that contain caffeine, such as Excedrin, Fiorinal and Fioricet. Fortunately, their suffering was short-lived. Through high-nutrient eating, these individuals have been able to make dramatic recoveries.

High-nutrient eating was crucial for this result. Toxic wastes build up in our tissues, and we are unable to remove them unless high-levels of phytochemicals are present and the intake of toxins is stopped. You must allow this detoxification to occur. An important hurdle to achieving your ideal weight and excellent health is getting rid of your addictions. After that occurs, you may feel like you have been freed from prison and will find it easier to move forward and be one step closer to truly eating for health.

This is an excerpt from Dr. Fuhrman’s book Eat For Health.

1. Colantuoni C, Rada P, McCarthy J, et al. Evidence that intermittent, excessive sugar intake causes endogenous opioid dependence. Obes Res. 2002;10(6):478-488. Rada P, Avena NM, Hoebel BG. Daily bingeing on sugar repeatedly releases dopamine in the accumbens shell. Neuroscience 2005;134(3):737-744.

Image credit: Elizabeth Thomsen

Eat Less Salt, Get More Taste!

Once you understand why salt must be dramatically lowered in your diet, you may still be questioning how you will do it without eating bland food every day. Part of the answer is that you won’t be entirely eliminating sodium. To do that is impossible because all foods, especially vegetables, contain sodium, and this natural sodium adds to their flavor. Up until now, you have probably never noticed this natural sodium because when we over-stimulate the taste buds with too much added salt over a long period of time, our taste receptors can’t sense lower levels of salt. Thus, natural, unsalted foods seem to have less flavor. Food then tastes flat without added salt, and you need to add even more salt to almost everything. This is part of the addiction cycle: we build up tolerance for unhealthy substances. The good news, however, is that you can re-train your taste buds to be more sensitive to salt when you decrease its presence in your diet.

Most people consume between 2000 and 8000 milligrams of salt a day. When you get rid of the salt habit, your food may taste bland for a few weeks, but, within a few months, you will find that your taste buds, which were deadened by the overuse of salt, have gradually gained their sensitivity back. You will discover tastes that you never knew existed in natural foods. Even a simple pear or a leaf of lettuce will taste better. Foods that you once enjoyed will now taste too salty.

When we eat a diet low in salt, eventually, our sensitivity to salt and other tastes gets stronger and simple foods begin to have a better flavor. As you eventually get accustomed to a diet that stimulates your salt receptive taste buds less, you can enjoy more flavors in natural foods. This isn’t just limited to salt. You will also see the phenomenon at work when eating a simple strawberry or slice of red pepper. Amazingly, your taste buds become stronger when you are off salt and sugar. Try eating some plain romaine lettuce with no dressing on it now. Then eat some after reducing your salt intake for a month. You will be amazed at how much more flavor that plain, unseasoned piece of lettuce has. The bottom line is that once you break your addiction to salt, you likely won’t miss it at all, and you will find that food actually has more flavor not less.

This is an excerpt from Dr. Fuhrman’s book Eat For Health.

Image credit:  fortinbras