Archive for June, 2010

The Brits weigh in on salt; my last post until the 8th

Wednesday, June 23rd, 2010

We're heading out on a two+ week trip and, since I had back surgery 15 days ago, I can't carry much. So I'm leaving my laptop at home, bringing my Kindle to get the news (it also has eight books I could read) and will only take one paperback book. That one is by Marion Nestle, a named-chair nutrition professor at NYU, and is her take on how the food industry tries and largely succeeds in influencing nutrition and health, usually not for our benefit. More on that subject later.

In the meantime I found an article on a branch of the United Kingdom's health system, their National Institute for Health and Clinical Excellence (That leads to a great acronym: NICE), wants the U.K. government to help further restrict salt intake.

As I've noted before, most of the salt in the American diet, and apparently most in the U.K population's diet, comes from salt added to "prepared foods." So the NICE group wants the government to get the food industry, via new laws or taxes or restricting some TV ads, to stop pushing salt (and fat and sugar) at the consumers.

The average daily salt intake in the U.K is about 8.5 grams, which is the equivalent of 3.34 grams of sodium. The current recommendation there is 6 grams of sat or 2.36 grams of sodium. The goal espoused by NICE is to gradually lower the salt intake to 3 grams (1.18 grams of sodium) by 2025.

They think such diminution of sodium content of foods (and fat content also) could help prevent about 40,000 premature deaths from heart attacks, strokes and other cardiovascular disease. Of course the U.K. food industry, through a lobbying group, is protesting, saying NICE is out of touch with what's been happening for years and that the steps recommended are totally unnecessary.

NICE has come up with some great new concepts, including restricting permits for fast food outlets in some areas (presumably near schools), barring some food ads during hours when kids may be watching TV and a "traffic light" system for color codes on foots that would reveal their level of salt, fat and sugar.

If I have to say so myself these are very NICE ideas.

More on salt intake

Saturday, June 19th, 2010

I've written several posts on sodium intake (table salt, of course, is sodium chloride, but I tend to think in terms of the sodium itself). I printed our most of the sodium, potassium and water section in the new Dietary Guidelines Advisory Committee's (DGAC) 2010 draft which I had barely touched on in my last post. The entire DGAC report is huge; there was a nine-page Executive Summary and the section on salt and water is more than thirty pages in length. I also went to another section, one on high potassium foods.

The bottom line isn't new at all, probably little changed from the 2005 Guidelines. But the data behind the recommendation is more and more solid. So here's the short version and some background.

We get way too much sodium in our American diet and way too little potassium.

Most of the sodium comes from processed foods: yeast breads, chicken, pizza, pasta, cold cuts, condiments, cheese, grain-based desserts, soups and beef. The natural sodium content of foods gives us about 10% of our total intake and table and cooking salt another 5 to 10%. So roughly 75% comes from salt added in the manufacture of foods. It's associated with high blood pressure (AKA hypertension), strongly felt to be a highly significant contributor to that disease. More than 90% of us will develop hypertension in our lifetime.

Eating a diet lower in sodium makes great sense, especially for anyone with pre-existing hypertension, middle-aged and older adults, Blacks (who have a higher risk of hypertension-related complications, e.g., stroke and kidney failure) and diabetics. We ingest more than twice the 1,500 milligrams per day the DGAC thinks we should.

For people who have normal kidney function and aren't on meds that cause potassium to go up or be retained, more dietary potassium helps reduce blood pressure. Somewhat absurdly, most of us get our potassium from reduced fat milk, coffee, chicken and beef, OJ or grapefruit juice, fries and chips. We get roughly 3,000 milligrams (less for women) of the recommended 4,700 the DGAC thinks we should be eating/ingesting. There's a list of high-potassium foods that starts with baked potatoes and their skins and includes lots of fresh (or canned) foods: beet green, carrot juice, nonfat plain yogurt, some fishes, and of course, bananas and other fruits.

I'm going to read more of the DGAC report and will be eager to find out how many of the recommendations make it into the final 2010 Dietary Guidelines. It sure makes sense to me, but a lot of folk would have to gradually adapt to less sodium and some countries are going that route.

Then there's the issues of affording a healthy diet and of food companies going along with with what the Advisory Committee recommends.

The 2010 Dietary Guidelines

Wednesday, June 16th, 2010

I was reading the papers this morning (our local newspaper + "The Wall Street Journal" + the New York Times breaking news) and saw an interesting article in the local paper titled "Four Steps to Fighting Obesity." It even had a box titled "Putting limits on sodium." Well that certainly got my attention and led me to a great website:

It seems a 13-member advisory committee (called the DGAC) of health and nutrition experts was set up by the two relevant government agencies, the Department of Agriculture (USDA) and Health and Human Services (HHS). They've been working a couple of years and their charge was to update, if necessary (and I'm sure it is) the 2005 Dietary Guidelines.

The website led me to a very large document and thus far I've read the nine-page Executive Summary and printed off another thirty-two pages on "Sodium, Potassium and Water." I'll read that section later, but the overview made me decide to pause in my posts on Omega-3s and point you toward the 2010 guidelines. At this stage the public has thirty days to comment on them before it's made final. I doubted it will change much, but a professor of nutrition posted on "The Atlantic" website some comments that made me wonder.

First this set of dietary guidelines has to be reviewed every five years, by Congressional fiat. Then the professor, Marion Nestle, has written a book titled "Food Politics: How the Food Industry Influences Nutrition and Health." I just ordered a paperback copy of her revised edition and also a copy of her book, "What to Eat." She doesn't think the guidelines change much from version to version

I'll await the final version of the 2010 DGAC Report, but in a nutshell they're recommending we get our dietary sodium intake way down (70% of us need to go to 1,500 mg/day), eat less saturated fat. exercise more, avoid junk food, and follow Michael Pollan's advice: "Eat food. Mostly plants. Not too much."

I'm doing that already; we got our first "Couple Veggie Share" delivery Monday from our local CSA
and will soon be starting on our "fruit share." What I want to see is the final ideas on how the vast majority of us can also eat healthy, affordable fresh fruits and vegetables. Now if the committee can solve that quandary and convince Americans to follow the Dietary Guidelines, we may get somewhere.

So here's the problem (and perhaps the answer): We've got to do something and soon. The issue starts with kids and what they eat; if we don't find a way to change that, we're not doing our primary job as parents and grandparents and citizens.

More Fish, Less Chips

Saturday, June 12th, 2010

I'm four days out from back surgery and can sit up long enough to post on my blog tonight. I've been reading more about the omega-3 fatty acids and especially about DHA, otherwise known as docosahexanoic acid. DHA was discussed in great detail at a recent meeting of the Royal Society of Medicine (RSM) and the article in the May 29, 2010 issue of "The Economist" led me to a book, "The Omega-3 Connection" written by a Harvard medical School professor and an online medical article on "Fish Oil: Getting to the Heart of It."

There's an amazing amount of new information coming out about the importance of the Omega 3s and maybe DHA in particular (The other Omega 3 of interest is EPA, eicosapentanoic acid). This may take three or four posts to cover, but let's start with some general statements. DHA, according to one researcher who presented at the May RSM meeting, may explain why dolphins, which weigh about the same as zebras, have brains nearly five times as large. It seems to play a role in a number of significant mental health diseases and low levels of DHA appear to be associated with a higher risk of suicide. The Department of Defense in the United States is paying attention to that last factor and plans to supplement the diets of its troops with Omega 3s.

The problem links to our current diets, high in omega 6s, low in omega 3s. It's time for a change, both in diet and in supplements. More later on the topic.

Even The Economist

Monday, June 7th, 2010

The publications I read regularly, besides our local newspaper, are "The Wall Street Journal," the "New York Times,", the "Annals of Internal Medicine" (and its every-other-month "Journal Club") and "The Economist." I frequently get blog topics from the WSJ and then try to trace their source back into the medical literature, often going through the National Library of Medicine's website. The NYT somewhat less frequently has provided leads, the "Annals" is a great source, but this week I actually found two articles in "The Economist" that were well worth blogging about.

The first was titled Fish and No Chips with a subtitle of "The Wonders of docosahexaenoic acid (DHA)." There apparently was a scientific meeting in London recently which focused on DHA. We're both taking fish oil, 1,000 mg a day, one capsule with each meal, as a source of Omega-3 fatty acids. Each softgel capsule contains 300 mg of Omega-3s, coming from anchovy and sardines.

I'm having back surgery this week and the pre-op-clinic nurse going trough my list of meds noted I had stopped taking my prophylactic 81 mg of baby aspirin a day (there are pros and cons to taking even this dose and I keep watching the debates in the medical literature; don't take it without talking to your own doc.). What I hadn't realized, was the fish oil capsules, according to the nurse, also have some form of anticoagulant effect and should be stopped before surgery. Now that she mentioned this, I reread the bottles label and noted it said to consult your doctor if you're planning any sort of medical procedure.

The medical literature on this is sparse at the levels recommended: The average US total intake is about 1.6 gm/day and the suggested dose is 2.85 gm/day. There appears to be little anticoagulant effect at doses under 3 gm/day, although a prospective study, published in 2009 in the "British Medical Journal" was enrolling hemodialysis patients in a low-dose aspirin vs. fish oil trial in an attempt to see how best to keep arterio-venous fistulas from clotting.

But the new article in "The Economist" is worth returning to and I'll do that in my next blog. In the meantime, fish oil sounds reasonable to me, so I'll restart it after my surgery. Oh and the brand we take says, "purified to remove mercury."

Protecting your arteries

Saturday, June 5th, 2010

I read an article in the "Wall Street Journal" dated June 1, 2010. The subtitle was "How to Turn Back
the Clock when your blood vessels grow old before you do" and that really caught my eye. Most of the article wasn't anything new; you can prevent or lessen damage to your arteries by some combination of eating a healthy diet, controlling your weight, sticking the meds your physician gives you for heart or blood pressure and not smoking.

Okay, so I already knew all that and so should you, whether you actually "walk the walk" or just talk about doing so as so many of us do. Over the years I've quit smoking (when I was a third year medical student and saw a cancer patient smoking through his tracheoestomy), decided, progressively,to lose weight (I'm now under 150 pounds consistently, allowing myself to bounce up and down a few pounds; my max weight, many years ago was 218), eaten a more healthy diet (just got a notice from our local CSA that our weekly "couples veggie share" and "fruit share" will start on the 14th and made sure my blood pressure was controlled

The striking data here appeared in the journal "Circulation" last August, co-authored by a professor of preventive cardiology at Northwestern. Men and women, in his study, who followed the precepts I've mentioned above, could have arteries that were equivalent to those of people 14 to 21 years younger. The flip side was certainly true also. A 35-year-old man who does the exact opposite (smokes, doesn't exercise, has diabetes (probably Type 2 and obesity related) and abnormal cholesterol levels), may have arteries equivalent to those of a 76-year-old.

Your heart, if your resting heart rate is ~70, beats about 100,000 times a day; every time it does so it exposes your arteries to wear and tear. So I had an EKG done last week. My resting heart rate is 53, down from higher levels before I started to exercise regularly. There were no signs of heart damage on the cardiogram and my own personal physician said a while back, "Peter, you've gradually increased your exercise level over the years; now you're doing the equivalent of a stress test every day."

I think I'm on the right track, but I spent time yesterday with a friend whose belly overflowed his belt buckle. I mentioned that I thought he might want to read my blog and he said, "I weighed 174 in high school and I'm only at 185 now."

The problem is where the weight is distributed. Many of us had more muscle mass and less belly fat in high school. We may weigh the same, or nearly so, but still be at considerable risk for heart disease and other blood vessel problems.

I've taken four and a half inches off my waist measurement; is it time for you to do the same?

Eating Kale, among other things

Tuesday, June 1st, 2010

Our friend Maggie sent me an email copy of "HEALTHbeat" (I'm putting titles into quotes today as my computer seems to have developed an aversion to italics), a Harvard Medical School publication. It's free on the Web and I signed up to get it regularly. This edition happened start with "Advice to women about supplements-use selectively." and my wife read that with great interest. I ordered two of their print publications, one for women over 50 and one on losing weight and keeping it off. I also sent them an email about what I think was a typo about the recommended vitamin D dosage.

Anyway they talked about nutrient-dense foods as being the best way to get many things we need in a synergistic fashion, which might turn out to be the more effective way as well. I looked through their list which included lots of foods we already eat in our high-fruit-and-vegetable, low-red-meat diet. Among the choices were avocados, bell peppers sweet potatoes, low-fat yogurt, peas, various nuts, salmon and chicken.

So far it sounded like a typical meal at our house. Then Lynnette, to whom I was reading the list, said, "We don't eat kale very often."

That intrigued me, so I went to an older book we frequently consult, "Food" by Waverly Root. The subtitle of this 1980 tome is "An authoritative visual history and dictionary of the foods of the world" and Mr. Root wasn't kidding. Sometimes he'll spend four pages on the histroy of a particular food item. If you ever run across a copy, I'd suggest buying it; we love this book. We also recently found "The New Food Lover's Companion" (the 2007 4th edition) by Sharon Tyler Herbst and Ron Herbst which had a paragraph on kale.

It's a member of the cabbage family, low in calories, high in vitamin C and calcium, and eaten more in Europe than in America, where it's been made into so-called pot greens. My copy of Barbara Kafka's great book, "Microwave Gourmet" gave me a way to cook kale and we'll try some soon.

But back to the Harvard Medical School advice. They appear to think women in America are taking too many multivitamins and that those haven't given all the benefits they've been touted to offer. Their publication for seniors does suggest taking one, but only one such pill a day. They do want you to try some of the foods I mentioned instead (there are more on their list) and to get some extra vitamin D.

We both take one senior vitamin pill a day (which has 125% of the daily recommended vitamin D dose), some calcium, B12, and vitamin C. They'd have us cutting back on some of that, but I'll read more before I do; nothing we're taking seems to offer a risk, as some preliminary studies show may be there for excess vitamin A and E, folic acid and beta carotene. Those studies, Harvard notes, "warrant further studies."