People with high blood pressure are generally advised to reduce their intake of dietary salt. The average U.S. salt consumption is about 3,400 mg per day, but the latest Dietary Guidelines for Americans recommend keeping sodium intake below 2,300 mg per day for healthy people, and under 1,500 mg for people with high blood pressure and for those at risk of high blood pressure, most notably blacks and people over age 50. These groups make up about 70 percent of the U.S. population. The American Heart Association recommends that everyone should consume less than 1,500 mg of sodium per day.

These recommendations come from the results of the DASH (Dietary Approaches to Stop Hypertension) studies, which have found that a reduction of salt intake to below 1,500 mg per day is an effective method for reducing blood pressure.¹ Whether or not the reduction of dietary salt leads to further cardiovascular benefits has been a subject of debate, however.

In July of this year, a controversial² Cochrane Review published in the American Journal of Hypertension found that recommendations for a reduction in salt intake did lead to reduced salt consumption and a small reduction in blood pressure after six months, but that, “cutting down on the amount of salt has no clear benefits in terms of likelihood of dying or experiencing cardiovascular disease,” concluded the study.³ In fact, one finding of the study was an increase in the risk of death in people with congestive heart failure. The lead researcher stated, “We believe that we didn’t see big benefits in this study because the people in the trials we analyzed only reduced their salt intake by a moderate amount, so the effect on blood pressure and heart disease was not large.”

The saga continues with a recent Cochrane Review, also published in the American Journal of Hypertension, which reviewed 167 studies and found that reduction of dietary salt intake resulted in a modest 1 percent decrease in blood pressure in Caucasians with normal blood pressure and a 3.5 percent decrease in Caucasians with high blood pressure.⁴ Further, the study also found that salt reduction increased renin, aldosterone, adrenaline and noradrenaline (all hormones that affect blood pressure), in addition to raising cholesterol by 2.5 percent and triglycerides by 7 percent. These potentially harmful effects call into question the recommendation to reduce salt intake in Caucasians on cardiovascular risk overall.

The major source of sodium in the Standard American Diet (SAD) comes from processed food—cheese, bread, pizza, and grain-based foods and desserts being the main sources. This is a problem in itself. Perhaps it’s not the sodium that is the major contributor to cardiovascular risk, but rather the overall poor quality of the diet. Processed foods, refined grains, sugars, and chemical additives have turned the American diet into a ticking time bomb for heart disease—and most all chronic disease, for that matter. Remember that salt, in its natural form (from the sea) contains an array of minerals that help support nutrient sufficiency in the diet. Sea salt, like any salt, should be consumed in moderation—don’t overdo it, but you might not want to reduce levels as drastically as have been recommended.

The good news is there are other ways to eat a tasty (or even spicy) moderate amount of salt in your food:  Herbamare is a product which contains sea salt, lemon, fennel, leek, onions, chives, parsley, dill, basil, carrots, garlic, bay leaves,  marjoram, rosemary, thyme, chili, and kelp. Some varieties have hotter chili for those who like it. In addition, adding more kelp, nori, or dulse, all sea vegetables, adds more minerals (including iodine) in a natural form that would be beneficial for most everyone.  Through the use of medicinal foods like these, eating can be a joy that balances salt and herbs, providing much more than just table salt. And now for dessert:  It turns out that dark chocolate and almonds are quite beneficial in lowering blood pressure as well.

References

1. F.M. Sacks, et al., “Effects on blood pressure of reduced dietary sodium and the Dietary Approaches to Stop Hypertension (DASH) diet. DASH-Sodium Collaborative Research Group.” N Engl J Med. 2001 Jan 4;344(1):3-10.
2. F.J. He and G.A. MacGregor, “Salt reduction lowers cardiovascular risk: meta-analysis of outcome trials.” Lancet. 2011 Jul 30;378(9789):380-2.
3. R.S. Taylor, et al., “Reduced dietary salt for the prevention of cardiovascular disease: a meta-analysis of randomized controlled trials (Cochrane review).” Am J Hypertens. 2011 Aug;24(8):843-53.
4. G. Jurgens and N.A. Graudal, “Effects of low sodium diet versus high sodium diet on blood pressure, renin, aldosterone, catecholamines, cholesterols, and triglyceride.” Cochrane Database Syst Rev. 2004;(1):CD004022.

Leonard Smith, M.D.
Dr. Leonard Smith is a prominent Board-Certified, general, gastrointestinal and vascular surgeon who had a successful private practice for 25 years. In addition to his active surgery practice, he also incorporated lifestyle, diet, supplementation, exercise, detoxification, and stress management into many of the therapies he would prescribe. Many of his patients with cancer, cardiovascular disease, and other serious illnesses did so well under his treatment regimes that he began to devote most of his career to foundational health care and preventive medicine.

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Metabolic syndrome is a condition that involves a group of metabolic abnormalities that may lead to the development of type 2 diabetes or cardiovascular disease. People with metabolic syndrome have an accumulation of abdominal fat (also known as central obesity, but many of us call it plain, old belly fat) as well as two of the following:

• High triglycerides
• Reduced “good” cholesterol (HDL)
• High blood pressure
• High blood sugar

This condition is also known as Syndrome X. About 76 million adults in the U.S. over the age of 20 have Syndrome X. The bright side is that diet and lifestyle factors can control and reverse each of the four indicators above, and lessen someone’s central obesity.

A recent study found that a low-fat, high-complex carbohydrate (whole grains, please!) diet supplemented with omega-3s resulted in lower blood lipid levels in people with metabolic syndrome than the same diet without the omega-3s.

Previously, a low-fat, high-complex carbohydrate diet was found to be beneficial for those with metabolic syndrome, except for one thing – it increased triglyceride levels. Since omega-3s are known to reduce triglyceride levels, adding them to this diet seemed a good idea. Time and good results have proven that they were right.

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Recent findings by Harvard researchers in the Women’s Health Study (which involved more than 17,000 female health professionals) indicate that women whose work is highly stressful are at a 40 percent increased risk of developing heart disease compared to their less-stressed colleagues. The study also showed that women who worry about job loss are more likely to have high blood pressure, unhealthy cholesterol levels and be obese.

More studies back this up. A large study in Denmark found a higher risk for heart disease among women aged 51 and older who were under greater work pressure. Another study in Beijing found that women with job strain had increased thickness of the carotid artery—a sign of cardiovascular disease.

The effects of stress, and especially chronic stress, are far-reaching. The body is designed to respond to stress by increasing blood pressure, speeding heart rate, quickening breathing, and slowing digestion. Did you know that stress even alters the microbial balance in the digestive tract? Chronic stress has these same effects, but over a longer time period. The result? Chronic disease.

There are some aspects about work-related stress that cannot be changed. We all know that. How we handle the stress is another story. Stress-reducing therapies such as relaxation techniques, meditation, or yoga can be helpful. Regular exercise is another stress reducer, and is also good for the heart. Reducing stress outside of work can also help lessen the stress load.

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The American Heart Association (AHA) released a scientific statement this week on triglycerides and cardiovascular disease. In the statement, certain lifestyle factors—diet and exercise—were considered with regard to their effects on lowering triglycerides. Almost one-third of Americans have high triglycerides. Since 1976, average triglyceride levels have risen alongside the growing epidemic of obesity, insulin resistance, and type 2 diabetes, all of which can lead to cardiovascular disease. 

The AHA statement recommends the optimization of nutrition-related practices, which can result in a marked triglyceride-lowering effect ranging between 20% and 50%.  They recommend the following:

• Weight loss
• Reducing simple carbohydrates
• Increasing dietary fiber
• Eliminating trans fats
• Reducing fructose (mainly high-fructose corn syrup)
• Reducing saturated fats
• Eating a Mediterranean-style diet (high in fresh fruits and vegetables, high fiber, lean meats, healthy fats)
• Consuming marine-derived omega-3s

These recommendations are right on, and in line with what I have been recommending for years—not just for a healthy heart, but for overall health and well being. 

The statement made a point of talking about the importance of marine-based omega-3s.  Here’s a quote:

“Non–marine-based PUFAs [like canola, flaxseed, walnuts] have not demonstrated consistent reductions in triglycerides; this may reflect very low conversion rates of alpha-linolenic acid [ALA]…to the active triglyceride-lowering omega-3 compounds EPA and DHA.”

While ALA is a great source of omega-3s, it takes many complex steps in the body to convert it to the heart-healthy DHA and EPA, which are naturally found in fish oil.  Further, they state:

“Because the amount needed for significant triglyceride lowering (2 to 4 g) is difficult to attain through diet alone on a daily basis, supplementation with capsules may be needed.”

That’s why I recommend fish oil supplements—it’s not easy to get all that EPA and DHA from eating fish alone.  And then you have to worry about the contaminants found in fish… (that’s another blog).

I know that for a while now, the AHA has been recommending EPA and DHA fish oil for high triglycerides.  It’s nice to see this statement together with other recommendations for supporting heart health.  Cardiovascular disease is such a huge problem in this country, and it can largely be avoided by incorporating the lifestyle changes mentioned above. 

Right on AHA!

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A very interesting study was just published in the journal Archives of Internal Medicine documenting the association between high dietary fiber intake and lower risk of dying from some of the most common killers—heart disease, cancer, and diabetes. This was a huge study with over 388,000 participants aged 50 to 71.

The nine-year study looked at dietary fiber intake and found men’s intake ranged from 13 to 29 grams per day, and women’s fiber intake from 11 to 26 grams per day. Over a nine-year period, those who had the highest intake of fiber (29.4 grams in men and 25.8 grams in women) had a 22 percent lower risk of dying from certain diseases than those participants who consumed the lowest levels of fiber. Subjects with the highest daily intake of fiber were at lower risk of dying from cardiovascular disease and infectious and respiratory disease compared with the lower fiber intake group.

Researchers noted that fiber “has been hypothesized to lower the risk of coronary heart disease, diabetes, some cancers, obesity, and premature death because it is known to:

• Improve laxation by increasing bulk and reducing transit time of feces through the bowel;
• Increase excretion of bile acid, estrogen, and fecal procarcinogens and carcinogens by binding to them;
• Lower serum cholesterol levels;
• Slow glucose absorption and improve insulin sensitivity;
• Lower blood pressure;
• Promote weight loss;
• Inhibit lipid peroxidation; and
• Have anti-inflammatory properties.”

I recommend at least 35 grams of fiber daily for those very reasons noted above. High daily intake of fiber has so many health benefits. Unfortunately, however, the average American only consumes between 10 and 15 grams daily— and that’s not nearly enough.

It can be difficult to obtain 35 grams of fiber from the diet, so fiber supplements are a great way to increase fiber intake. In addition, consuming plenty of whole grains, fruits and vegetables (and fewer bad fats, refined grains and sugars) will help to boost your daily fiber intake.

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Brenda and I have been talking for years about the toxic soup that we all live in. It’s in our food, in the water, in the air and in our own bodies. It’s impossible to completely avoid toxins, and that’s a problem, especially in light of the scientific evidence that shows environmental toxins are destroying our health.

Many recent studies have looked at air pollution and its many harmful effects. It has been known for some time that exposure to air pollution is associated with health conditions like asthma, cardiovascular disease and attention deficit hyperactivity disorder (ADHD). In fact, polluted air can even create serious ventricular arrhythmias.¹ Also, the incidence of heart attacks in rush hour traffic in the United Kingdom are thought to be due to the polluted air. In support of this is a quote from the August 2005 Environmental Health Perspectives (EHP) referring to particle laden dirty air, “Ultrafine particles < 0.1 µm (UFPs) dominate particle number concentrations and surface area, and are therefore capable of carrying large concentrations of adsorbed or condensed toxic air pollutants. It is likely that redox-active components in UFPs from fossil fuel combustion reach cardiovascular target sites. High UFP exposures may lead to systemic inflammation through oxidative stress responses to reactive oxygen species and thereby promote the progression of atherosclerosis, and precipitate acute cardiovascular responses ranging from increased blood pressure to myocardial infarction.”²

The studies on this topic keep rolling in. The latest issue of EHP published a study on the link between prenatal exposure to air pollutants and subsequent behavioral problems in children.³ Children with the highest levels of pollution exposure had more attention problems, anxiety and depression at age 5 to 7 than those children with the least exposure. It is also known that exposure to organophosphate pesticides found on foods is linked to ADHD symptoms, by the way. And we wonder why ADHD is on the rise.

Other new studies continue to support just how air pollution affects health. One study in animals found that chronic inhalation of polluted air triggered inflammation that spread throughout the body.⁴ To quote one of the researchers, “Our main hypothesis is that particulate matter stimulates inflammation in the lung, and products of that inflammation spill over into the body’s circulation, traveling to fat tissue to promote inflammation and causing vascular dysfunction.”

This comes as no surprise to me. Inflammation is involved in most every disease, and certainly plays a role in all chronic diseases. Inflammation can be triggered by a number of factors—toxins, stress, illness, digestive imbalance—and it can travel throughout the body causing disease.

Another recent study, again published in EHP, found that short term exposure to air pollution damaged areas of the brain associated with memory loss and Alzheimer’s disease in mice.⁴ Guess what the study found? The brains affected by air pollution showed signs of inflammation associated with premature aging and Alzheimer’s disease.

Finally, the New England Journal of Medicine showed that reductions in air pollution accounted for as much as 15% of the overall increase in life expectancy in the areas that were studied!⁶

It’s difficult to know just how to avoid all this pollution, but there are things we can do to reduce toxicity. First, use high efficiency particulate air filters (HEPA filters) throughout your house (or at least your bedroom), and in your car cabin. According to Carla Kalogeridis at the Filter Manufacturers Council, only 40 percent of North American vehicles have cabin air filters despite the ongoing concern of consumers regarding cabin air quality.⁷ Others say as many as 80% or more now have cabin filters. I couldn’t find a clear answer from the www.epa.gov site, but did find where they recommended a portable cabin filter.⁸ In any case if you have a cabin filter they generally need to be replaced annually or every 15,000 miles. The filters can be easily bought from the dealers or online⁹ with instructions on how to change them at home.

If you can avoid daily bumper-to-bumper traffic jams, that’s a good start, and if you can’t it would be very wise to change your cabin air filter. If your vehicle doesn’t have one there are portables available.⁸ Eating a healthy diet high in fruits and vegetables, whole grains, healthy fats and lean proteins will help your body get many nutrients and fiber it needs. Reduce inflammation with omega-3 oils, and quell gut inflammation with probiotics. And support the body’s seven channels of elimination: colon, liver, lungs, lymph, kidneys, skin and blood with nutrients that promote the healthy function of these channels, plus periodic colon hydrotherapy, and infrared sauna. Lastly, find stress-reducing activities including exercise and meditation to round out a healthy lifestyle. All of the above strategies will help to keep your detoxification pathways open.

1. M.S. Link and D.W. Dockery, “Air pollution and the triggering of cardiac arrhythmias.” Curr Opin Cardiol. 2010 Jan;25(1):16-22.
2. R.J. Delfino, et al., “Potential role of ultrafine particles in associations between airborne particle mass and cardiovascular health.” Environ Health Perspect. 2005 Aug;113(8):934-46.
3. F.P. Perera, et al., “PAH/Aromatic DNA Adducts in Cord Blood and Behavior Scores in New York City Children.” Environ Health Perspect. 2011 Apr 4.
4. T. Kampfrath, et al., “Chronic Fine Particulate Matter Exposure Induces Systemic Vascular Dysfunction via NADPH Oxidase and TLR4 Pathways.” Circ Res. 2011 Mar 18;108(6):716-26.
5. T.E. Morgan, et al., “Glutamatergic neurons in rodent models respond to nanoscale particulate urban air pollutants in vivo and in vitro.” Environ Health Perspect. 2011 Apr 4.
6. C.A. Cope, et al., “Fine-particulate air pollution and life expectancy in the United States.” N Engl J Med. 2009 Jan 22;360(4):376-86.
7. http://www.ehow.com/about_6404803_hepa-cabin-filter_.html#ixzz1JnfTQzQA
8. http://www.epa.gov/nhsrc/pubs/TISPortableMotorVehicleCabinAirPurifier.pdf
9. www.filters-now.com

Dr. Leonard Smith is a prominent Board-Certified, general, gastrointestinal and vascular surgeon who had a successful private practice for 25 years. In addition to his active surgery practice, he also incorporated lifestyle, diet, supplementation, exercise, detoxification, and stress management into many of the therapies he would prescribe. Many of his patients with cancer, cardiovascular disease, and other serious illnesses did so well under his treatment regimes that he began to devote most of his career to foundational health care and preventive medicine.

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Here is your newest weekly challenge (I mean, opportunity!) to help set you off on the right foot and in the right direction for bringing health to your week. You could even add it to your calendar. Join us!

With the new release of the Dietary Guidelines for Americans comes the recommendation to eat more fish. This is not surprising, as it reflects the recommendations by the American Heart Association. Americans consume about 3 ½ ounces of seafood each week, but are encouraged to more than double that to 8 ounces.

Why the recommendation? Because research shows it reduces the risk of cardiovascular disease and stroke. Fish is rich in nutrients, especially omega-3 fatty acids thought to be the main contributor to heart health. Just how much fish to consume has been debated due to the presence of toxins—especially methyl mercury—in certain fish. However, the dietary guidelines say the health benefits of eating a variety of seafood outweigh the risks associated with methyl mercury.

Any more than two servings of fish per week (and it depends on the fish—some are much higher in mercury than others), and you’re better off with a fish oil supplement that has been purified to meet purity standards set by International Fish Oil Standards (IFOS). IFOS standards meet or exceed world standards for purity, potency and freshness of fish oil.

This week, try to eat at least two servings of fish high in omega-3s, like salmon, sardines, anchovies, herring or light canned tuna (not albacore). Can’t stand to eat that much fish, or want to get even more heart healthy omega-3s? Look for a fish oil that is tested by IFOS. Look for the IFOS seal on the box.

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For over 60 years now, it has been recommended that baby’s first food be white rice cereal mixed with either breast milk or regular milk. Rice is known for being well-tolerated by babies’ sensitive digestive tracts due to its low allergen status.  Recommending white rice as baby’s first food is coming under scrutiny, however, and I agree.

White rice is a highly refined product. In processing, it is stripped of fiber, vitamins and other beneficial nutrients.  What’s left is little more than a simple carbohydrate—the very food that leads to the development of obesity, diabetes and cardiovascular disease. The risk of these diseases seems far off when we are talking about infants, but experts believe that starting off a baby’s diet with white rice cereal may be setting the stage for unhealthy eating habits to come.

So this week’s challenge is to substitute brown rice cereal for white rice cereal in the diet of a baby you know. This simple substitution could be the beginning of better dietary choices later in life.

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 Most people have a difficult time making the association between what is going on in the gut and health problems in other parts of the body. I help them connect the dots so that they can achieve better health. I help them get started on The Road to Perfect Health.

The Road to Perfect Health begins in the gut (your digestive system). If your digestive system is not healthy, the rest of you is typically unhealthy in some way.

Sure, you know that conditions like heartburn, gas, bloating and indigestion are related to your gut. But did you know that conditions like fibromyalgia, chronic fatigue, skin conditions, cardiovascular disease, diabetes and even arthritis are all related to the gut? It’s true. And I have seen it in so many people, including myself.

There are many different factors contributing to chronic illness that begin in the gut, but one primary factor is gut microbial balance. You need the proper balance of gut bacteria. I call it your “GPS”—your Gut Protection System. Your GPS is made up of 100 trillion bacterial cells. In fact, the bacterial cells in your gut outnumber the cells in your entire body by 10 to 1! That’s right, there are 10 times more gut bacteria than all the rest of the cells that make up your body.

The beneficial bacteria in your gut are known as probiotics. Probiotic means, literally, “for life.” Pro means “for” and biotic means “life.” This is in contrast to “antibiotic” (“against life”). The most common and most widely studied probiotic bacteria are what I call the L’s and the B’s—Lactobacillus and Bifidobacteria. Lactobacillus bacteria are most associated with the little (small) intestine, and the Bifidobacteria are mostly found in the big (large) intestine, or colon. Having the right balance of good bacteria (more good guys than bad guys) is essential on The Road to Perfect Health.

For more information on how your GPS can help you return to perfect health, check out my new PBS show, The Road To Perfect Health. Check your local PBS listings for show times.

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You know how I feel about toxins, right? Right. So when I heard that the FDA had finally updated its warning about one of the most harmful toxic chemicals out there today, I thought to myself, “It’s about time!”

The folks at the U.S. Food and Drug Administration have been dragging their feet for some time now on the issue of bisphenol A (or BPA for short). BPA, which I’m sure you’ve heard of by now unless you’ve been living under a rock, is one of the most prevalent chemicals in use today, and it’s found in 90% of the population—which means yes, it’s probably inside you right now!

BPA is used in the lining of canned foods and in many hard plastic products like those reusable water bottles you see everywhere. One of the most concerning uses of BPA, however, is its presence in plastic baby bottles and ‘sippy’ cups, as well as in containers for infant formula and food.

Whereas before they said BPA was ‘safe’ for infants, the FDA has since changed its tune. Now when you go on their website and research BPA, you can see that their new statement says they are concerned about the “potential effects of BPA on the brain, behavior, and prostate gland in fetuses, infants and young children”. So as a result the FDA is now supporting the removal of BPA from containers that are used by infants. Well, thank goodness!

But still, let’s not forget how BPA affects adults too—another study just came out that confirmed the link between high BPA levels and cardiovascular disease, showing that people who have the highest amounts of BPA in their urine also had the highest rates of heart disease. How’s that for a wake-up call? Just something to keep in mind the next time you consider buying canned foods or filling up your water bottle.

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