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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The benefits of omega-3 oils from fish were first noticed in Inuit populations of Greenland. Researchers noticed that these people consumed high amounts of fat, yet did not develop heart disease or experience heart attacks like people in the Western world. Thus began studies of the Inuit diet in which beneficial omega-3 fatty acids from fish—EPA and DHA—were found to be the heart-protective components.

Many thousands of studies later, the benefits of omega-3 fish oil are still being found in many different areas of health. In a new study of Yup’ik Eskimos in Alaska, researchers evaluated the effects of a high-fat fish-based diet on disease markers in obese Eskimos. The rate of obesity in these people is similar to that in the lower US—the difference is the source of dietary fat. In the US, saturated and trans fats are high in the diet, and healthy polyunsaturated fats, like omega-3s, are low.  

In obese Yup’ik Eskimos with the highest blood levels of EPA and DHA, blood triglyceride and C-reactive protein (a measure of overall inflammation) were the same as normal weight people. In those Eskimos with the lowest EPA and DHA levels, however, blood triglyceride and CRP levels were high. High triglycerides and CRP levels are risk factors for the development of cardiovascular disease and possibly diabetes.

Results of this study suggest that omega-3 fatty acids EPA and DHA found in fish may have health protecting effects even in obese people. More studies are needed to confirm these results, but this study is promising.

Now, don’t get carried away and think you can eat all the fatty foods you want and just pop a fish oil supplement. Instead choose healthy fats as part of your diet with plenty of fish on the menu, and supplement that with omega-3s from fish oil to be sure you’re getting enough of these great fats. Just be sure to look for a fish oil that meets International Fish Oil Standards (IFOS—look for the IFOS seal on the bottle).

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Renew You Challenge

Let’s start this week off right!

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!

Many people are familiar with the term “omega-3.” And many people also know that good sources of omega-3 are fish and flaxseeds. But did you know that these two sources contain different types of omega-3? That’s right. Flaxseed contains the omega-3 called alpha-linolenic acid (ALA) and fish contains two different types of omega-3: docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA).

ALA actually converts into EPA, which then can convert into DHA (and vice versa). These conversions, however, occur on a very limited basis. ALA only converts to EPA at a rate of between 8 and 20 percent, and only converts to DHA (by way of EPA) at a rate of between 0.5 and 9 percent. Many people take omega-3 in the ALA form, like flaxseed oil, thinking that they are getting all the benefits of omega-3s, but they’re not getting the whole story. Certainly ALA is a beneficial omega-3. I don’t refute that. But most of the benefits of ALA are thought to be due to its eventual conversion into EPA and DHA—especially when it comes to heart health.

A recent study published in the American Journal of Clinical Nutrition highlights this point. Data based on 3,277 healthy Danish adults found that a higher intake of ALA over 23 years was not associated with a reduction in risk of ischemic heart disease—the most common form of heart disease, and the most common cause of death in the U.S. But intake of other long-chain omega-3s—like EPA and DHA—was associated with a reduced risk.

The researchers found that intakes ranging from 0.45 to 11.2 grams per day were associated with a 38 percent reduced risk of ischemic heart disease for women. This is a large range, certainly, and higher doses of EPA and DHA should only be taken under the consult of a doctor. But the American Heart Association does recommend that people consume the equivalent of 500 mg per day of EPA and DHA (not ALA) if they are healthy and want to maintain heart health; 1 gram per day if they have coronary heart disease; and 2 to 4 grams per day if they have high triglycerides.

This week, if you are taking an omega-3 supplement, take a look at the label and see how much EPA and DHA you are getting. This is what you should be looking for in a high-quality omega-3.

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The science behind omega-3s—especially EPA ad DHA, the omega-3s found in fish—is particularly strong for cardiovascular benefits. In fact, the American Heart Association recommends that healthy adults consume the equivalent of 500 mg daily of EPA and DHA; that people with heart disease consume 1,000 mg of EPA and DHA daily; and that patients who need to lower triglyceride levels consume 2 to 4 grams of EPA and DHA daily.

The reasons why fish oil is so heart healthy are many. In addition to helping lower triglyceride levels, omega-3s from fish oil have also been found to reduce blood clots and improve blood pressure, heart rate and vascular function. On top of that, a recent meta-analysis (a study which compiles data across many studies—in this case 10 randomized, controlled, human clinical trials) found that omega-3 intake was effective in reducing arterial stiffness, also known as hardening of the arteries.

Arterial stiffness is associated with an increased risk of cardiovascular events like heart attack and stroke. It is the result of atherosclerosis, the buildup of plaque in the artery wall, and is more common with age. “Reduction in arterial stiffness by omega-3 may account for some of its purported cardio-protective effects,” stated researchers.

Fish oil supplements are not all created equal. The most beneficial omega-3s found in fish oil are EPA and DHA. Be sure you are getting the most of your fish oil—read the label and add up the amounts of EPA + DHA. That’s what you’re looking for when it comes to a good fish oil supplement.

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Belly fat is usually detectible—people generally have a good idea if they tend to accumulate fat in their midsection, as opposed to their hips and bottom. But how do you know if your liver is fat? Well, abdominal fat and liver fat often go hand in hand. In fact, fat from the liver can be sent to the belly, and vice versa. Often, an underlying feature of both of these is inflammation, which may come from the gut. Nutrients and other substances—including fat, toxins and inflammatory compounds—are absorbed from the small intestine and travel straight to the liver via the portal vein.

A recent study found that obese individuals with high amounts of abdominal fat and liver fat are at increased risk for heart disease. The researchers found that liver fat is strongly associated with increased secretion of very-low-density lipoproteins (VLDL), which contain the highest amounts of triglycerides, known to increase heart disease risk.

It has long been known that abdominal fat can be dangerous. The increasing knowledge about the dangers of liver fat adds to the story, as these two go hand in hand, each setting the body up to be more susceptible to metabolic syndrome, type 2 diabetes and heart disease. Together, belly and liver fat mean trouble.

Both liver and abdominal fat can be reduced with exercise and weight loss. These steps, in addition to addressing any underlying gut dysfunction that may be contributing inflammation to the liver, can help reverse these metabolic precursors to heart disease.

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Renew You Challenge

It’s Monday again and let’s start this week off right!

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!

A recent study to be published in the Journal of Clinical Endocrinology & Metabolism found that consuming fructose or high fructose corn syrup for two weeks at the upper acceptable recommended levels (according The Dietary Guidelines for Americans 2010—25 percent of total daily calories) increased blood levels of cholesterol and triglycerides—both risk factors for heart disease.

Researchers tested three forms of sugar—fructose, high fructose corn syrup and glucose. Only the fructose groups were found to have a negative effect. Glucose is the basic unit of sugar that is used by the body, but it is derived from other dietary sugars like fructose and sucrose.

The researchers stated, “Our findings provide evidence that the upper limit of 25 percent of daily calories consumed as added sugars as suggested by The Dietary Guidelines for Americans 2010 may need to be re-evaluated.” In contrast to these guidelines, the American Heart Association recommends that only five percent of total calories come from added sugar. This study may serve to help bridge the gap between both recommendations.

Excess sugar consumption is not difficult to reach in today’s world, and can have a host of negative health consequences. This week, take a closer look at the foods you eat. Read the ingredient labels of packaged foods and try to avoid products that contain added sugars in the ingredient list. Be careful, though, these sugars like to arrive in disguise under a host of names. Here’s a list to look out for:

•Agave nectar

•Brown sugar

•Cane crystals

•Cane sugar

•Corn sweetener

•Corn syrup

•Crystalline fructose

•Dextrose

•Evaporated cane juice

•Fructose

•Fruit juice concentrates

•Glucose

•High-fructose corn syrup

•Honey

•Invert sugar

•Lactose

•Maltose

•Malt syrup

•Molasses

•Raw sugar

•Sucrose

•Sugar

•Syrup

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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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Omega-3 fatty acids are wonder nutrients that offer many benefits to the body, from head to toe. Now, even the mouth is included in the long list of body areas that function better after intake of omega-3s.

A recent study found that a moderate, daily intake of the omega-3s DHA and EPA (found in marine sources, usually fish oil) was associated with up to a 20 percent decreased risk of gum disease (periodontitis).

Gum disease is an inflammatory disease that is caused by microorganisms like the bacteria Streptococcus mutans, Candida albicans and Porphyromonas gingivalis. Usually antibiotics are prescribed in an effort to eliminate these bacteria, but other treatments have been used that target the inflammation of gum disease, like scaling and root planing (ouch!) and in extreme cases surgery.   

Omega-3s are most known for their anti-inflammatory effects, so it is not surprising that they would help quell inflammation in the mouth. Additionally, this study also found that omega-3 fatty acids also demonstrated antibacterial activity against oral pathogens.

The mouth is the very beginning of the digestive tract, and the bacterial balance in the mouth is proving to be more important than previously thought. In fact, gum disease is also associated with the development of heart disease! Everything is connected, folks, and it all goes back to the gut!

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Optimum heart health involves paying attention to a lot of different factors. There’s cholesterol (but not just cholesterol—there’s good cholesterol, bad cholesterol, total cholesterol, oh my!), triglycerides, blood pressure, and inflammation markers like C-reactive protein – not to mention omega-3 levels and even vitamin D! Trying to look after your ticker is enough to make your head spin.

Let’s break it down. First of all, there are different types of heart disease, but atherosclerosis takes the cake. Atherosclerosis involves a buildup of plaque in the artery walls, causing a thickening of the arteries, which blocks blood flow. Eventually the plaque can rupture, causing a blood clot, which can even lead to stroke or death.

Cholesterol levels are usually first on everyone’s mind when it comes to heart health. You want to have plenty of good (HDL) cholesterol, and not too much bad (LDL) cholesterol, all the while making sure your total cholesterol is at the right level. Whew! Next—triglycerides. Those can’t be too high either. Then there’s inflammation. Inflammation takes many forms in the body, but one way it can be measured is with a blood test for C-reactive protein (hsCRP).

All this usually begins with poor diet, lack of exercise and chronic systemic inflammation (which can be caused by a number of factors, including digestive imbalance). Fortunately, this is one condition that can be stopped in its tracks and even reversed. But it’s up to you to stop it.

Take a look at your diet. Are you eating plenty of vegetables, fruits, whole gains, lean proteins, healthy fats and plenty of water? Do you exercise regularly? Do you have digestive issues that are bogging you down? Start from the inside out:

Clean up your diet—You need at least 35 grams daily of dietary fiber from vegetables, fruits, whole grains, and a fiber supplement if needed. Reduce sugar intake, and avoid processed and refined foods. Eat foods rich in healthy omega-3 fats, or take a fish oil supplement.  

Balance your digestive system—Correct digestive imbalances with probiotics from fermented foods and good quality probiotic supplements.

Reduce toxin exposure—Install HEPA air filters inside your home, choose organic foods when possible and use non-toxic cleaners.

Drink plenty of water—Drink half your body weight in ounces per day (if you weight 140 lbs., that’s 70 ounces daily!)

Exercise regularly—At least 30 minutes of aerobic exercise 5 days per week, and strength training two to three times per week.

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Did you ever think that what goes on in your gut could affect your heart? It may seem far-fetched, but it’s not. Think about it: the intestinal lining is connected to the bloodstream, which acts as a direct communication line with the heart and the rest of the body.

Recent studies have found an interesting gut-heart connection. When gut bacteria break down phosphatidyl choline from lecithin, a common dietary ingredient found in foods like eggs, dairy, meat, fish and soy, a metabolite called trimethylamine N-oxide (TMAO) is formed. TMAO promotes atherosclerosis, and higher amounts of this metabolite in the blood increase the risk of heart disease.

This is an interesting study, but there are many questions that still need to be answered. Which bacteria are more likely to produce this TMAO? How does modifying gut bacteria change the heart disease risk? More studies are needed to determine this, but researchers suggest that probiotics may be used in the future for preventing heart disease.

It’s exciting science, though still in the early stages. But the overall message is clear: what happens in your gut affects the rest of your body. No question.

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