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Could A Low-Salt Diet Be Bad For Your Heart?

A spilled salt shaker

A paper in a recent edition of  Journal of the American Medical Association (JAMA) offers the contradictory conclusion that taking in less salt—a key goal of U.S. health and dietary recommendations—is bad for you. But before you roll your eyes and groan about flip-flops in science, know that this study isn’t the kind of work on which you or anyone should base dietary decisions.

In this study of 3,681 men and women from Belgium, Bulgaria, Italy, Poland, Romania and Russia whose health was followed for eight years, participants with the lowest sodium excretion (which is a good measure of sodium intake) were 56% more likely to have died from cardiovascular disease than those with the highest sodium excretion. Among the nearly 2,100 participants with normal blood pressure at the study’s start, sodium excretion (sodium intake) had no effect on the development of high blood pressure.

These are startling findings. If true, they would undercut major programs by the U.S. government to reduce Americans’ intake of salt—the main source of sodium—from prepared and processed foods and at home. Read more »

*This blog post was originally published at Harvard Health Blog*

More Potassium, Fewer Strokes

There are few medical conditions that people fear more than a stroke. We know that blood pressure control and lowering cholesterol levels reduces stroke risk. Now, thanks to a huge analysis from Italy published in the Journal of the American College of Cardiology, we know that higher dietary consumption of potassium is associated with lower rates of stroke and could also reduce the risk of coronary heart disease and total cardiovascular disease, too. What is even more remarkable is that the results apply to all parts of society and not just to specific “at-risk” subgroups.

Most doctors aren’t even aware of how important it is to eat potassium-rich foods. And what are these foods that have potassium? Surprise: It’s fruits and vegetables like bananas, tomatoes, oranges, apricots, most legumes, spinach, winter squash, avocado, kiwi, and cantaloupe. Actually, almost all fruits and veggies have moderate to high potassium content.

The researchers looked a number of well-done studies that included 247, 510 participants over age 30 and found that those patients with the higher potassium intake reduced their stroke risk by 21 percent. The Italian doctors say the protective effect of potassium against stroke is in part due to its blood pressure lowering effects and also due to other properties of the potassium mineral, such as the inhibition of free radical formation.

I’ve written before about the DASH diet, which also found that reduction of sodium and addition of fruits and vegetables to the diet is an effective way to control blood pressure. The DASH diet is high in potassium.

Think about it: Did you have five servings of fruits and vegetables today? Numerous studies have shown their life-prolonging benefits. This new study just adds to what we already know. I challenge all readers to keep a diet count and make sure you are eating five fruit and vegetable servings a day — every day — to help reduce your risk of stroke, cancer, and heart attack.

*This blog post was originally published at EverythingHealth*

Eat More Calcium To Prevent Calcium-Containing Kidney Stones?

Over the years I have had a number of patients with painful kidney stones and once they have passed (or been removed) I have felt at a loss to helping them prevent them. ”Stay hydrated” somehow didn’t seem adequate, although we know fluid intake can help stave off recurrent kidney stone attacks.

Some textbooks said “avoid calcium” since most stones are made of calcium oxylate. High oxylate levels can be found in some fruits and vegetables, as well as in nuts and chocolate. Yet there was no real scientific evidence that these foods caused stones. The evidence for who got kidney stones was all over the ballpark and for a physician, that means no prevention advice is really proven.

A new study published in the Clinical Journal of the American Society of Nephrology says that calcium rich foods such as low-fat milk and yogurt can be protective. What? Eat more calcium to prevent calcium-containing stones? It seems that higher intakes of calcium are actually associated with a reduction in kidney stone risk. Read more »

*This blog post was originally published at EverythingHealth*

McDonald’s Vs. DASH: Two Days, Two Diets

This week I’ve been trying to eat according to the DASH guidelines for lowering blood pressure. It actually hasn’t been too difficult — partly because I’m not following their strictest guidelines, which call for just 1,300 milligrams of sodium and 16 grams of saturated fat a day. I’ve been shooting for 2,300 milligrams of sodium and 22 grams of saturated fat.

In 2003, I tried a somewhat different “diet,” which in some ways was more difficult to follow, even though it only lasted one day. My son Jim (then age 11) and I ate every meal at McDonald’s for an entire day (yes, this was before Super Size Me). We recorded the experience on the Web. I thought it would be interesting to compare my day at McDonald’s to a typical day on DASH. Read more »

*This blog post was originally published at The Daily Monthly*

Can High Blood Pressure Be Controlled With Diet?

Do a search on the Internet for “high blood pressure” or “hypertension” and you’ll find that nearly every health website recommends the DASH diet to control blood pressure. It makes some sense: If sodium and saturated fat cause high blood pressure, then removing them from your diet should make it come back down.

But changing your eating habits is easier said than done. It’s easy to say you want to cut down on fat and sodium, but it’s hard to resist a hot slice of Chicago-style pizza piled high with sausage and cheese. Read more »

*This blog post was originally published at The Daily Monthly*

Latest Interviews

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors…

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How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

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Latest Book Reviews

Book Review: Is Empathy Learned By Faking It Till It’s Real?

I m often asked to do book reviews on my blog and I rarely agree to them. This is because it takes me a long time to read a book and then if I don t enjoy it I figure the author would rather me remain silent than publish my…

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The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

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Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

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