Tag: heart disease

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Salty Advice About Dietary Salt

A spilled salt shaker. (iStockphoto/Thinkstock)
A spilled salt shaker. (iStockphoto/Thinkstock)

None of us are strangers to table salt. Everytime you eat something, you probably make a remark regarding the amount of salt in the food. Some people may think it is just right, some may find it too salty and some may feel extra salt is required.

Our body contains many salts. Table salt (sodium chloride) is a major one making up around 0.4 per cent of the body’s weight at a concentration pretty much equivalent to that in seawater. Somebody has calculated a 50 kg person would have around 200 gm of sodium chloride in his body. That makes around 40 teaspoons.

We continually lose salt when we lose water from our body as salt is in a solution. So when we are sweating, vomiting, having diarrhea or voiding water by act of urination, we are losing salt. Salt cannot be made in our body so we have to replenish it otherwise there can be serious consequences.

Salt is needed to maintain our blood volume and blood pressure. Sodium is also needed for nerves and muscles to work properly. Low levels of body sodium can make our brain swell and cause confusion.

Too much sodium is bad for us as well. Excessive consumption of sodium can increase blood pressure, and that salt is a major determinant of population blood pressure levels. Some research estimates suggest the numbers of deaths averted by moderate reductions in population salt consumption would be at least as many as those achieved by plausible reductions in population smoking rates (CMAJ June 12, 2012).

The fast food industry is making its own contribution towards increasing the general population’s salt intake. Fairly large population is relying on fast food industry to provide their daily food needs. Fast food tends to be more energy dense, contain more saturated fat and salt, contain fewer micronutrients and be eaten in larger portions than other foods, says the CMAJ article.

Fast food items such as fried potatoes, pizzas and sugar-sweetened soft drinks typically provide between one-third and one-half of daily energy intake but less than one-quarter of most micronutrients.

Now what? Too much or too little salt in the diet can lead to muscle cramps, dizziness, or electrolyte disturbance, which can cause neurological problems, or death. Generally, more emphasis is given to the evidence showing an association between salt intakes and blood pressure among adults. We also know reduced salt intake results in a small reduction in blood pressure. Evidence suggests that high salt intake causes enlargement of the heart and swelling of the legs.

There is a clear scientific evidence that a modest and long term reduction in population salt intake can result in a lower population blood pressure, and a reduction in strokes, heart attacks and heart failure.

Then what are we waiting for? Most of us consume more salt than we need. General recommendation is no more than six grams (about one teaspoon) of table salt a day. This includes salt used in cooking and at the table. If you have high blood pressure or heart disease then less than two grams of table salt per day will be helpful. Are you willing to try that?

So, how is your food tasting today?

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Research Shows Laughter and Music Good for Your Heart

A group of smiling women. (Goodshoot)
A group of smiling women. (Goodshoot)

In 2009, for the first time, research showed that there is some truth in the good old saying, “Laughter is the best medicine.” But anger and stress, hmm… not so good.

Laughter, along with an active sense of humour, may help protect you against a heart attack, according to the 2009 study by cardiologists at the University of Maryland Medical Center in Baltimore. The study found that people with heart disease were 40 percent less likely to laugh in a variety of situations compared to people of the same age without heart disease. They also displayed more anger and hostility.

The researchers could not explain how laughter protects the heart but they found that mental stress is associated with impairment of the lining of the blood vessels. The damage to the lining is followed by inflammatory reactions that lead to fat and cholesterol build-up in the coronary arteries and ultimately to a heart attack.

Now let us fast forward to 2011. Location: Paris, France. At a session entitled, “Don’t worry, be happy,” a series of research papers were presented at the European Society of Cardiology Congress highlighting the role of laughter, positive thinking (cognitive therapy), anger, and job stress on developing cardiovascular events.

The cardiologists from Baltimore presented their research related to the effects of humorous and stressful movies on the function of the lining of the blood vessels. They found that the blood vessels constricted by as much as 30 to 50 per cent when watching movies which were emotionally stressful. In contrast, blood vessels dilated when investigators measured vascular function in subjects watching the comedies.

Positive or negative effects on blood vessels can last for about an hour. Other researchers have seen the benefits of laughter on vascular function extended to 24 hours. The magnitude of change in the blood vessel is similar to the effects observed with statins and physical activity.

Other studies presented at the Paris conference dealt with the effect of anger, job stress, and depression. A study from University of Helsinki, Finland, observed that public-sector individuals who work more than three hours overtime per day were at an increased risk of coronary heart disease compared with those who worked no overtime.

A study from the Institute of Clinical Physiology in Pisa, Italy, recruited 228 patients with the diagnosis of myocardial infarction (heart attack), 200 of whom were men, and assessed the long-term effects of anger on recurrent cardiovascular outcomes. They found that over the course of 10 years, 78.5 per cent of patients without an angry-personality profile were free from a recurrent infarction compared with 57.4 per cent of patients with angry personalities. People with angry personalities tend to eat more and use alcohol too much to curb stress.

A study from Australia showed at four months, cognitive therapy reduced depression and reduced waist girth, increased good (HDL) cholesterol levels and increased physical activity. Patients were better at managing their anger, depression and anxiety.

A researcher from Germany, believes that classical music offers the ideal therapy for patients with hypertension and increased heart rates. He is now planning a prospective study called “Bach or beta blockers.”

Come to think of it, preventing heart attack is lot of fun. Laugh a lot, listen to music, have a positive attitude, meditate a bit, eat healthy, exercise regularly, have a glass of red wine, have a fulfilling relationship with your partner, go dancing and manage your anger. Easy.

Now, go and have some fun.

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Safety of calcium supplements questioned – how much is enough?

One thing is beyond dispute – whatever the age, we all need calcium to make our teeth and bones strong. Calcium is also required to make our muscles and nerves function. Calcium is also a necessary factor for blood clotting.

Although these facts are well known, many people continue to be deficient in their calcium intake and hence in their body’s total calcium requirement. This leads to bad teeth and osteoporosis, bone fractures and its nasty complications.

On the other hand, studies have shown that too much calcium is not good for your health. But how much is enough? There is no agreement on that.

-In Britain, women over 50 are urged to consume 700 milligrams a day.
-In Scandinavia the level is set at 800 mg.
-In the United States and Canada it’s 1,200 mg.

-In Australia and New Zealand top the list with 1,300 mg.

A Swedish study published in the British Medical Journal found that women who consumed less than 700 mg of calcium a day had a higher risk of fractures than those who took in larger amounts. But an intake of more than 700 mg per day didn’t seem to provide any additional protection. The results suggest that there are no further benefits to taking more than 700 mg. of calcium every day.

Some studies have suggested that taking calcium supplements (but not calcium from food) may increase a woman’s chances of developing heart disease. Other studies have suggest that calcium may play an important role in the development of prostate cancer but evidence also shows calcium may lower the risk of colon cancer and age-related thinning of the bones.

Men are also prone to getting osteoporosis. In women, bone loss begins before menopause and is accelerated in old age. So prevention is better than cure.

One glass of milk contains 300 mg of calcium. About 175 ml of plain yogurt and 42 grams of cheese each contain about 300 mg of calcium. You can get enough calcium on a daily basis just by drinking milk and enjoying natural yogurt and cheese.

And don’t forget your vitamin D 1000 to 2000 IU per day especially in winter months. Vitamin D has an important role in preventing prostate cancer and other cancers.

A report published in the Journal of the American Geriatrics Society says vitamin D, taken in a high dose, may help prevent falls in the elderly. The study shows that nursing home residents who took a daily dose of 800 international units (IU) of vitamin D for five months were less likely to fall than those who took either lower doses or no vitamin D.

Another paper reviewed 29 observational studies and concluded that in North America, a projected 50 per cent reduction in colon and breast cancer incidence would require a universal intake of 2,000 to 3,500 IU per day of vitamin D.

A third report came out in the Archives of Internal Medicine. This review paper analyzed the results of 18 vitamin D studies says that taking vitamin D supplements may help people live longer. But it’s not yet clear exactly how vitamin D does that. But it appears to be a life extender.

Don’t be confused now. Eat a healthy balanced diet, take vitamin D and do regular exercise. Talk to your doctor to find out what is the best dose of calcium and vitamin D for you. Then sit on a recliner and enjoy a cold or hot glass of milk. Sounds like a good idea to me.

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Mr. Heart, Who’s Your Daddy?

February is meant to be a fun month. We have Valentine’s Day and Family Day. Children have reading week. Many families make use of this time to take a holiday. Put real meaning to what family means. This is the month when many people find their life partner and make life-long commitment.

Then there are people who are born on February 29. You wonder whether it would have been better to be born on February 28 or Mar 1. February is also Heart Month. Every day you hear and read about heart disease and how it is going to kill you or paralyze you. You say, “Enough of this. Life is too short. Let me have my fun. Leave me and my heart alone.”

Your heart belongs to you. It has only one daddy. That is you. Same thing applies to me. I am responsible for my heart’s well being. We should all take as much responsibility as we are able for our own health. An editorial in the Canadian Medical Association Journal (CMAJ Jan 31, 2006) says, “…we know that people who are likely to live longer eat less, exercise more and are unlikely to smoke tobacco…” I call this simple and basic personal responsibility for taking care of our health.

The WHO research has shown that high proportion of the world’s illness can be attributed to relatively small number (20 or so) modifiable risk factors. In affluent countries like Canada, we talk about lifestyle factors in diseases like obesity, hypertension, cardiovascular disease, diabetes and cancer. Remember, we are talking about modifiable risks factors.

Lifestyle changes mean any activity of an individual, family or community, with the intention of improving or restoring health, or treating or preventing disease. Lifestyle changes can result in large reductions in premature death and increase national productivity, says the CMAJ editorial. These changes can be made slowly in incremental fashion to achieve your goal. When it comes to eating, replace bad fats with good fats. Eat more fruits and vegetables. Do not forget little bit of red wine, almonds, garlic and dark chocolate. Who said making lifestyle changes was dull and uninspiring?

You can go dancing, swimming, make love, pray, meditate, laugh and go for a walk. Be involved in your community. There are lots of fun things you can do to stay healthy. You are only limited by your imagination.

In the last three columns, we have covered most of the areas you need to work on and be heart smart. Heart Month is almost over. Weather is still lousy. Snow is still on the ground. But don’t get depressed. Go out and have some fun.

Start reading the preview of my book A Doctor's Journey for free on Amazon. Available on Kindle for $2.99!