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Low Salt Intake - Good Or Bad For Your Heart Risk?

>> Tuesday, September 2, 2014




High blood pressure, called hypertension, is a major risk factor for cardiovascular disease.  Because we know that high salt intake is associated with a higher risk of having high blood pressure (especially in those who are genetically prone to hypertension, and those who carry other medical conditions that increase risk for hypertension such as obesity), huge efforts have been made around the world to try to get the general population to eat less salt.  Interestingly, recent studies have raised the question as to whether too little salt may be associated with higher heart risk as well.

This issue was addressed in a recent issue of the New England Journal of Medicine, with two studies (3 articles) and an accompanying editorial.

The first study, called the PURE study, looked at urine samples from over 100,000 adults in 18 countries, and found that 96% of people studied exceed the current US guidelines for sodium intake. They found that the relationship between blood pressure and salt intake was strongest in those with high salt intake.  They also found that people with both high and low sodium excretion had a higher risk of cardiovascular disease.

Interestingly, high salt intake was more strongly associated with high blood pressure in people with lower potassium intake, and there was a lower risk of cardiovascular events and death in people who had higher potassium intake.  These findings suggest that higher potassium diets might achieve better blood pressure reduction and cardiovascular protection than sodium reduction alone.

The second study, called the NUTRICODE study, looked at global salt intake based on surveys from 66 countries, analyzed data from 107 published clinical trials, and found a strong relationship between sodium intake and cardiovascular events.  They estimated that a whopping 1.65 million cardiovascular deaths in 2010 were attributable to excess sodium consumption.

So where does this leave us?   One major take home message is that 96% of people studied are eating more salt than what is recommended.  We know that excess salt intake is linked to increased risk of high blood pressure and heart disease, so for the vast majority of us, cutting back on our excess salt intake is needed.  There is much added salt in our food supply, especially in processed foods, so cutting back on manufactured food is one of many steps in the right direction!

Second, it appears that eating more potassium may be beneficial - BUT - there are many people in whom it could be dangerous to up potassium intake, such as patients with kidney problems.  There are also many medications (especially some blood pressure meds) that can increase potassium levels.  Too much potassium in the blood can be dangerous, so it is VERY important to discuss with your doctor before making any changes to your potassium intake.

As to whether low salt intake could increase the risk of heart disease - the question has definitely been raised by the above data.  The American Institute of Medicine has evaluated the data, and concluded that current data is not sufficient to make conclusions on this.  Now, we need a high quality clinical trial to give us a definitive answer to this provocative question.


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What Does 200 Calories Look Like?

>> Monday, August 25, 2014

While we often talk about how many calories a person needs in a day to maintain or lose weight, it's often difficult to grasp what these numbers mean in real life.

Here's a really interesting graphic from the Huffington Post, with some great examples of what 200 calories looks like.  (You can access a higher resolution version in the original article).  Notice how much 'good stuff' (eg veggies and fruit) you can get for 200 calories, compared to how little of some other foods adds up to 200 cal.  You can think of calories like a daily budget (similar to the Weight Watchers' program) - when you are preparing to pop something in your mouth, think about that budget and ask yourself... is it worth it?

Also interesting is the section on 'Ways to Burn 200 Calories'.  The point is that it takes a loooong time to burn off those 200 calories that may have taken only seconds to eat - 37 minutes of dancing, 25 minutes of running stairs, or 40 minutes of badminton.  (Note that this calorie burn does vary greatly depending on intensity, body weight, gender, etc.).   Again, think about that daily calorie budget - most people don't realize how the calorie burn from a long bout of exercise actually takes very little food to make up again.

Please note that the 'recommended calorie intake' part of the infographic below is not correct - this number varies widely depending on age, weight, gender, and activity level.  You can calculate an estimate of your approximate calorie requirement in the right hand panel of my main page here.




Thanks to Bob for the heads' up on this graphic!

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Raw Food Diet - Dr Sue's Review

>> Tuesday, August 19, 2014




The premise of the raw food diet is just that – eating only foods that are uncooked and unprocessed.  This includes raw meat, fish, veggies, fruit, nuts, seeds, eggs, and non pasteurized dairy products.

The philosophy behind this way of eating is that cooking can deplete foods of useful nutrients (which is true eg for veggies, though depending on how they are cooked – boiling veggies brings some of the nutrients into the water, whereas steaming retains the nutrients inside the vegetable).  Raw foodists also wish to avoid potential carcinogens that can be present in cooked/processed food (eg heterocyclic amines that are found especially in burned meat (eg BBQ’d), and a long list of environmental pollutants that could make their way into our processed foods (BPA being just one example)). Chemicals and stimulants (such as coffee and tobacco) are also avoided.

Good things about this diet are that one does truly decrease exposure many chemicals that are ubiquitous in our food supply.  Foods that are raw are in their purest form, and highest in nutritive value (especially if wild/organic foods are sourced, as rawists tend to do). 

However, a major risk of eating in this way is food poisoning.  There is a reason why we pasteurize our dairy products and cook our eggs and meat.  Processes such as pasteurization have allowed us to function in urban society, enabling us to keep food longer, to feed the masses living in a relatively small space, as we were perhaps not meant to do, but which is a part of modern life for most people.

While some raw foods are very easy to prepare (eg salads), others are very time consuming.  For example, to eat rice or other grains, they have to be sprouted and/or soaked overnight to be digestible. 

And finally, the question that is central to the discussion of any diet:

Is It A Permanent Change?  I would submit that this is very difficult to adhere to over the long term – but this concern is overridden by my greatest fear which is that of the unsafe consumption of uncooked foods and risk of food poisoning that may ensue.




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South Beach - Dr Sue's Review

>> Monday, August 11, 2014





As regular readers will know, I'm reviewing some of the most common diet plans over the course of this summer and fall.  This week, I'm sharing my thoughts on the South Beach diet.

South Beach is a lower carb approach, but not as rigorous as the Atkins diet in terms of carb restriction after the first two weeks (read my review of Atkins here).

The South Beach Diet is divided into three phases:

  • Phase 1 (2 weeks): avoidance of most carbohydrates
  • Phase 2: gradual reintroduction of lower glycemic index carbs
  • Phase 3: lifelong maintenance phase - up to 28% of energy can come from carbs in this phase
Healthy food choices are emphasized, including lower glycemic index carbs, monounsaturated fats, and lots of fibre.

Overall, the South Beach approach is pretty good in the long term, though I don't agree with the carbohydrate avoidance in phases 1 and 2.  My preference would be to skip straight to Phase 3, which provides a reasonable balance of macronutrients (protein vs carb vs fat) while advocating for healthy food choices.  This is a permanent lifestyle change that has a better chance of longevity than many other food plans that are not realistic; but remember, no one food plan is the right one for everyone.  It's all about following it over the long term, and a permanent change has to be the one that is right for you.

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Eat Right For Your Blood Type - Dr Sue Review

>> Tuesday, August 5, 2014



The 'Eat Right For Your Type' diet is based on the idea that a person's blood type (A, B, AB, or O) is an important factor in determining what kind of nutrients an individual needs, and recommends different dietary intake for each of these blood types.

Naturopath Peter J D'Adamo, who came up with this idea, asserts that carbohydrate binding proteins in food, called lectins, react differently with each ABO blood type.

In this diet program, Type A blood stands for 'Agrarian', believing that this blood type dates from the dawn of agriculture.  Type As are therefore advised to eat something resembling a vegetarian diet, avoiding red meat.

D'Adamo labels Type B individuals as the 'Nomads', and states that these are the only people who do well with dairy products.

Type O is the 'Hunter' group, so D'Adamo recommends a higher protein diet for these people.

AB blood types are called the 'Enigma' group, falling somewhere between the As and the Bs for dietary recommendations.

So, is there scientific evidence to support these claims?  In short, the answer is no.  No to the point where the American Journal of Clinical Nutrition has spoken out specifically against this diet.  In fact, biochemical research has established that lectins specific to ABO blood types are not even found in most foods.   There are also no published clinical trials to substantiate D'Adamo's claims.

Another one bites the dust.

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A HEARTFELT WELCOME!

I am excited that you have arrived at my site, and I hope you are too - consider this the first step towards a Healthier New You!! As a medical doctor, Endocrinologist, and obesity specialist, I am absolutely passionate about helping people with weight management. Though there is certainly no magic cure for obesity, there IS a successful treatment plan out there for you - it is all about understanding the elements that contribute to your personal weight struggle, and then finding the treatment plan that suits your needs and your lifestyle. The way to finding your personal solution is to learn as much as you can about obesity: how our toxic environment has shaped us into an overweight society; the diversity of contributors to obesity; and what the treatment options out there are really all about. Knowledge Is Power!!


Are you ready to change your life? Let's begin our journey together, towards a healthier, happier you!!




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