A Salty Study

I received an email recently from a patient wanting to know what to do in regards to salt intake in light of a study which was released this month from the Journal of the American Medical Association.  There has been long standing consensus that too much salt in the diet raises blood pressure.  High blood pressure (hypertension) indisputably increases the risk of both heart attacks and strokes.  The study looked at a group of people for eight years and followed them till they were 49 years old.  The Centers for Disease Control made a public statement expressing concern over the study's findings and reiterated their support of the stand of the World Health Organization and the American Heart Association that sodium be limited to 1500-2300 mg a day.  Interestingly, the Salt Institute, was the lone organization that hailed the study.

One of my big concerns about the study is how young the patients were.  The chance of dying of heart disease before the age of fifty is quite low.  The fact that they could measure a statistically significant difference surprises me.  It makes me wonder if those who died had preexisting heart disease.  They would be much more likely to be on low salt diets because that is what their doctors would have told them to do in order to minimize their risk.  If that were the case, it would not be salt restriction which caused them to have more adverse events, but rather their underlying heart disease.

Tropical fruit high in potassium with no salt!

Some of the best information we have in regards to sodium restriction come from studies done in relation to the DASH (dietary approaches to stop hypertension) diet.  It is sponsored by the National Institutes of Health (NIH).  Recent studies are summarized on their website at www.dashdiet.org.  Some years back I came across a study from a remote pacific island.  The population that lived there did not have access to processed foods.  The amount of sodium in their diet was exceedingly low and the amount of potassium was quite high due to a high intake of the native tropical fruits and vegetables.  The astonishing finding to me was that they did not find one single person with high blood pressure.  Not one!  I would have thought that someone would have had a genetic aberration that would have caused their blood pressure to be high.  To me, this study stands as a testimony of what eating the right foods will do for us.  Remember, if it sounds too good to be true, it usually is.  Leave the salt in the cupboard.

Make Every Step Count

"I don't have time for exercise."  I hear this all the time.  Most people, frankly, can make time to exercise.  It won't be found because there is always something that will fill a void.  Time for exercise has to be made.  I do know of some people, that truly have no time for exercise.  Some work two jobs or who care for elderly parents who are not well.  Exercising with small children is difficult also.  How is one to do it?

First, make every step count.  Go buy a pedometer (step counter).  They are rather inexpensive and can be found at most sporting good stores.  It is worn at the waist and will activate every time a step is taken.  Sufficient activity for one day is 10,000 steps.  Wear one around for a day and see how many steps you take.  See how many steps you need to make up and find ways of increasing them.  Park in a far corner of the lot wherever you go.  Take the stairs instead of the elevator.  It has been years since I have used the elevator at the hospital.  Take your dog for a walk.  Take a friend for a walk.  Take a bag lunch to work and go for a walk while you eat it.  Every step counts but you've got to take them.

What do you do during your down time?  Instead of going to a movie, go to the park.  Eat at a restaurant in an interesting area of town so that you can take a stroll afterwards.  When was the last time you have been dancing?  It is fun and burns those calories.  If you are going to sit and play a video game, then for goodness sake, get the Wii fit or one of the dance programs that makes you get up and move.  Walk over to your neighbor's house.  Go to the mall, but park on the other side.  Don't take the escalators but find the stairs.  In everything you do ask yourself, "How can I make every step count?"


Track your progress.  This will make you accountable to yourself.  Just this week I spoke with an 89 year old who told me that over the last 15 years he has biked over 40,000 miles.  This is a frail, old man.  He is not breaking any records for speed.  I have no doubt, though, that it has kept him alive.  By keeping track of your progress, you will find that you will naturally do small things to increase your activity.  If you only need to climb one flight of stairs to get to work, you may decide to go up two or three flights and then go back down to your level.  If you work on the 45th floor of a building, you may get off on the 40th floor and walk up the remaining five flights.  Make every step count.

The Buddy System

Like a group of boy scouts on a mountain adventure, to safely ascend the peak of good health it is helpful to have someone at your side.  A partner gives you a reason to show up at the gym when the alarm goes off, the air is cold and the bed is warm.  A partner helps you stay on track.  Your "buddy" may be an exercise class.  It might be a family member.  It could even be your dog who needs to talk a walk.  Being accountable to others transforms desire into resolve; good intentions into a way of life.

Staying on track with health is like walking on the straight and narrow path.  If we can't stay on it, we need to at least cross over it as often as possible.  A buddy helps to get us back on the wagon.  They will cheer for us when we are doing well, comfort us when times are hard and encourage us when we want to quit.  It can be as difficult to forge good habits as it is to break bad ones. Just as Alcoholics Anonymous uses mentors to keep a drunk dry, a mentor can also keep you going.  It has been shown that it generally takes twelve weeks of persistent effort to forge a good habit.  The hardest aspect of healthy living is to take a healthy choice and repeat it again and again and again.  It would be so much easier if we could exercise just one week out of a month and reap the same rewards.  Our bodies don't respond that way.  Consistency is the key.  I came across an article that found that Olympic level swimmers were studied as to their level of physical fitness at the peak of their exercise routine and then followed after stopping.  It only took six weeks for them to get out of shape.


A little competition never hurts either. Choosing a friend who is just a little better than you can do wonders.  Set a goal together.  Sign up for a walk or a run.  Support your favorite charity.  Buy yourself a bathing suit that is two sizes too small in the winter and pay for a summer vacation.  Upcoming weddings, reunions and other occasions can serve as goals to keep you going as well.  If you make the goal with a buddy, it will keep you going even on days when you may need to exercise on your own.  Do what works for you, but having a partner will keep healthy living a priority in your life.

Move That Body

Fifteen years ago there were two states that had obesity rates over 20%. Currently all states but two have such rates.  As a society we are getting bigger and bigger and bigger.  Much of that has to do with how and what we eat (see my previous posts) but the biggest reason in my mind is that we are getting more and more sedentary.  Most of us live in neighborhoods where it is impossible to walk to the store.  Very few of us take public transportation that would require us to walk to and from a bus stop or train station.  Most jobs are now desk jobs.  Many jobs that require physical activity have now become automated.  Even farming is not as physical as it once was.  We have machines that do most of the work for us.  When I was a child, we spent most of the day outside playing.  There are currently many children that spend all of their free time in front of either a television or computer screen.  Physical education at school has been cut back in many districts.  The combination of a diet that is full of foods requiring very little metabolism with a life style that does very little to activate our metabolism, adds up to caloric excess.  Our body is only too happy to store it away as fat and the weight comes on.

I came across an astounding statistic a few years back.  There is a group of people followed by the UCLA medical center who have lost about 100 pounds a piece and have kept it off.  The researchers were eager to try and find out what characteristics these people had in common.  They could only find two.  First, they all ate breakfast.  Second, they all exercised on average one hour per day for at least five days a week.  I'll talk about the first point in a later post but it is the second one that I want to stress.  This kind of exercise requires a complete life change and priority adjustment.  Those who try to find time to exercise, don't.  Time for exercise is not found, it is made.  It is only after exercise becomes a priority that big changes occur.  Anyone who has watched, "The Biggest Loser" can attest that the winners have all learned how to work out hard.  The ones who go home and don't keep up their routine regain weight.  Those who have changed their life for good, keep it off.

I have seen patients lose 10-20 pounds through watching their diet better but the only ones that I have seen lose 40-100 pounds are the ones who made exercise a priority.  Diet alone will fail because at a certain point of calorie restriction the body will just shut off metabolism.  Exercise is needed to keep it going.  I recently saw a 93 year old patient who is doing wonderfully well.  She remains active, her mind is sharp and is a delight to be around.  I don't think that it is any coincidence that her only complaint to me that day was that the "CURVES" in her neighborhood closed down.  When I asked if she found other ways to exercise, she slapped me on the shoulder and said, "of course!"


I know that I am not proposing anything that everyone doesn't already know.  It is not a lack of knowledge that keeps us back, it is motivation.  In the weeks to come I hope to inspire you a little more by sharing my thoughts on why exercise is so important, how it keeps us healthy, ways to begin exercising and helpful hints to keep it up and keep it going.  Tune in and keep moving!