Do Beets Help Blood Pressure?

In one word….YES!

I could leave it at that and let the world either revel in the fact or find some way to avoid them altogether regardless of the hypertensive crushing power because of how they taste.

Seeing as this month is heart month, lets dive into why these red tubers are actually quite healthy and can play a most excellent part in a diet.

Beets may help lower your blood pressure

Beets may help lower your blood pressure

But first, the study.

Our British friends across the pond were the ones that did the study. They took 64 subjects with hypertension who either were on medications or who hadn’t yet been prescribed anything and assigned them to 2 beet juice groups; one group had nitrates in the juice (which are naturally occurring), and the other had no nitrates.

Now if the idea of drinking beet juice sounds revolting, hold on just a moment.

In the group that was receiving the nitrates in their juice, blood pressure was reduced by ~8/4 mmHg. [1] That’s on par with some blood pressure medications. Endothelial function also improved as well as arterial stiffness reduced. The article said that the treatment was well tolerated. I’m sure the only real side effect was that of red urine and stool. The dose was 250ml juice/day.

Another study done with 500ml daily found a reduction of 4-5 mmHg systolic pressure 6 hours after ingestion. [2]

Another study found that beets may increase exercise tolerance. [3]

Researchers at Wake Forest have shown increase blood flow to white matter in the anterior brain and believe that beet juice has potential to decrease the chances of poor cognition and dementia in older people. [4]

Beets are great! And they appear to have some great benefits. The only problem is you actually have to ingest them to get the benefit. So what’s a person to do?


You can eat beets raw, and there is nothing wrong with that. They are somewhat tough though, especially if they aren’t young. Slice em thin or cut them small to make them easier to masticate. Thinly sliced beets with some other veggie like celery or onion, with olive oil drizzled over and some salt or crushed garlic makes for a great appetizer.


Roasted or steamed beets with oranges or other citrus and some crumbled cheese is a great salad

Roasted or steamed beets with oranges or other citrus and some crumbled cheese is a great salad

Steam those suckers and add a pinch of salt and pepper. Place them atop the beet greens and crumble some cheese on top.


If you have a juicer, you can always juice them, just beware of staining. The pulp can be used in other recipes if you’re looking for some coloring or fibre. Also be aware that because you take the fibre out when you juice, you also increase the glycemic index of the food. Beets are no exception. Don’t drink 500ml of veggie and fruit juice a day and expect your triglycerides to stay low. Keep it to mostly veggies and maybe just a bit of fruit to keep the sugar level down.


You can do it yourself and this is probably the best method. Pickeled beets are great on salads or just straight.


Add them to soups, any salad, bake them till soft and marinate them in some balsamic vinegar and salt. Borscht is also popular. Crush it up and put it in your gnocchi dough to make some red/purple gnocchi. Here’s one recipe you can try:

One word of caution. If you are a person with a history of oxalate kidney stones, be careful as to the amount of beets you actually consume. As beets have lots of oxalates, the risk for stones in this population would be increased.

Let me know how you eat your beets.





1.Dietary nitrate provides sustained blood pressure lowering in hypertensive patients, Vikas Kapil, et al., Hypertension, doi:10.1161/HYPERTENSIONAHA.114.04675, published online 24 November 2014,

2.Coles, Leah T., and Peter M. Clifton. Effect of beetroot juice on lowering blood pressure in free-living, disease-free adults: a randomized, placebo-controlled trial. Diss. BioMed Central, 2012.

3.Bailey, Stephen J., et al. “Dietary nitrate supplementation reduces the O2 cost of low-intensity exercise and enhances tolerance to high-intensity exercise in humans.” Journal of Applied Physiology 107.4 (2009): 1144-1155.



Writing and Health: Part Deux

Last weeks post about writing was pretty popular, so I decided to do another post about it and some of its benefits. If you missed last weeks’ post you can click on it here:

writeThis won’t be a comprehensive overview of everything beneficial from writing. It is a fascinating thing and I do agree that writing and command of language is a skill that can only benefit everyone that is involved; writing or reading.

In many of the studies that I’ve looked at, the writing performed has been centered around self-expression and dealing with emotions and experiences rather than mundane and the everyday. I find this interesting, as mentioned in the previous post, as it focuses our brains on things that affect us very deeply, rather than external “things” that really matter very little.

One study found that blood pressure was reduced as an effect of expressive writing. [1] Another study assessed blood pressure only right after the writing, and found that it was elevated and mood was more negative. [2] This might be explained by people either reliving events, or just having stress associated with thinking about them. The interesting part is that during follow-up, people reported fewer health center visits. This might be a result of expressing the emotions and getting them out of the system, so to speak, rather than having to deal with them in a clinic setting.

In a study of women, it was found that those with chronic pelvic pain who wrote about the stressful consequences of their pain reported lower pain intensity ratings than women who only wrote about positive events. [3]

PTSD (post traumatic stress disorder) is a problem among many people, especially members of the military. During a writing period of just 2 weeks, sufferers of PTSD were asked to write about the trauma or a trivial topic. In both groups “everyone reported less severe PTSD symptoms, impact, and dissociation, and fewer health visits, but about the same suicidal ideation and depression” [4] The trauma group got worse right after writing but were better at the 6 week follow-up. The trivial group was better after and continued to be so at the follow-up.

Another study looking at “traumatic events” found that writing also helped with depression and avoidance behavior. No benefit was found in a “waiting list” group who received no instructions, and who effectively didn’t participate in the trial. [5] It is possible that people with traumatic events in their past simply need to write to receive benefit, with content not so important.

In one interesting study of prison inmates, 3 groups; traumatic writing, trivial writing, and no writing, were assessed pre and post writing assignments. No differences were found between groups with the exception of the traumatic writing and sex offenders. They were found to have decreased infirmary visits than others. [6]

I again reiterate what I said in my last post: WRITE! Write and express thoughts and feelings in a journal. Write a short story too while you’re at it. Look at a writing exercise as just that, an exercise. If that is too much stress, because it sounds like a chore, then write for fun. Exercise is always more productive when you’re having fun doing it, so is writing.

So start a writing club. Try your hand at poetry. Maybe divulge your feelings and emotions concerning things that have happened in the past. Share it with the world or keep it to yourself, but write and enjoy the benefits of learning to command your language.


1.Davidson, K., Schwartz, A. R., Sheffield, D., et al (2002) Expressive writing and blood pressure. In The Writing Cure: How Expressive Writing Promotes Health and Emotional Well-being (eds S. J. Lepore & J. M. Smyth), pp. 17–30. Washington, DC: American Psychological Association.

2.Pennebaker, J. W. & Beall, S. K. (1986) Confronting a traumatic event. Toward an understanding of inhibition and disease. Journal of Abnormal Psychology, 95, 274–281.

3.Norman, Sally A., et al. “For whom does it work? Moderators of the effects of written emotional disclosure in a randomized trial among women with chronic pelvic pain.” Psychosomatic Medicine 66.2 (2004): 174-183

4.Deters, Pamela B., and Lillian M. Range. “Does writing reduce posttraumatic stress disorder symptoms?.” Violence and victims 18.5 (2003): 569-580.

5.Schoutrop, Mirjam JA, et al. “Structured writing and processing major stressful events: A controlled trial.” Psychotherapy and psychosomatics 71.3 (2002): 151-157.

6.Richards, Jane M., et al. “Effects of disclosure of traumatic events on illness behavior among psychiatric prison inmates.” Journal of Abnormal Psychology 109.1 (2000): 156.

Blood Pressure Apps

Happy New Year everyone!

I hope all is well in this new year and that any resolutions that have been made are realistic and being accomplished. This year I’m writing a book. It’s to be done by Christmas. I think it will be with time to spare. My hopes are to get it published one day.  Enough about me…

I wanted to start the new year by talking about something that interests me from a professional perspective, as well as personal; Apps.

Apps are on most everyone’s phone and tablet and even on your computer, depending on the browser you use. With Microsoft recently releasing Office for free for use on Android and iOS, I find myself writing my book on my iPad just as much as my computer and laptop. Dropbox and Google Drive are indispensable as my need for a thumb drive is all but vanished. My kids play Angry Birds, any assortment of Disney games and some interesting human body apps that teach about how the body works to kids. I even like going outside on a starry night with my Starry Night app and looking at the stars, learning names, and even following the paths of satellites as they cross into my field of view. Too much screen time is problematic of course, but we’ll save that for another post.

Apps seem to be as plentiful as bad ideas about health

Apps seem to be as plentiful as bad ideas about health

Health apps have been popular too. I’ve used MyFitnessPal to track calories and workouts. I just received a FitBit from my company as a Christmas gift. It measures steps taken, sleep, etc. It syncs with my phone and I can make alarms for multiple things, track calories eaten, and even has caller id which is nice so I don’t have to fish my phone out of my pocket, I can just look on my wrist. I don’t have the model that measures pulse, but I’m thinking about springing for one, who knows?

Some docs are using medical apps in their practice, at least for things like atrial fibrillation. AlliveCor is one such app, and will only set you back $200. It can read certain rhythms in the heart and show them on your phones screen. These apps can quite read if you’re having a heart attack and can’t replace a 12 lead scan, but they seem to be gaining popularity and could be a huge help in the future for a more tech savvy generation as it ages.

One very common app, the one I want to focus on a bit more, is one that measures blood pressure. Actually there are several. One of them is called “Instant Blood Pressure — Monitor Blood Pressure Using Only Your iPhone” and you only have to shell out $3.99 for it. You apparently put your finger over the camera and it is able to read your pulse, and then you put the mic to your chest. The combination of the two can then spit out a number. Not convinced? Yeah, me neither.

There are several others, several. Many of them have very favorable ratings. The problem I run into is I can’t find any information on comparisons that have been done to cuff readings. That’s a bit problematic in any event because if the app is giving you false data, what good is it? It’s not good, that’s the only correct answer, especially since blood pressure is a crucial part of living. Too low = bad, too high = bad. Like everything else there is a happy medium.

Think of it this way. Having some nice rib eye steak is good. Not having it ever is bad. Having it every night isn’t good because you’ll get sick of it, swear it off, and then never again enjoy the wonderful creation of rib eye steak, grilled and seasoned to perfection… oh man I think I need a steak.

In other words there is a happy medium. I don’t think anyone is really unaware of this in blood pressure. The problem though is the app. The interesting thing about the above mentioned app is there is a small fine print disclaimer stating that the app is for entertainment purposes only and not FDA approved. In other words the makers are admitting that you shouldn’t use it for actual blood pressure monitoring.

If a person were to base their decision to go see a doctor or to the ER based on an app like this because their readings were “normal” when in fact they aren’t, I’d be very worried about the outcomes for that patient, especially if they have hypertension.

I’m all for technology advancing and especially for the ability of phones and other devices to advance medical care. I think if something is useful and beneficial and if it can fit in your pocket then why not? We need to be careful though because sometimes, when we get into consumer mode (which is especially easy to do on a phone of tablet), we forget to double check what it is we’re actually getting. Health is something you don’t want to take casually like buying an app.



Are Sodium Guidelines Too Restrictive?

If you missed my previous post on salt you can access it here:

The CDC seems to be the perp when it comes to misinforming everybody about salt intake and what it does (or doesn’t) do for health. As I mentioned in my other article, salt is crucial for us to survive. Sodium is found in every cell and is key for electrolyte balance as well as nerve conduction. Without sodium your nerves wouldn’t work…period!

Without sodium you wouldn’t see, hear, feel or taste anything. While I don’t put salt on all my food, some things need a pinch or so and I don’t feel bad about it in the least bit. I think there is a reason we crave salty foods and that is because our bodies need it.

While overdoing salt isn’t a good practice, just like overdoing anything, underdoing it is also nonsense. From the first DASH study performed you’ll see that while the three groups who were assigned to different diets all had roughly the same amount of sodium, the group that lowered blood pressure was the group that got rid of the junk and ate more vegetables and increased their potassium intake. This was all while the sodium level was around 3 grams/day in all the groups.[1]

Potassium intake in the form of vegetables IS a healthy thing to do. Carrots, broccoli, celery, kale, onions, and all the other bounty that is mother nature’s goodness should be consumed regularly. This I believe is a building block of solid health.

A new study has been released (although I haven’t been able to access it so what I say is based on the news article, not the study itself) that shows that,

“The study recorded ‘a U-shaped correlation between sodium intake and health outcomes.’ The researchers found that when consumption of sodium fell outside the range of 2,645-4,945 mg per day, there was an increase in mortality. This means that both excessively high and excessively low intakes of sodium were linked to an increased risk of death” [2]

U-shaped curves seems to be common in medical studies which corroborates the idea that too much is bad and too little is bad. Goldilocks wins everytime in biology.

So I wouldn’t worry too much if you’re consuming closer to 3 grams a day of sodium. The evidence in my opinion of detriment to health just isn’t there. Unless of course your sodium is coming from chips, McDonalds, Cheetos or other forms of garbage. Then you might need to be a little more careful.

In addition it might be beneficial to reduce added sodium to your food to be able to enjoy other flavors that might not be readily accesible to your palate if your tongue has had sodium overload. It takes some adjustment but changing up your preparation of food can bring about some amazing and remarkable changes in how you perceive taste. Try it out and enjoy your food.



1.Sacks, Frank M., et al. “Effects on blood pressure of reduced dietary sodium and the Dietary Approaches to Stop Hypertension (DASH) diet.” New England Journal of Medicine 344.1 (2001): 3-10


Is Stevia Safe?

steviaWell we’ve hit the major artificial sweeteners in previous posts in this series. Today we look at a natural sweetener, stevia.

Stevia (stevia rebaudiana) is a sweetener that many people have been using for hundreds of years. It is native to Central America and South America. The leaves are around 40 times sweeter than sugar and the extract is about 300 times sweeter. It dissolves very quickly in and can have somewhat of a bitter aftertaste.

So we can’t call stevia an artificially sweet seduction since it is natural. But is it another sweet seduction or is it a winner to make things oh so wonderfully sweet?

Study Time!

In a study of rats, 0.5mg/kg of stevia lowered blood glucose levels in diabetic rats and glucose tolerance testing in normal rats. It also reduced insulin sensitivity in the diabetic rats and enhanced insulin secretion and insulin utilization.1

So even though insulin increased, sensitivity and utilization of the insulin was better. That is important to remember. If insulin merely goes up and isn’t used because of sensitivity, that is bad. If insulin goes up and is used, like in healthy individuals that’s ok. That’s the way it’s supposed to be.

In another study of diabetic induced rats, stevia was used to compare blood glucose levels with normal and diabetic controls. Subjects were fed 150mg/kg, 200mg/kg and 250mg/kg of stevia per day. Significant decreases in blood glucose were measured as well as non-significant decreases in body weight. Glimepiride (a diabetic drug which increases insulin secretion) was also used as a comparator. Glimepiride lowered blood glucose significantly more than stevia at all doses.2

In yet another rat trial, rats were made diabetic and given stevia, methi seeds, stevia with methi seeds, or glimepiride. They were followed for 60 days. Blood glucose decreased the greatest with glimepiride, next with methi and stevia combo, then methi alone, then with stevia alone. Stevia did create a significant effect on blood glucose by itself. 3

Another study shows that rats fed lots of fructose were able to decrease insulin resistance with a good ol dose of … guessed it, stevia.4

In an actual human study, subjects were given preloads of stevia, aspartame or sucrose before being fed a meal. 20 min after the meal blood was drawn and glucose and insulin measured. Compared to sucrose, aspartame and stevia produced less postprandial glucose levels. Stevia produced significantly lower insulin levels compared to aspartame and sucrose.

In another human study in subjects undergoing glucose tolerance tests, 5 grams of steavia leaves were given at 6 hour intervals for 3 days. The groups were separated into stevia and an aqueous arabinose solution. Stevia increased glucose tolerance and decreased glucose levels during the study.6

Other effects

Stevia appears to have some fertility effects, at least in rats. In one study a water decoction (a way of extraction by boiling chemicals from herbs or plants) was given to rats that were fertile. The infertility continued for 50-60 days after intake stopped. To the researchers no other effects were noticed. This was in females.7

In male rats in chronic (60 days according to the paper) administration produced,

“produced a decrease in final weight of testis, seminal vesicle and cauda epididymidis. In addition, the fructose content of the accessory sex glands and the epididymal sperm concentration are decreased. Stevia treatment tended to decrease the plasma testosterone level” 8

So these poor buggers not only had smaller testes but also less sperm and decreased testosterone. Not exactly a thrilling side effect.

Gut Flora

Stevia doesn’t appear to alter gut flora which is a good thing. The bacteria are able to alter it to steviol however that was the end of it. The tests were done with samples from human donors in vitro.9, 10  How’s about that for donating to science!? We can suppose that this would translate over to a real life human intestine but you never know in these types of studies. This information is promising though.

Blood Pressure

In a study in China, participants were given 500mg of stevia 3 times per day for two years vs placebo and blood pressure was measured. A significant decrease was noted after 1 week. The change was from 150 [7.3] to 140 [6.8] mm Hg; DBP, from 95 [4.2] to 89 [3.2] mm Hg. That’s not too bad. A side note from this study is that more people on placebo had a thickening of the left ventricle than people on stevia (34% vs 11.5% respectively) Quality of life scores were better with stevia. There was no difference in adverse effects between groups.11

Another study found no difference in blood pressure using 3 different doses of stevia, up to 15mg/kg/day.12 This for me would be the 500mg three times daily. The difference in this study is that it was dosed twice daily rather than three times daily. Is this enough to make a difference? I don’t know. I could develop all kinds of protocols for a study to look at these questions but the real question is does this harm you? In both of these studies no adverse effects were seen compared to placebo.

Some have claimed that stevia will raise epinephrine and cortisol. I can’t find any evidence to support this. If anyone has anything I’d love to see it. If that is true it would be a big ding against stevia but again I can’t find evidence to support it.

Stevia may also have oxalates in them which can be problematic for people with kidney stones made from the same substance. I can totally buy that the leaves have them, but I haven’t been able to confirm the extract.

Final thoughts….for now

It looks as though stevia is probably OK for use. If a person is having problems with infertility it may be best avoided. Some forms are sold with other fillers like maltodextrin so they may not truly be zero calories, although if you’re using 1 packet of the stuff it will be less than 4 calories. But if you’re using bulk you’ll have to take care like you would with sucralose, which you’ll never find in my house. Nasty stuff that is!

If you’re diabetic or worried about blood sugar then it appears stevia is beneficial, at least to some degree. Like I always say, try it out and see what happens to you because you and I are not the same people, and neither of us are rats.

You probably won’t find me using 500mg caps of stevia for blood pressure reduction either since I feel that a good diet and some movement will likely take care of that, but it won’t raise it either (unless you’re eating it with junk). From time to time you might see me sweeten something with it, but not regularly and certainly not in bulk. I like my testes the way they are thanks.


1.Chen, Tso-Hsiao, et al. “Mechanism of the hypoglycemic effect of stevioside, a glycoside of Stevia rebaudiana.” Planta medica 71.02 (2005): 108-113.

2.Sumon, M. H., et al. “Comparative efficacy of powdered form of stevia (Stevia rebaudiana Bertoni) leaves and glimepiride in induced diabetic rats.” Bangladesh Journal of Veterinary Medicine 6.2 (2008): 211-215

3.Rafiq, Kazi, et al. “Comparative efficacy of stevia leaf (stevia rebaudiana bertoni), methi seeds (trigonella foenum-graecum) and glimepiride in streptozotocin induced rats.” International Journal 2229 (2011): 7472.

4.Chang, J-C., et al. “Increase of insulin sensitivity by stevioside in fructose-rich chow-fed rats.” Hormone and metabolic research 37.10 (2005): 610-616.

5.Anton, Stephen D., et al. “Effects of stevia, aspartame, and sucrose on food intake, satiety, and postprandial glucose and insulin levels.” Appetite 55.1 (2010): 37-43.

6.Curi, R., et al. “Effect of Stevia rebaudiana on glucose tolerance in normal adult humans.” Brazilian journal of medical and biological research= Revista brasileira de pesquisas médicas e biológicas/Sociedade Brasileira de Biofísica…[et al.] 19.6 (1986): 771.

7.Planas, G. M., and J. Kucacute. “Contraceptive Properties of Stevia rebaudiana.” Science (New York, NY) 162.3857 (1968): 1007.

8.Melis, M. S. “Effects of chronic administration of< i> Stevia rebaudiana</i> on fertility in rats.” Journal of ethnopharmacology 67.2 (1999): 157-161.

9.Gardana, Claudio, et al. “Metabolism of stevioside and rebaudioside A from Stevia rebaudiana extracts by human microflora.” Journal of agricultural and food chemistry 51.22 (2003): 6618-6622.

10.Koyama, E., et al. “In vitro metabolism of the glycosidic sweeteners, stevia mixture and enzymatically modified stevia in human intestinal microflora.” Food and Chemical Toxicology 41.3 (2003): 359-374.

11.Hsieh, Ming-Hsiung, et al. “Efficacy and tolerability of oral stevioside in patients with mild essential hypertension: a two-year, randomized, placebo-controlled study.” Clinical therapeutics 25.11 (2003): 2797-2808

12.Ferri, Letícia AF, et al. “Investigation of the antihypertensive effect of oral crude stevioside in patients with mild essential hypertension.” Phytotherapy Research 20.9 (2006): 732-736.

Salt, Sodium, NaCl and what ocean water tastes like

Hi folks! Today I want to spend a little, and by little I mean a ton, of time on something that gets a lot of bad press and causes increases in blood pressure, some of it from merely speaking about it…SALT!

If you live in the USA or any other modernized western country you’ve heard the mantra over and over that we need to reduce our sodium intake. This is what was preached at the podiums of pharmacy school during my 4 years. It is still preached and probably will be for quite some time. Today I want to challenge a notion or two about sodium.

First I want to start with a biology lesson. For those of you reading who have little to no background in biological functions, don’t worry, I will sum it up at the end.

Our bodies maintain sodium levels within a tight range. Generally it ranges from 135-145 mEq/L, so the average is about 140. Sodium is an element absolutely required for life. Nerve transmission would not be possible without sodium and potassium gradients. It also helps in regulation of cellular water content and a host of other things. So what happens when your sodium gets too high or too low?

Our water volume as well as our sodium concentrations are both always being adjusted to maintain a level which is beneficial to living. Too high or too low can cause problems. Our hypothalamus constantly monitors our salt concentration, as does our adrenal cortex, which is in our adrenal glands right above our kidneys. When osmolarity increases (sodium concentration goes up) these cells detect this in the hypothalamus and adrenal cortex. Two things happen at this point. Since osmolarity is increasing the body wants to rid itself of the excess sodium and conserve some water to keep the concentration down in the desired range. The hypothalamus will release ADH or anti-diuretic hormone (also known as vasopressin). ADH acts on the kidneys to conserve more water. This decreases concentration. The adrenal cortex will also inhibit production of aldosterone, which is a steroid hormone that increases sodium retention and raises blood volume levels. When blood volume increases, blood pressure also increases.

So when you get too high in sodium your body increases fluid retention and lets go of the sodium. When things go back to normal. The process slows down to allow for homeostasis. But what about when your sodium gets too low you ask? Well kind of the opposite. This can be due to very poor intake of sodium (unlikely in the United States) or because of increased intravascular volume which lowers osmolarity. It makes sense if you have a cup of water with a teaspoon of salt that if you double the volume of water the concentration of salt goes down. Now we have to activate the renin-angiotensin system. Renin is secreted into the blood which ultimately (through a few steps; angiontensinogen to angiotensin to angiotensin II) secretes aldosterone. Sodium is reabsorbed in favor of potassium. You might also begin to crave some salty food. Makes sense right, if not enough salt, the body yells at you and says,”Hey! I’m low, eat some chips or something”. This will lead to increase blood pressure as well. Angiotensin II is a vasoconstrictor so it’s not surprise that this system is the target of many, many drugs including lisinopril, enalapril, fosinopril, quinapril, make-billions-of-dollars-april, as well as many others.

So in a nutshell, when your body has too much sodium, your body gets rid of it. When it has too little sodium, it conserves it and/or yells at you to go eat something salty. I prefer my salt in the form or a nicely seasoned steak or a good paella. I try to steer clear of things like chips and dips. Most of them have crappy oils and host of other garbage ingredients that will likely not do any good for the body.

So what’s the beef….mmmm beef….with people telling us to reduce the amount of sodium in our diet? Well it turns out that a study was done called “A Clinical Trial of the Effects of Dietary Patterns on Blood Pressure” 1. AKA “DASH”. The researchers split the study subjects into 3 groups; 1 control group whose “nutrient composition of the control diet was typical of the diets of a substantial number of Americans” (1), 1 group with veggies and fruits, and a third that they called the combination diet which had less saturated fat and more calcium than the other two.

The study had a run in period of 3 weeks where all participants had the control diet. After that they were separated into their different groups and continued the study on their respective diets. The researchers had a cafeteria where food was prepared and could be consumed for lunch or dinner. All other meals were packaged and could be consumed at home. Participants could have no more than 3 caffeinated beverage/day and no more than 2 alcoholic drinks/day. On the first day, the participants were given their diet for the 30 day time frame.

Now call me crazy, but if I was given a normal American diet for 3 weeks and then fed a significant amount of fruits and veggies after 1 day, I think I might figure out that I’m on some sort of healthier diet. Mama always told me to eat my veggies, and now they’re making me. It’s possible that the people in the 2 study groups figured this out really quick and became more health conscientious. It’s also possible that people didn’t report accurately about their food intake to the researchers, even though they were paid ….I mean reimbursed and incentivized to follow the study. I’m sorry but if I tell people that if they report to me that they followed the protocol without me monitoring that they will get paid, how many people do you think will tell me the truth? Yeah.

So anyway, onto the diets.

“The potassium, magnesium, and calcium levels were close to the 25th percentile of U.S. consumption, and the macronutrient profile and fiber content corresponded to average consumption”. So from the get go, these poor saps were receiving poor nutrition, or the standard American diet (this will be refered to as SAD from now on). You can see this in the provided table from the study.

Fruits were higher in the study groups over the control group. Of course fruits will have certain qualities such as proper minerals and antioxidants that are conducive to a healthy body. Vegetable intake was more than double in the combination group than the control group. Veggies are known to be an excellent source of potassium and you’ll notice that the combo group had around 2.5 times the potassium as the control. They also had more potassium per day than sodium, where the control group had more sodium than potassium. More on that later. Veggies are also a source of antioxidants, cancer fighting agents etc, etc,etc. Another big difference was the amount of magnesium that was received. The study groups had over 400mg/day while the control had less than 200. Magnesium is known to be crucial for proper functioning of enzymes and arterial wall function. Could a large magnesium difference been enough to tip the scales one way?…maybe.

Sodium levels were kept very similar in the groups. The article did mention that participants were given two salt packets containing 200mg of sodium each for discretionary use. As far as weight is concerned, “Their weight was measured each weekday and was kept stable by changing calorie levels and by adding 100-kcal cookies or muffins with nutrient contents that corresponded to those of the assigned diets” I’m not sure I feel like this was a good thing. I know they were studying the effects of blood pressure by diets but at those caloric intakes some people could have lost weight and theoretically could have lowered blood pressure, but we won’t know. Both groups average weight and BMI were high. I know they are trying to control for variables, but introducing extra to maintain weight seems like an added variable to me.

You’ll notice quickly too that the control group had about 4 servings of snacks or sweets, whatever those entail. The ever glaring detail that looms over this study though is what I already mentioned, that the participants had essentially total control over what they wanted to eat while not at the kitchen of the researchers.

Now all those things aside does it surprise us that blood pressure was decreased? Not really. I’d be willing to bet that anyone on a SAD diet who switched to a diet rich in veggies, lean proteins and few sweets would probably lower blood pressure.

You might be asking yourself right now, “Hey buddy, what’s this got to do with sodium!?!? The intakes were the same.” And that’s my first point. They didn’t reduce sodium intake, they increased veggies and fruits that have health benefits and cut out the garbage with has anti-health benefits. What’s that you say, they still recommend low salt, below what was done in this study? Well lets take a look at another study.

This was a DASH follow up that was very similar. They had control diet and DASH diet (previously combination diet in the last study) at differing sodium intake levels. It was a crossover design so participants were getting varying levels of sodium during four 30 day periods. The sodium intakes were 150mmol/day, 100mmol/day, and 50mmol/day (3450mg, 2300mg, and 1650mg sodium respectively) .(2)   Lets look at what happened.

Blood pressure went down with a dash diet but the difference between the sodium intakes was small.

So systolic pressure differed from the high sodium to low sodium by 3mmHg and diastolic by 1.6mmHg. That’s not really a whole lot. In fact that is small. Not only that but that is on a low amount of sodium. So low in fact have fun following that diet. It’s possible the results between the DASH groups was from mild hypovolemia, or lack of fluid in the blood, but we don’t know that.

On an anecdotal note, I remember a story one of my professors told us about following the DASH diet. She felt that she didn’t want to recommend following it without first trying it herself. She said she quickly became weak and turned pale. She had a hard time concentrating and after a week or two decided to go back on her regular diet. It didn’t inspire a lot of confidence for me in the diet and thinking about it now makes me think why the heck she’d recommend the low salt to anyone.

This study in particular is touted as one major reason why we need to drop sodium intake. Eating lots of fresh vegetables and getting rid of the garbage in your diet has seemingly escaped mainstream. I know docs and others recommend eating good veggies and what not, but this whole salt nonsense is the one that gets the most press. I guess it goes to show that things that get press often when it comes to health policy is probably just wrong or not complete.

Remember when we were discussing the biological mechanisms for the kidney to retain or get rid of sodium? Well when you have consistently low sodium intake your body has to conserve some of that because it’s needs to maintain homeostasis. So what happens? RENIN! Renin is secreted and starts the cascade to angiotensin II which then sends the message to secrete aldosterone. As you remember from above, aldosterone is a steroid hormone that retains sodium and angiotensin II increases blood pressure. Here’s the problem, if you have chronically low levels of sodium intake, this system could be activated regularly. Aldosterone also increases magnesium excretion (3) which can have an effect on blood pressure. Blood pressure is good and all but lets look at some more endpoints because a risk factor doesn’t always show us the whole picture.

In a prospective population trial, researchers looked at sodium excretion levels, which indicate sodium intake, and cardiovascular outcomes. The participants were divided into 3 groups by the amount of sodium that was excreted in the urine. The more sodium excreted, the more intake. The group with the highest amount of sodium excreted also had the least amount of deaths. Or as the article puts it, “Cardiovascular deaths decreased across increasing tertiles of 24-hour urinary sodium: from 50 in the low (death rate, 4.1%; 95% CI, 3.5%-4.7%), 24 in the medium, (death rate, 1.9%; 95% CI, 1.5%-2.3%); and 10 in the high tertile (death rate, 0.8%, 95% CI, 0.5%-1.1%; P < .001). The mean 24-hour urinary sodium excretion for each tertile was defined as 106 mmol for the low, 165 mmol for the medium; and 250 mmol for the high tertile.“(4). That’s a difference of 3.3% between the low intake and high intake. Not bad.

In another study looking at 146 patients admitted for acute decompensated heart failure, researchers looked at the difference between normal fluid and sodium intake (in the study termed at least 2.5L fluid and 3-5 gm sodium intake per day) vs a restricted fluid and sodium intake (800ml fluid and 800mg sodium). They compared weight loss, perceived thirst and clinical stabilization during a 7 day period. After 7 days there were no significant differences between the groups with the exception of thirst perception. Those who had higher amounts of sodium reported feeling less thirsty than those with low sodium. (5) Why is that important? A patient with heart failure has to be careful about too much fluid in the body because of a decreased ability to get rid of it and an increased load on a weak heart. Increased thirst could potentially lead to increased fluid intake without additional sodium, causing activation of that renin-angiotensin system we talked about earlier.

Another study looking at heart failure compared 2 groups of heart failure patients on a diet with 120mmol sodium (about 2.76gm) per day and 80mmol sodium (about 1.8gm) per day and both groups with high doses of diuretics. Both groups were allowed 1L fluid per day and were followed for 180 days with regular follow ups in the interim. The higher sodium group had a readmission rate of 7.63% while the low sodium group was at 26.32%, a significant difference. (6) The combined endpoint of mortality and hospital readmission rates were 12.71% and 39.47% in the high and low groups respectively. There was an absolute risk reduction of mortality of 8.07%, but it wasn’t significant. Still pretty impressive. The high sodium group also enjoyed a reduction of serum creatinine, which indicates improved kidney function and lower BNP than that of the low sodium group.

A meta analysis done looking at blood pressure reductions determined that it may be beneficial in the elderly crowd who already have hypertension to lower sodium, but there was little to no difference in younger normotensive patients. The reduction in the elderly for systolic pressure was 3.7mmHG and 0.9mmHg diastolic for every 100mmol decrease in sodium excretion.(7) That’s 2.3 grams of sodium being excreted! Not exactly a huge decrease of pressure and a potential for decrease quality of life.

A Cochrane review looked at hormone levels such as aldosterone, renin, epinephrine, norepinephrine, as well as cholesterol, triglycerides and of course blood pressure. The results showed that blood pressure did go down in hypertensives about the same as the above mentioned meta analysis, but all the other things I just listed increased. (8)

I don’t know about you, but I will take the 3 points of increased blood pressure over increased epinephrine and norepinephrine and aldosterone and renin any day. I think because blood pressure is so cheap and easy to measure we tend to look at that too much rather than what else is going on chemically in the body. And those chemicals are important to keep in mind while treating someone as a whole.

So when are we going to talk about potassium? I’ve been blathering on about actual endpoints and hormones. So lets look a bit at potassium.

A group did a comprehensive look of studies done regarding potassium and blood pressure. I’m not going to hit every single point because it is a rather extensive article, but here are a few things to consider when talking about sodium and potassium.

Most countries in the world have a sodium intake that is at around 100mmol or higher per day. For those that aren’t familiar with millimoles (mmol), 100mmol sodium is about 2.3 gm. I will no longer be converting. The observation with this is that many people with those levels of sodium still don’t develop hypertension, so something must be going on. (9) The article then goes on to explain how isolated populations have extremely low levels of hypertension. When the diet is analyzed, higher levels of potassium are being consumed by the isolated populations than industrialized nations. Potassium is plentiful in vegetables and fruits, something usually very lacking in a western diet. The potassium to sodium ration is 3-4:1 in the isolated populations.

This difference was seen in the above mentioned DASH study. You’ll notice that potassium was much higher in the study group than the control group by about 2.5 times. It is very likely that getting rid of garbage from your diet and adding foods high in potassium (which will likely also be high in other nutrients) will lower blood pressure as well as make you feel better.

The INTERSALT group found that a decrease of potassium excretion by 50mmol/day led to an increase of blood pressure of 3.4/1.9 SBP/DBP. (10) That means when you excrete less potassium it’s because you are eating less.

As with many of the nutrients in our diet, these two electrolytes appear to have a need to be balanced if the body is to function properly. It is probably a good idea to get much more potassium than sodium.

The last thing I want to leave you with is a review that was recently release by the National Academy of Sciences. They looked at a lot of studies and concluded that “when considered collectively, it indicates a positive relationship between higher levels of sodium intake and risk of CVD. This evidence is consistent with existing evidence on blood pressure as a surrogate indicator of CVD risk“. (11) I believe this is due to the junk we eat that is higher in sodium and the lack of potassium in the diet. A can of soup can have as much as 50mmol of sodium and as much as 1mmol of potassium. Cured and processed meats are no better. Potassium is a crucial element for human function.

The last quote comes again from the last study cited. “The committee determined that evidence from studies on direct health outcomes
is inconsistent and insufficient to conclude that lowering sodium intakes below 2,300 mg per day either increases or decreases risk of CVD outcomes (including stroke and CVD mortality) or all cause mortality in the general U.S. population”. (11) They also mentioned that there is evidence to keep sodium intake higher in heart failure patients. They generally recommend a level of 2300mg/day, which is 800mg more than the US recommendations.

I don’t think anyone should take this info as a pass to eat all the sodium you want. But I do think that you probably don’t need to count every mg either if you have a proper diet in order. I do encourage everyone to eat more potassium rich foods. With that said, don’t go out and start downing every banana you can get your hands on. Try green leafy veggies. They don’t have all the carbs bananas do (although I don’t mind carbs either, just don’t over do it).

All in all remember, be moderate.


The Brute

Disclaimer: All info on this website is for education purposes only. Any dietary or lifestyle changes that readers want to make should be done with the guidance of a competent medical practitioner. The author assumes no responsibility nor liability  for the use or dissemination of this information. Anyone who chooses to apply this information for their own personal use does so at their own risk.

1. L.J. Apell et. al. A Clinical Trial of the Effects of Dietary Patterns on Blood Pressure. N Engl J Med 1997; 336:1117-1124

2.Sacks, Frank M., et al. “Effects on blood pressure of reduced dietary sodium and the Dietary Approaches to Stop Hypertension (DASH) diet.” New England Journal of Medicine 344.1 (2001): 3-10.

3.HORTON, RICHARD, and EDWARD G. BIGLIERI. “Effect of aldosterone on the metabolism of magnesium.” Journal of Clinical Endocrinology & Metabolism22.12 (1962): 1187-1192.

4.Stolarz-Skrzypek K, Kuznetsova T, Thijs L, et al. Fatal and Nonfatal Outcomes, Incidence of Hypertension, and Blood Pressure Changes in Relation to Urinary Sodium Excretion. JAMA. 2011;305(17):1777-1785

5.Aliti, Graziella Badin, et al. “Aggressive Fluid and Sodium Restriction in Acute Decompensated Heart FailureA Randomized Clinical TrialFluid and Sodium Restriction in Heart Failure.” JAMA internal medicine (2013): 1-7.

6.Paterna, Salvatore, et al. “Normal-sodium diet compared with low-sodium diet in compensated congestive heart failure: is sodium an old enemy or a new friend?.” Clinical science 114 (2008): 221-230.

7.Midgley, Julian Paul, et al. “Effect of reduced dietary sodium on blood pressure.” Jama 275.11 (1996): 1590.

8.Graudal, Niels A., Thorbjørn Hubeck-Graudal, and Gesche Jürgens. “Effects of low-sodium diet vs. high-sodium diet on blood pressure, renin, aldosterone, catecholamines, cholesterol, and triglyceride (Cochrane Review).” American journal of hypertension 25.1 (2011): 1-15.

9.Adrogué, Horacio J., and Nicolaos E. Madias. “Sodium and potassium in the pathogenesis of hypertension.” New England Journal of Medicine 356.19 (2007): 1966-1978.

10.Intersalt Cooperative Research Group. Intersalt: an international study of electrolyte excretion and blood pressure: results for 24-hour urinary sodium and potassium excretion. BMJ 1988;297:319-28