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Salt May Not Be As Bad As They Say…Or Is It?

regulate salt intakeUsing a sufficiently large set of data, the Cochrane Library, a highly respected international collaboration of evidence-based medicine reviews, was able to draw startling conclusions about the association of salt intake with high blood pressure and cardiovascular risks. After looking at almost 6,500 people, comprising several well-conducted studies, Cochrane found that, for CVD mortality and all-cause mortality in persons with normal or elevated blood pressure, there is no strong evidence for restricting salt intake.

The American Journal of Hypertension reported Cochrane’s findings in July of 2011, stating that, “Although meta-analyses of randomized controlled trials of salt reduction report a reduction in the level of blood pressure, the effect of reduced dietary salt on cardiovascular disease events remains unclear.”  However, it was also found that salt reduction “was associated with reductions in urinary salt excretion…and reductions in systolic blood pressure between 1 and 4 mm Hg.”  Additionally, relative risk did not show evidence of any effect of salt reduction on cardiovascular episodes in people with normal BP, but noted that, “salt restriction increased the risk of all-cause mortality in those with heart failure.”

The Cochrane reviewers admitted that, despite collecting more data than ever before, there is still no definitive proof that salt reduction will have beneficial effects on all-cause mortality or on the risk of cardiovascular disease.  At the same time, Katherine Jenner, campaign director of the Consensus Action on Salt and Health (CASH), disputes these findings, adding that there are no trials to account for other chronic exposures, such as smoking and being overweight, and eating too few fruits and vegetables.  She stated strongly that it would be unethical to expose humans to a long period of high salt intake merely to satisfy the curiosity of researchers.  To add to this confusion, the Cochrane leader, Rod Taylor, said that large benefits were not seen because salt reduction was sufficiently minimal as to cloud significant effects on BP and heart disease.  Huh?

Prior to the development of refrigeration, salt was necessary for the preservation of food.  Milk was made into cheese using salt, and fish was salted to keep it for long periods.  Eating as we do, many of us accumulate more salt and water than the kidneys can handle.  Some folks have genes that control cellular channels, enzymes and hormones at various places in the kidneys, conserving salt to enable adaptation to hot and dry climates.  If water and salt were scarce, as would often be the case in mankind’s early days, the kidney would conserve salt to hold the water that would become sweat, which would evaporate from the skin and cool the body enough to keep temperature stable.  Without sweat the body would overheat.  These genes that were important to early mankind never stopped doing their job, regardless of climate.  About 20% of us will continue to reabsorb salt as long as excessive amounts are ingested.  Salt retains water through osmosis.  It also promotes thirst.  Why else would there be a bowl of salty pretzels or nuts on the bar?

Excess salt keeps circulatory volume higher than it needs to be, putting extra fluid pressure on blood vessel walls.  The walls react to this stress by getting thicker and narrower, leaving less space for the fluid already cramped inside, thereby raising resistance to flow and increasing the pressure needed to get it moving.  Because the heart has to pump against greater pressure, it can grow larger, just like the skeletal muscles subjected to heavy pressure from lifting weights.  Whatever excess pressure is exerted on the kidneys causes those organs to compromise their delicate filtration system, leading to disease.

Beyond reducing blood pressure, a low sodium intake improves the dilation of the blood vessels and consequently improves heart function.  Dilation of blood vessels is considerably greater in a low-sodium environment. (Dickinson. 2009)  Systolic pressure will drop, as well.

At a time when the U.S. advocates lowering salt intake from 2,300 mg a day to 1,500 mg a day, the Europeans are happy to see their intake lowered to 5,000 mg a day.  Considering that the typical European intake seems to be around 9,000 to 12,000 mg a day, that is quite a change.  Naturally, they would see a drop in blood pressure.  (He and Burnier. 2011)  Salt sensitivity is subjective, though, and not everyone would have a BP spike because of intake.

But now there might just be way to help control salt-induced blood pressure elevation. Researchers at Loyola University, under the direction of Dr. Paul Whelton, learned that the ratio of sodium to potassium is a more important indicator of cardiovascular problems than either salt or potassium alone.  (Whelton and Cook. 2009)  Little studied, potassium is the element on the other side of the cell membrane from sodium. Most of us are potassium deficient, consuming far less than the 4,700 mg a day that is suggested. The recommended 9 to 13 servings of fruits and vegetables a day, the most reliable sources of this mineral, is uncommon in the contemporary diet.  A high sodium to potassium ratio can be predictive of future coronary episodes; a low one, the opposite.  In his study, Dr. Whelton says that 2,300 milligrams should be the maximum sodium intake a day for those less than 30 years old, half that for those who are older.

Sodium is not salt, and salt is not sodium. About 40% of salt is sodium, the remainder being chloride, the chemical of which stomach acid is made.

For some of us, salt might be off the hook. For others of us, it might be a gremlin. It can be hidden in frozen dinners, some cereals, vegetable juice, canned vegetables and soups, sauces and marinades, snacks, and condiments. Potassium, on the other hand, is friendly to all. Jing Chen and his colleagues agree. (Chen. 2008)

References

MAIN ABSTRACT
Am J Hypertens. 2011 Jul 6. doi: 10.1038/ajh.2011.115. [Epub ahead of print]
Reduced Dietary Salt for the Prevention of Cardiovascular Disease: A Meta-Analysis of Randomized Controlled Trials (Cochrane Review). Taylor RS, Ashton KE, Moxham T, Hooper L, Ebrahim S.

Cochrane Database of Systematic Reviews 2011, Issue 7.
Reduced dietary salt for the prevention of cardiovascular disease.
Taylor RS, Ashton KE, Moxham T, Hooper L, Ebrahim S.

SUPPORTING ABSTRACTS
Am J Clin Nutr February 2009 vol. 89 no. 2 485-490
Effects of a low-salt diet on flow-mediated dilatation in humans
Kacie M Dickinson, Jennifer B Keogh, Peter M Clifton

Arch Intern Med. 2008;168(16):1740-1746.
Association Between Blood Pressure Responses to the Cold Pressor Test and Dietary Sodium Intervention in a Chinese Population
Jing Chen, MD, MSc; Dongfeng Gu, MD, MSc; Cashell E. Jaquish, PhD; et al

Arch Intern Med. 2009;169(1):32-40.
Joint Effects of Sodium and Potassium Intake on Subsequent Cardiovascular Disease
The Trials of Hypertension Prevention Follow-up Study
Nancy R. Cook, ScD; Eva Obarzanek, PhD; Jeffrey A. Cutler, MD; Julie E. Buring, ScD; Kathryn M. Rexrode, MD; Shiriki K. Kumanyika, PhD; Lawrence J. Appel, MD; Paul K. Whelton, MD

Eur Heart J. 2011 Jun 23. [Epub ahead of print]
Nutrition in cardiovascular disease: salt in hypertension and heart failure.
He FJ, Burnier M, Macgregor GA.

Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK.

*These statements have not been evaluated by the FDA.
These products are not intended to treat, diagnose, cure, or prevent any disease.

Cold Weather Coronary Episodes

snowblowerThe way the body responds to low temperatures involves more than comfort. Cold temperatures cause arteries to tighten, restricting blood flow and reducing the oxygen supply to the heart, all of which can set the stage for a cardiac event. The heart has to work harder in the cold weather to keep the body warm, especially in the morning when blood pressure is on the upswing. The “blood pressure surge” just before waking is higher in the winter than at other times of the year. The tight management of blood pressure and cardiovascular health requires careful attention, but more so when the thermometer drops.

Since global climate change has been realized, more because of Earth’s orbital fluctuations than man’s dominion over its resources, interest has grown in the relationship between weather and health.  Measures of mortality have seen a decline when temperatures increase from the coldest days up to a certain point, above which mortality increases with temperature.  Detrimental effects of both hot and cold days also have been associated with cardiovascular mortality.  But it appears that winter has the most impact on circadian rhythm and disturbances in homeostasis that may lead to coronary episodes.

At London’s School of Hygiene and Tropical Medicine, researcher Krishnan Bhaskaran and his team found, “…a broadly linear relation between temperature and myocardial infarction…” whereby “…each 1° C reduction in daily mean temperature was associated with a 2.0% cumulative increase in risk of myocardial infarction over the current and following 28 days, the strongest effects being estimated at intermediate lags of 2-7 and 8-14 days..” (Bhaskaran.  2010)

Do bad things happen only to other people?  Most of us are guilty of the “it-can’t-happen-to-me” syndrome.  But could we be right?  This study mentions that, “the risk of infarction in vulnerable people might be reduced by the provision of targeted advice and other interventions, triggered by forecasts of lower temperatures.”  (Ibid.) The operative term here is vulnerable people.”  That deserves a sigh of relief, but not until you determine if you are in or out of that group.  However, the study points out that the adverse effect of the cold temperatures may linger for as long as two weeks.  Keep that in mind.  If you smoke, you’re vulnerable.  Got high blood pressure?  You’re vulnerable.  Lousy diet and nix on the exercise bit?  Yep, vulnerable.  How about being a type A personality with a high-stress lifestyle, or skipping a few visits with the dentist, or being large enough to have your own zip code?  Yup.  You’re in.  Now that you know, what’re you gonna do about it?

Mastering your Self can change the odds much in your favor.  It’s true that additional studies need to be conducted to ascertain the measures that could be taken to reduce risk for cold-weather coronary episodes, but there’s no reason not to start making changes right away.

Meteorological factors that include heavy snowfalls were examined in Scandinavia to look for any implications in cardiac events.  It was found that myocardial infarction (MI) increased especially in people older than 65, but not necessarily in younger groups, when the temperature dropped and the snowfall was heavy.  However, prudent behaviors, such as dressing for the conditions and delaying snow removal until the afternoon, could excuse a considerable number of people from cardiac episodes.  (Hopstock.  2011).  Similar work done by the Mayo Clinic has documented low-temperature peaks in coronary heart disease, suggesting that temperatures below 0° C are associated with sudden cardiac deaths. (Gerber. 2006).

Hypertension prevalence increases in the cold weather and in cold regions of the world, and that can trigger an event.  Animals exposed to these conditions exhibit cardiac hypertrophy (enlargement of the heart) and overactivity of the sympathetic nervous system, which is activated in stressful states and elevates heart rate and narrows blood vessels, thereby spiking blood pressure and setting the stage for an unwelcome happening.  (Sun. 2010).  The proteins designed to constrict blood vessels are especially sensitive to frigid temperatures.  (Chen. 2006).  Strangely, winter temperatures in Sicily hover near 60° F, yet researchers there have found seasonal peaks in infarction-related hospital admissions.  (Sicily’s latitude is very close to that of Washington, DC.) Humidity was included there as a partner in crime.  (Abrignani. 2009)  You’d expect cold weather to be a causative factor in Switzerland, and you won’t be surprised to learn that heavy winds are also implicated, while snowfall and rainfall have shown inconsistent effects.  (Goerre. 2007).

Morning blood pressure is typically higher than later in the day, so taking your medication in the evening may be suggested.  Dressing for the weather is just as important, and warming the air you breathe through a scarf might be a good idea.  Eliminating tobacco and being careful about alcohol intake can keep blood pressure lower.  Waiting for the sun to get higher in the sky, and for the temperature to rise above early-morning freeze, may alleviate cardiovascular stress.

If latitude is considered, it seems that any place outside the tropics is fingered as a winter time hazard for cardiac health.  The body’s ability to manufacture vitamin D from exposure to the sun is compromised at that time of year.  Since certain conditions are prevalent in the winter, when the angle of the sun is low, maybe vitamin D has something to do with it.  Hmm.

References

Krishnan Bhaskaran, Shakoor Hajat, Andy Haines, Emily Herrett, Paul Wilkinson, Liam Smeeth
Short term effects of temperature on risk of myocardial infarction in England and Wales: time series regression analysis of the Myocardial Ischaemia National Audit Project (MINAP) registry
BMJ 2010; 341:c3823

Hopstock LA, Fors AS, Bønaa KH, Mannsverk J, Njølstad I, Wilsgaard T.
The effect of daily weather conditions on myocardial infarction incidence in a subarctic population: the Tromso Study 1974-2004.
J Epidemiol Community Health. 2011 Jun 6.

Gerber Y, Jacobsen SJ, Killian JM, Weston SA, Roger VL.
Seasonality and daily weather conditions in relation to myocardial infarction and sudden cardiac death in Olmsted County, Minnesota, 1979 to 2002.
J Am Coll Cardiol. 2006 Jul 18;48(2):287-92. Epub 2006 Jun 22.

Sun Z.
Cardiovascular responses to cold exposure.
Front Biosci (Elite Ed). 2010 Jan 1;2:495-503.

Chen GF, Sun Z.
Effects of chronic cold exposure on the endothelin system.
J Appl Physiol. 2006 May;100(5):1719-26.

Abrignani MG, Corrao S, Biondo GB, Renda N, Braschi A, Novo G, Di Girolamo A, Braschi GB, Novo S.
Influence of climatic variables on acute myocardial infarction hospital admissions.
Int J Cardiol. 2009 Oct 2;137(2):123-9.

Goerre S, Egli C, Gerber S, Defila C, Minder C, Richner H, Meier B.
Impact of weather and climate on the incidence of acute coronary syndromes.
Int J Cardiol. 2007 May 16;118(1):36-40.

Bhaskaran K, Hajat S, Haines A, Herrett E, Wilkinson P, Smeeth L.
Effects of ambient temperature on the incidence of myocardial infarction.
Heart. 2009 Nov;95(21):1760-9.

Mercer JB.
Cold–an underrated risk factor for health.
Environ Res. 2003 May;92(1):8-13.

Murakami S, Otsuka K, Kono T, Soyama A, Umeda T, Yamamoto N, Morita H, Yamanaka G, Kitaura Y.
Impact of outdoor temperature on prewaking morning surge and nocturnal decline in blood pressure in a Japanese population.
Hypertens Res. 2011 Jan;34(1):70-3.

*These statements have not been evaluated by the FDA.
These products are not intended to treat, diagnose, cure, or prevent any disease.

Beta-Glucans, The Healer

oatmeal-and-white-backgroundThere are quite a few products on the market that promise to heal wounds quickly. The one made from a combination of bacitracin, neomycin and polymyxin is so popular that it’s been copied as a generic. But it isn’t all-natural. For those interested in a natural alternative, there’s a new kid on the block, called beta-glucans, found in baker’s yeast and a few other common sources, and destined to be on the shelves as a gel in 2012. Heralded as a “super medicine,” beta-glucans are currently used in veterinary medicine, dietary supplements, and cosmetics. And Norwegian scientists say it has even more potential.

The Research Council of Norway announced the results of a study headed by Rolf Einar Engstad, of Biotec Pharmacon, that proclaimed, “Since the mid-1980’s we have known that these substances (beta-glucans) fight infection and have a bearing on the body’s ability to kill cancerous cells, but never knew why.”  At the start of the project, the researchers were uncertain of the efficacy of the delivery method, but in infected laboratory animals, “…determined that animals receiving beta-glucans orally acquired protection that was at least as good as rats that received an injection into their bloodstream.”  Effectiveness of topical application in the healing of wounds was welcome news.  Incisions, bed sores, diabetic ulcers, and other skin insults can be treated with topical beta-glucans.  A matter that has since been addressed is short shelf life, something that can happen to any organic material, such as organic produce.  To add to beta-glucans’ acclaim is its capacity to enhance the innate immune system, that immunity with which we are born and which is first mobilized if the body is invaded by a pathogen.  (The Research Council of Norway.  2011)

As a supplement, beta-glucans has been around for a while.  These sugars are found in the cell walls of bacteria, fungi, yeasts, algae, lichens, and plants, such as oats and barley.  Orally, they have been used for treating cholesterol, diabetes, cancer and HIV/AIDS, and for bolstering the immune systems of those suffering from chronic fatigue syndrome and emotional or physical stress.  It may be given IV post-surgery to prevent infections.  Topically, it’s been used for dermatitis, eczema, wrinkles, bedsores, radiation burns, and other skin conditions.  The enhancement of macrophage function aids in healing wounds, although the exact mechanism of this improved healing is uncertain. (Portera. 1997)  Besides that, increases in collagen manufacture have been noticed, resulting in improved tensile strength of the new wound covering.  (Browder. 1988)  The activity in this arena includes the stimulation of growth factors and the release of cytokines, regulatory proteins that mediate the immune response.  (Wei. 2002)  This results in stimulation of fibroblast (giving rise to connective tissue) collagen biosynthesis.

Yeast-based beta-glucans is being taken more and more seriously as an immune health ingredient.  Because it can stand a wide range of body pH, yeast-based product could supplant—or at least enhance—probiotics as a first line of defense against invasion by bacteria and viruses.  (Watson, 2011)

Beyond healing wounds, beta-glucans may prevent the absorption of cholesterol from the stomach and intestine when it is taken orally.  The beta-glucan found in oats led oatmeal makers to petition the FDA to allow such a claim on their labels.  The FDA agreed, as long as the amount is 10% of the product.  (Federal Register. 2002)

By injection, beta-glucans stimulate the immune system by increasing chemicals that prevent infections.  Used in immunotherapy, as in treating certain invasive diseases, beta-glucans incites cytotoxicity (cell toxicity) in neoplastic (abnormal new growth) tissue while leaving healthy tissue alone.  (Vetvicka. 1996)

As with any promising developments in alternative approaches to wellness, funding for additional studies becomes a roadblock.  The promise of beta-glucans, which, because it appears in food cannot be patented as a drug (yet), paints a rosy picture for treating cuts and scrapes, and perhaps for the prevention of contagious diseases and chronic illnesses.

References

Siw Ellen Jakobsen and Else Lie
Baker’s yeast aids healing
The Research Council of Norway. Published: 07.09.2011

Portera CA, Love EJ, Memore L, Zhang L, Müller A, Browder W, Williams DL.
Effect of macrophage stimulation on collagen biosynthesis in the healing wound.
Am Surg. 1997 Feb;63(2):125-31.

Browder W, Williams D, Lucore P, Pretus H, Jones E, McNamee R
Effect of enhanced macrophage function on early wound healing.
Surgery. 1988 Aug;104(2):224-30.

Wei D, Zhang L, Williams DL, Browder IW.
Glucan stimulates human dermal fibroblast collagen biosynthesis through a nuclear factor-1 dependent mechanism.
Wound Repair Regen. 2002 May-Jun;10(3):161-8.

Elaine Watson
Biothera on a roll as yeast beta-glucan moves into the mainstream
Nutra-Ingredients-USA.com.  12 September, 2011

Food and Drug Administration, HHS
Food labeling: health claims; soluble dietary fiber from certain foods and coronary heart disease. Interim final rule.
Fed Regist. 2002 Oct 2;67(191):61773-83.

Vetvicka V, Thornton BP, Ross GD.
Soluble beta-glucan polysaccharide binding to the lectin site of neutrophil or natural killer cell complement receptor type 3 (CD11b/CD18) generates a primed state of the receptor capable of mediating cytotoxicity of iC3b-opsonized target cells.
J Clin Invest. 1996 Jul 1;98(1):50-61.

Charlotte Sissener Engstad, Rolf Einar Engstad, Jan-Ole Olsen and Bjarne Osterud
The effect of soluble beta-1,3-glucan and lipopolysaccharide on cytokine production and coagulation activation in whole blood.
Int Immunopharmacol 2(11):1585-97 (2002) t

Suzuki I, Hashimoto K, Ohno N, Tanaka H, Yadomae T.
Immunomodulation by orally administered beta-glucan in mice.
Int J Immunopharmacol. 1989;11(7):761-9.

Delatte SJ, Evans J, Hebra A, Adamson W, Othersen HB, Tagge EP.
Effectiveness of beta-glucan collagen for treatment of partial-thickness burns in children.
J Pediatr Surg. 2001 Jan;36(1):113-8.

Borchers AT, Stern JS, Hackman RM, Keen CL, Gershwin ME.
Mushrooms, tumors, and immunity.
Proc Soc Exp Biol Med. 1999 Sep;221(4):281-93.

Akramiene D, Kondrotas A, Didziapetriene J, Kevelaitis E.
Effects of beta-glucans on the immune system.
Medicina (Kaunas). 2007;43(8):597-606.

Ross GD, Vetvicka V, Yan J, Xia Y, Vetvicková J.
Therapeutic intervention with complement and beta-glucan in cancer.
Immunopharmacology. 1999 May;42(1-3):61-74.

*These statements have not been evaluated by the FDA.
These products are not intended to treat, diagnose, cure, or prevent any disease.

Calcium and CVD, Is There a Connection?

dairy-productsIs there a difference between, “I have blue paint in my bedroom,” and “My bedroom walls are painted blue?”  A gallon of paint in the closet or on the floor in your bedroom verifies the first quote. An empty can and blue walls verify the second. Maybe this isn’t the best analogy, but you can apply it to the calcium in your body, which is either part of your bones or used as an electrolyte, or not. It’s either where it belongs, or not. The body has a remarkable system for keeping the concentrations of calcium in the blood and tissues just right, for ensuring that calcium is where it belongs. If the balance gets upset, certain organs will suffer. You see, besides bones and teeth, calcium helps muscles by keeping nerve impulses firing properly; otherwise the muscles can twitch and cramp. This is the last thing we want to happen to the heart muscle. If necessary, calcium is drawn from bone, where ninety-nine percent is stored, to maintain body pH in times of calcium deficiency. The protein-bound calcium of the blood is a secondary reservoir of calcium, usually becoming available locally to meet needs, as in clotting after getting cut. In the electrophysiology of the heart, calcium works with sodium to enable a heartbeat.

Research on calcium in the last ten years, particularly on supplements, has raised eyebrows about calcium intake and the form in which it is taken. Whether inadvertently or by design, co-factors that enhance calcium bioavailability and absorption from supplements were overlooked by some researchers and the supplements were accused of causing heart attacks. One study, published in the British Medical Journal in 2008, decided that adverse cardiac events were attributable to calcium supplements. The study included almost fifteen hundred women over seventy years old, and reported that those who used calcium supplements experienced more heart problems than those who did not (Bolland, 2008). Neither health conditions, smoking habits, environmental and lifestyle status, prior illnesses, family history, dietary regimens, type of supplement used (carbonate, malate, citrate, etc.), nor other influences were scrutinized. Later study by the same group added vitamin D to the equation and arrived at the same conclusion, that calcium supplements with or without vitamin D modestly increased the risk of cardiovascular episodes, but only in women who did not take calcium supplements regularly and scrupulously prior to the study. It seems, then, that the sudden onrush of calcium nutrition was too much for the body of a geriatric subject, who might even have suffered a different pathology, to handle at one time, and that instead of moving to bone, the mineral clogged up the works (Bolland, 2011). These papers recommended that the role of calcium supplementation in the management of osteoporosis be reassessed. But it doesn’t stop here.

Critics of these studies question the accuracy of the conclusions by closely examining coronary artery calcification, wondering how the calcium got there in the first place, when it’s supposed to make bone, not arterial plaques. When comparing / contrasting dietary calcium and supplemental calcium, the results were similar:  there is no support for the hypothesis that high calcium intake increases risk for coronary artery calcification, held to be a definitive measure of atherosclerosis burden (Samelson, 2012) (Prince, 2011).

We know that vitamin D is necessary for the absorption of calcium and that its insufficiency is common in the northern latitudes. Oddly, insufficiency also occurs in the sub-tropical areas of the planet, partly because of sun avoidance and partly because of sunscreen use, though other factors weigh in, such as cloud cover, altitude and air pollution. Vitamin D is supposed to regulate serum calcium and phosphorus concentrations. In the absence of vitamin D, only about 10% of calcium is absorbed. Maybe the rest goes to places where it doesn’t belong, like your arteries. But you have to get enough vitamin D to make a difference.  The 400 IU used in the study (Bolland, 2011) is barely enough to prevent outright deficiency.

An inflammatory model of CVD has challenged the cholesterol model, and vitamin D plays a role in sequestering the cascade of activities that lead to cardiac episodes. When monocytes rush to the site of inflammation they become macrophages that swallow oxidized LDL and then provide the basis for plaque formation, part of which is trapped calcium. Because vitamin D can suppress macrophage cholesterol uptake, it can interrupt the foam cell cycle and subsequent plaques (Oh, 2009), thereby disrupting the cardiac incident. That’s cool. Hold on, there’s more…vitamin K. Most of us consider blood clotting and vitamin K in the same thought. While that’s true, this compound, associated with green leafy vegetables, does a few more things. There is evidence that low vitamin K levels are associated with reduced bone mineral density and increased arterial calcification (Jie, 1996). Concurrent work shows that vitamin K is able to escort calcium to the place where it belongs—bone. Although deficiency of this vitamin is infrequent, insufficiency is common, and that almost certainly would account for the presence of calcium where it isn’t supposed to be (Vermeer, 2000). Proteins that rely on vitamin K for their activity have shown the ability to inhibit vascular calcification. Even accounting for smoking, diabetes, age, dietary habits and other factors, it was found that subjects with the highest vitamin K levels in the menaquinone form (vitamin K2) experienced fewer incidents of all-cause mortality (Geleijnse, 2004), especially coronary heart disease (Beulens, 2009).

Humans can absorb only about 500 mg of supplemental calcium at a time, with the citrate form having better assimilation than the carbonate. Taking it with food, which encourages stomach acid formation to aid mineral metabolism, practically evens the field (Heaney, 2001, 1999). Considering that calcium is essential to human health, that dairy is not a significant player in most adult diets, that some vegetables high in calcium are also high in oxalates that bind the calcium,  that produce with available calcium contains only small amounts, and that too many of us shun beans for social reasons, supplementation remains the option. Get a dietitian to look at your diet and determine your calcium sources and values. Then take a supplement to bring daily intake up to about a thousand milligrams.  By monitoring vitamins D and K, too, vascular calcification becomes a relative non-issue. An important matter, though, remains for those taking warfarin. It might thin your blood and prevent a clot, but it also interferes with the activity of the proteins supported by menaquinone, and replaces the clot with a plaque.

References

Bo Abrahamsen, Opinder Sahota
Do calcium plus vitamin D supplements increase cardiovascular risk?
BMJ 2011; 342; (19 April 2011): d2080

Beulens JW, Bots ML, Atsma F, Bartelink ML, Prokop M, Geleijnse JM, Witteman JC, Grobbee DE, van der Schouw YT.
High dietary menaquinone intake is associated with reduced coronary calcification.
Atherosclerosis. 2009 Apr;203(2):489-93. Epub 2008 Jul 19.

Mark J Bolland, P Alan Barber, Robert N Doughty,  Barbara Mason,  Anne Horne,  Ruth Ames, Gregory D Gamble, Andrew Grey,  Ian R Reid
Vascular events in healthy older women receiving calcium supplementation: randomised controlled trial
BMJ. 31 Jan 2008; 336:262

Bolland MJ, Avenell A, Baron JA, Grey A, MacLennan GS, Gamble GD, Reid IR.
Effect of calcium supplements on risk of myocardial infarction and cardiovascular events: meta-analysis.
BMJ. 2010 Jul 29;341:c3691. doi: 10.1136/bmj.c3691.

Bolland MJ, Grey A, Avenell A, Gamble GD, Reid IR.
Calcium supplements with or without vitamin D and risk of cardiovascular events: reanalysis of the Women’s Health Initiative limited access dataset and meta-analysis.
BMJ. 2011 Apr 19;342:d2040. doi: 10.1136/bmj.d2040.

Geleijnse JM, Vermeer C, Grobbee DE, Schurgers LJ, Knapen MH, van der Meer IM, Hofman A, Witteman JC.
Dietary intake of menaquinone is associated with a reduced risk of coronary heart disease: the Rotterdam Study.
J Nutr. 2004 Nov;134(11):3100-5.

Heaney RP, Dowell MS, Barger-Lux MJ.
Absorption of calcium as the carbonate and citrate salts, with some observations on method.
Osteoporos Int. 1999;9(1):19-23.

Heaney RP, Dowell MS, Bierman J, Hale CA, Bendich A.
Absorbability and cost effectiveness in calcium supplementation.
J Am Coll Nutr. 2001 Jun;20(3):239-46.

Heller HJ, Greer LG, Haynes SD, Poindexter JR, Pak CY.
Pharmacokinetic and pharmacodynamic comparison of two calcium supplements in postmenopausal women.
J Clin Pharmacol. 2000 Nov;40(11):1237-44.

Jie KG, Bots ML, Vermeer C, Witteman JC, Grobbee DE.
Vitamin K status and bone mass in women with and without aortic atherosclerosis: a population-based study.
Calcif Tissue Int. 1996 Nov;59(5):352-6.

Khurana C, Rosenbaum CG, Howard BV, Adams-Campbell LL, Detrano RC, Klouj A, Hsia J.
Coronary artery calcification in black women and white women.
Am Heart J. 2003 Apr;145(4):724-9.

Li K, Kaaks R, Linseisen J, Rohrmann S.
Associations of dietary calcium intake and calcium supplementation with myocardial infarction and stroke risk and overall cardiovascular mortality in the Heidelberg cohort of the European Prospective Investigation into Cancer and Nutrition study (EPIC-Heidelberg).
Heart. 2012 Jun;98(12):920-5.

Oh J, Weng S, Felton SK, Bhandare S, Riek A, Butler B, Proctor BM, Petty M, Chen Z, Schechtman KB, Bernal-Mizrachi L, Bernal-Mizrachi C.
1,25(OH)2 vitamin d inhibits foam cell formation and suppresses macrophage cholesterol uptake in patients with type 2 diabetes mellitus.
Circulation. 2009 Aug 25;120(8):687-98. Epub 2009 Aug 10.

Richard L Prince,  Kun Zhu,  Joshua R Lewis
Calcium, vitamin D, and risk: Evidence of harm is unconvincing
BMJ. 7 Jun 2011; 342:  d3541 

Elizabeth J Samelson, Sarah L Booth, Caroline S Fox, Katherine L Tucker, Thomas J Wang, Udo Hoffmann, L Adrienne Cupples, Christopher J O’Donnell, and Douglas P Kiel
Calcium intake is not associated with increased coronary artery calcification: the Framingham Study
Am J Clin Nutr December 2012 vol. 96 no. 6 1274-1280

Vermeer C, Schurgers LJ.
A comprehensive review of vitamin K and vitamin K antagonists.
Hematol Oncol Clin North Am. 2000 Apr;14(2):339-53.

Weber P.
Vitamin K and bone health.
Nutrition. 2001 Oct;17(10):880-7.

*These statements have not been evaluated by the FDA.
These products are not intended to treat, diagnose, cure, or prevent any disease.

Mineral Balance: Sodium-Potassium

sodium-potassium-scaleLike children on a see-saw, some minerals work to balance each other in the body. Almost everything in nature is about balance. In humans and animals it’s called homeostasis, which is the property of the body to maintain its internal environment in a stable, constant condition. Occasionally, mainstream medicine overlooks the balance aspect and tends to look at isolated parts and actions of the body. One of these oversights involves sodium and its relationship with potassium, working together as the sodium-potassium pump, which is the mechanism of active transport by which sodium and potassium ions are moved across the cell membrane, into and out of the cell. With the help of ATP as the source of energy, sodium is extruded from the cell and potassium is invited in. This energetic display is necessary for protein biosynthesis, maintenance of osmotic equilibrium, initiation of nerve impulses and transport of some other molecules, such as glucose, across the membrane. To clarify, ATP is a high-energy phosphate compound used by the body to get things done, including muscle contractions and enzyme metabolism, among others.

Sodium (Na) and potassium (K) are essential minerals and electrolytes. As the latter, they dissociate into ions (charged particles), allowing them to conduct electricity. In order for the body to function the right way, they need to be regulated on both sides of the cell membrane. The recommended intake of sodium had been 2300 milligrams a day, but is now 1500 mg/d; that for potassium being unchanged at 4700 mg/day. The sodium:potassium ratio, therefore, has moved from 1:2 to almost 1:3, which is closer to what is believed to be the body’s ideal. In plants, of which humans eat too few, the natural ratio of Na to K is about 1:10.

Sodium is the chief ion outside the cell, potassium inside. Inside the cell, sodium concentrations are ten times lower than outside. Potassium concentration inside are about thirty times higher than outside. The difference across the membrane creates an electrochemical gradient known as membrane potential, which uses a lot of the body’s energy to maintain itself. Without this tight control, muscles would suffer, especially the heart. In the typical American diet, intake of sodium (as sodium chloride) is three times higher than potassium, just the opposite of what it should be. The dietary guidelines for sodium consumption are currently being met by only a tiny percent of the population (Drewnowski, 2012)

Table salt is about 39% sodium. A simple explanation is that one teaspoon of salt, which has a mass about 6200 mg, contains approximately 2400 mg of sodium.

The National Health and Nutrition Examination Survey (NHANES), first conducted in the early 70’s, reported in 2012 that more than 90% of adults consumed more than 2300 mg/d of sodium a day, and less than 2%–that’s two percent—met the recommendation for potassium (Cogswell, 2012). It’s no small surprise that high blood pressure is rampant (Wenberger, 1986) (Elliot, 1991, 1996) (Dyer, 1995) (He, 2004) (Levings, 2012)  Of course, you could argue that the relationship of sodium intake to hypertension is a genetic matter, but do you know your genes?

Increasing potassium and reducing sodium intake will help to reduce blood pressure. But be careful not to overdo it by using supplements without strict supervision, since potassium overload is almost as bad as potassium deficiency. After all, potassium is used to stop the heart in lethal injections. Aiming for the recommended 4700 mg a day means that vegetables and fruit intake needs to go up, while intake of cakes, cookies and prepared foods needs to go down. Overdosing potassium from foods is almost impossible…you can’t eat that much food.

If less than 2% of Americans get the recommended amount of potassium, how much do we get?  From data collected in 2009-2010, women get about 50% of the RDI, men about 81% (USDA, 2012). Besides supporting coronary health, potassium seems to lower the risk of stroke (Ascherio, 1998) (Larsson, 2011). If you’ve got abnormally high urinary calcium levels, you might be looking at kidney stones in your future, something we wouldn’t wish on anyone.  Increasing dietary potassium levels by increasing fruit and vegetable intake has been found to decrease urinary calcium excretion. Taking a supplement under supervision will do the same thing. It has been found that getting more than 4000 mg of potassium a day reduces risk of kidney stones (Curhan, 2004).

Diuretics may lower potassium levels, but not all do, so check with your doctor to find out if your diuretic is potassium-sparing or not. Laxatives, caffeine, tobacco and lots of sugar may also compromise potassium stores. Physical and mental stress interferes with potassium metabolism. If you haven’t already, try to increase potassium foods, including sweet potatoes, bananas, tomatoes, oranges, beans, squashes, nuts and seeds, green foods, avocados, garlic and a host of other produce. Look here for a list:
http://www.health.gov/dietaryguidelines/dga2005/document/html/appendixb.htm.

Look at both sodium and potassium in the context of what you eat every day and try to balance foods before you consider a potassium supplement. You know where most of the salt comes from (processed foods and the salt shaker), but you’ll have to read labels to find the rest. If you can maintain a ratio of one to one, you’ll be better off than most, but trying to get two to one, potassium to sodium, is preferred. Limiting sodium to about 500 mg in a meal is a virtuous endeavor. Look at some soup cans and you’ll see more than that in a tiny serving’s worth.  Even certain “light” soups have 650 mg of sodium in a 1-cup serving. Potassium values of these products are half that, which is the opposite of what it should be.  If the whole can is consumed, sodium-potassium balance needs to be addressed at other meals. Seeing kids unbalanced on a see-saw can be amusing. Viewing sodium-potassium balance from a gurney is not.

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*These statements have not been evaluated by the FDA.
These products are not intended to treat, diagnose, cure, or prevent any disease.