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Hydration: How much do you need?

waterWe have been counseled to drink eight, 8-ounce glasses of water a day (8 x 8) for such a long time that the advice has become unwritten law…and slavishly followed at that. This chant started so long ago that most people have no idea of its origin. At the same time, we are cautioned not to count alcohol and coffee as hydration elements. The science behind the recommendation is so scant that little support can be given to the exhortation, yet the possession of a water bottle is ubiquitous. It is possible that this idea is the result of misinterpretation or misreading of a notion proposed by the Food and Nutrition Board of the National Research Council that recommended one milliliter of water for every calorie consumed. The neglected fact is that there is water in our food. That would surely separate liquid intake from total dietary intake.

Dr. Heinz Valtin, a medical professor at Dartmouth, examined this mantra earlier in this century, and learned, “No scientific studies were found in support of 8 x 8.”  After reviewing surveys of food and fluid intake on thousands of adults of both genders, Dr. Valtin stated that, “…such large amounts (of water) are not needed because the surveyed persons were presumably healthy and certainly not overtly ill.”  He added that most other kinds of beverages, including soft drinks and coffee, contribute to one’s daily need for hydration, continuing that a considerable body of evidence supports the premise that the human body is fully capable of maintaining proper water balance.  But all this must be tempered with the qualifier, “in healthy persons.”  He leaves us with, “…large intakes of fluid, equal to and greater than 8 x 8, are advisable for the treatment or prevention of some diseases and certainly are called for under special circumstances, such as vigorous work and exercise, especially in hot climates.”  In the spirit of open-mindedness, Dr. Valtin asks that readers submit their own findings to him.

Including the 20% supplied by foods, the Institute of Medicine recommends a fluid intake of about 91 ounces a day for women and 125 ounces for men.  Do you know how much water is in your food?  Few of us do. The puzzling thing about this recommendation is the lack of sufficient data available on water metabolism in adults, especially those who are sedentary and living in a temperate environment.  Most of us take in more than that suggested level, when we account for comestibles, although the geriatric populace is apt to take in less of both food and liquid water, partly because of insensitivity to a thirst stimulus and partly because of a waning ability to taste foods and beverages as well as they did in their early years.  It appears that older men drink less than their younger counterparts, but excrete more urine.  Differences in women have shown to be insignificant, but contribute to the notion that, “water turnover is highly variable among individuals…”  (Raman et al. 2004)

Admittedly, older adults are at greater risk for dehydration, but water balance in this population had not been faithfully studied until Purdue University picked up the reins in 2005, and compared/contrasted water intake/output and total balance of fluids in an older population (63-81 y.o.) and a younger one (23-46 y.o.), finding that, in fat-free mass, there is little difference.  The study noted, though, that fat-free mass was lower in the elderly and that fat-free hydration was significantly higher.  Considering that the elderly have less muscle to begin with, this is simple to follow.  (Bossingham. 2005)

Many people complain that, if they increase water intake, they will spend more time in the lavatory.  While this is the case with many of us, there is a limiting factor—time.  The period of time over which a specific amount of water is consumed makes a difference in when the urge to evacuate that water will arise.  The faster you drink that glass of water, the sooner you will need to excrete it.  The longer the glass lasts, the more time there will be prior to evacuation.  “A water diuresis occurs when a large volume of water is ingested rapidly.”  (Shafiee. 2005)   Also note that water mixed with a poorly absorbed sugar (not glucose) will retard absorption and delay excretion.

The kidneys can process almost four gallons of water a day.  Too much water will make you sick because sodium stores will become depleted and electrolyte activity will be sorely jeopardized.  Drinking over a period of time can thwart this threat.  You need not measure urine output to figure out how much fluid to replace.  That is something you can eyeball.  Thirst should not be the barometer by which fluid need is determined.  While there is no absolute proof that we all need 8 x 8, have a glass of water even when you are not thirsty, working in the heat, or running a marathon.  To prevent electrolyte displacement, we might consider electrolyte replacement in at least a couple of our glasses.

References

MAIN ABSTRACT
Am J Physiol Regul Integr Comp Physiol. November 2002; vol. 283 no. 5: R993-R1004
“Drink at least eight glasses of water a day.” Really? Is there scientific evidence for “8 × 8”? Heinz Valtin and (With the Technical Assistance of Sheila A. Gorman)

SUPPORTING ABSTRACTS
Am J Physiol Renal Physiol. 2004 Feb; 286(2):F394-401. Epub 2003 Nov 4.
Water turnover in 458 American adults 40-79 yr of age. Raman A, Schoeller DA, Subar AF, Troiano RP, Schatzkin A, Harris T, Bauer D, Bingham SA, Everhart JE, Newman AB, Tylavsky FA.
Department of Nutritional Sciences, University of Wisconsin-Madison, Madison, Wisconsin 53706, USA.

Am J Clin Nutr. 2005 Jun; 81(6):1342-50.
Water balance, hydration status, and fat-free mass hydration in younger and older adults. Bossingham MJ, Carnell NS, Campbell WW.
Department of Foods and Nutrition, Purdue University, West Lafayette, IN 47907, USA.

Kidney Int. 2005 Feb;67(2):613-21.
Defining conditions that lead to the retention of water: the importance of the arterial sodium concentration. Shafiee MA, Charest AF, Cheema-Dhadli S, Glick DN, Napolova O, Roozbeh J, Semenova E, Sharman A, Halperin ML.

Renal Division, St. Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada.

Am J Physiol Regul Integr Comp Physiol. 2000 Sep;279(3):R966-73.
Effects of time of day, gender, and menstrual cycle phase on the human response to a water load. Claybaugh JR, Sato AK, Crosswhite LK, Hassell LH.

Department of Clinical Investigation, Tripler Army Medical Center, Tripler Army Medical Center, Hawaii 96859 – 5000. [email protected]

Eur J Clin Nutr. 2010 Feb;64(2):115-23. Epub 2009 Sep 2.
Water as an essential nutrient: the physiological basis of hydration. Jéquier E, Constant F.
Department of Physiology, University of Lausanne, Pully, Switzerland. [email protected]

J Am Soc Nephrol 19: 1041-1043, 2008
Just Add Water
Dan Negoianu and Stanley Goldfarb

Renal, Electrolyte, and Hypertension Division, University of Pennsylvania, Philadelphia, Pennsylvania

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

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.

Who Needs Electrolytes and Why?

Many people talk about electrolytes but do you have any idea what electrolyte really is? Being among the smallest of chemicals important to a cell’s function, electrolytes are crucial to the manufacturing of energy, the maintenance of membrane stability, the movement of fluids in the body, and a few other jobs, such as contracting a muscle, like the heart.

No Sweat

You know that you’ll taste salt if you lick the back of your hand after jogging or cutting grass on a hot summer day. Sodium is one of sweat’s main ingredients, along with chloride and potassium. All three are carried to the surface of the skin by the water made in sweat glands and the salt stays after the liquid evaporates. The purpose of sweating is regulation of body temperature, which is achieved by the eccrine glands that cover much of the body. An adult can easily sweat two liters an hour (Godek, 2008), up to eight liters a day (Vukasinovic-Vesic, 2015). It’s the evaporation of the water that has the cooling effect. Some animals do not have efficient sweat glands, such as dogs that have to pant to cool down, or hogs that needs to wallow in mud or cool water.

After exercise — or other cause of heavy perspiration — it’s important to restore fluid balance, especially in hot weather when it is easy to get dehydrated. Rehydration occurs only if both water and electrolytes are replaced. The amount of electrolytes lost through sweat varies from person to person. Accurately matching beverage electrolyte intake with loss through sweat is practically impossible. If you are eating at the same time as drinking plain water, this may suffice for rehydration. Otherwise, inclusion of electrolytes is essential.

What Are They and What Do They Do?

In the body, the electrolytes include sodium, potassium, calcium, bicarbonate, magnesium, chloride, and phosphate. Not all are contained — or needed — in an electrolyte replacement beverage. Sodium, the main cation outside the cell, controls total amount of water in the body, regulates blood volume and maintains muscle and nerve function. You need at least 500 mg a day. The suggested upper level is 2300 mg, but most Americans ingest more than 3000. Chloride, also from table salt, is an anion. Found in extracellular fluids, chloride, in the company of sodium, helps to maintain proper fluid balance and pressure of the various fluid compartments.

Potassium is the major cation inside the cell, where its job is to regulate heart beat and blood pressure while balancing the other electrolytes. Because it aids in transmitting nerve impulses, potassium is necessary for muscle contractions, actually the relaxation half of the contraction. Deficiency of potassium is more common than overdose, and may arise from diarrhea or vomiting, with muscle weakness and cramping being symptoms. Intake of potassium is generally much lower than the recommended 4700 mg a day, which is not surprising in light of the deficits in food caused by insulting agricultural practices. Perhaps the most under-appreciated mineral in the nutrient armamentarium is magnesium, not only a constituent of more than three hundred biochemical reactions in the body, but also a role player in the synthesis of both DNA and RNA. As an electrolyte, magnesium supports nerve and muscle function, boosts immunity, monitors heart cadence, stabilizes blood glucose, and promotes healthy bones and teeth. With half the U.S. population deficient, Mg is the orphan nutrient that is able to prevent elevated markers of inflammation (such as CRP), hypertension (It’s called nature’s calcium channel blocker), atherosclerotic vascular disease, migraines, asthma, and colon cancer (Rosanoff, 2012). Supplementation with magnesium is uncertain because absorption is inverse to intake.

Like the others, calcium is involved in muscle contraction and the transmission of nerve messages, but also in blood clotting. Calcium tells sodium to initiate a contraction so that you can pick up a pencil or scratch your nose. In opposition, magnesium tells potassium to let the pencil go or to move your arm back down. Because the heart needs calcium for a strong beat, it will pull the mineral from bone if dietary sufficiency is missing. After calcium, phosphorus — phosphate — is the most abundant mineral in the body. This anion helps to produce energy inside the cell besides being a bone strengthener. It’s a major building block of DNA and the cell membrane. Bicarbonate keeps pH in balance and is important when muscles make lactic acid from work.

Where Can I Get the Electrolytes I Need?

There are scores of electrolyte replacements on the market and entirely too many with sugar or additives. The issue with electrolytes is, in all honesty, that they taste bitter and salty. The fact that sugar is a carbohydrate hinders the processing of a hydration drink because absorption is slowed. That’s what carbohydrates do. Sugar concentrations in many sports drinks are higher than that of body fluid, so will not be readily absorbed. Plain water passes through too fast; carb-laden drinks pass too slowly. Therefore, an electrolyte balanced drink will do the job better and faster. Sodium and potassium, after all, encourage fluid retention and help to reduce urine output.

It is common knowledge that most of us gravitate to sweetness in times of dehydration; saltiness less so. But when you need rehydration, choose the real stuff, BodyBio’s E-lyte and E-lyte Sport, two electrolyte replacements that copy the mineral balance of the body. Elyte may be used as a daily addition to the diet, and is effective to restore homeostasis in times of virus-induced gastrointestinal distress for adults and children, in electrolyte deficit from uncontrolled diabetes and even for restless leg syndrome. When sodium loss is high from exercise, chose Elyte Sport.

References

Coyle EF.
Fluid and fuel intake during exercise.
J Sports Sci. 2004 Jan;22(1):39-55.

Robert W. Kenefick, PhD and Michael N. Sawka, PhD
Hydration at the Work Site
J Am Coll Nutr. October 2007; vol. 26 no. suppl 5: 597S-603S

Meurman JH, Härkönen M, Näveri H, Koskinen J, Torkko H, Rytömaa I, Järvinen V, Turunen R.
Experimental sports drinks with minimal dental erosion effect.
Scand J Dent Res. 1990 Apr;98(2):120-8.

Noble WH, Donovan TE, Geissberger M.
Sports drinks and dental erosion.
J Calif Dent Assoc. 2011 Apr;39(4):233-8.

Sports Med. 2002;32(15):959-71.
Hydration testing of athletes.
Oppliger RA, Bartok C.

Sawka MN, Montain SJ, Latzka WA.
Hydration effects on thermoregulation and performance in the heat.
Comp Biochem Physiol A Mol Integr Physiol. 2001 Apr;128(4):679-90.

Convertino VA, Armstrong LE, Coyle EF, Mack GW, Sawka MN, Senay LC Jr, Sherman WM.
American College of Sports Medicine position stand. Exercise and fluid replacement.
Med Sci Sports Exerc. 1996 Jan;28(1):i-vii.

Rehrer NJ.
Fluid and electrolyte balance in ultra-endurance sport.
Sports Med. 2001;31(10):701-15.

Maughan RJ, Shirreffs SM.
Dehydration and rehydration in competative sport.
Scand J Med Sci Sports. 2010 Oct;20 Suppl 3:40-7

Gal Dubnov-Raza, Yair Lahavb, and Naama W. Constantinic
Non-nutrients in sports nutrition: Fluids, electrolytes, and ergogenic aids
e-SPEN, the European e-Journal of Clinical Nutrition and Metabolism. 6(4); Aug 2011: pp. e217-e222

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

MSG and Weight Gain

No MSGThe Body Mass Index (BMI) is a measure of the relative percentages of fat and muscle mass in the human body, based on a person’s weight and height, used to assess obesity. This barometer was used by researchers to determine the effect of the food additive, monosodium glutamate (MSG), on weight over a period of time. It was learned that those persons who consume MSG regularly experience changes in the part of the brain that controls appetite, thus having an influence on energy balance and consequent weight gain.

When researcher, Ka He, and his colleagues at the University of North Carolina began to look for a relationship between monosodium glutamate and weight gain, they hypothesized that it would be a positive one.  As a design element of the study, “…overweight was defined as a body mass index ≥ 25…based on World Health Organization recommendations for Asian populations.”  With an average MSG intake of 2.2 grams a day, and a five-year follow-up, the study population demonstrated that “MSG consumption was positively, longitudinally associated with overweight development…”

The better it tastes, the more we’ll eat.  That seems logical.  Most Americans eat so fast that their brains don’t have enough time to process the information that says they’re full.  Since that lag time is about twenty minutes, we should take at least that much time to eat.  But the school cafeteria, the incessant phone calls, the pressures of the job, and other lifestyle components disallow that.  Combine any of these facets of life with food additives that enhance flavor, and start looking for a longer belt.

Leptin is a hormone that plays an important role in energy intake and expenditure, and it tells us when to stop eating…if it works the right way.  It’s made by fat cells, oddly enough, but can also come from other parts of the body, such as the bones, stomach, and liver.  It acts on parts of the brain’s hypothalamus, where it inhibits appetite. If leptin is not appropriately received and taken up by the hypothalamus, appetite fails to shut off and food intake is uncontrolled.  Where does MSG fit into this picture?  It seems to be able to induce hypothalamic lesions and ensuing leptin resistance (He, et al. 2008).  The stage is now set for weight gain.

Glutamate is the major excitatory transmitter in the brain, meaning that it makes things happen, especially in cognition, memory and learning.  It also affects brain development, cellular survival and the manufacture of synapses.  Too much glutamate, though, can raise serious concerns because its excitatory nature becomes intensified by virtue of its accumulation, allowing excess calcium to enter a nerve cell and damage it beyond repair.  This is what happens in the hypothalamus.

Glutamate, sometimes as glutamic acid, is responsible for the tantalizing flavors of poultry, some fishes, and eggs, among other foods.  Its salt, MSG, was introduced to the United States after WW II as “Accent” flavor enhancer.  It can be made by the fermentation of beets, sugar cane, or molasses.  People began to experience adverse reactions to MSG after eating Chinese food prepared with it, thereby coining the expression “Chinese Restaurant Syndrome.”  Sensitivity to monosodium glutamate may present with headaches, asthmatic symptoms, hyperactivity (especially in children), and obesity.  Frequency of such responses is low, but if it happens in your family, it’s high enough to merit attention.

We all know that the world revolves around the dollar bill and the ball point pen, the latter often employed to guarantee the former.  As long as clandestine groups can get away with something, they’ll persist.  And so it is with MSG.  It has more disguises than Artemus Gordon and Sherlock Holmes combined.  Here are a couple handfuls of MSG aliases:  glutamic acid, monopotassium glutamate, magnesium, glutamate, monoammonium glutamate, yeast extract, hydrolyzed anything, calcium or sodium caseinate, yeast nutrient, gelatin, textured protein, soy protein isolate, soyprotein concentrate, whey protein, ajinomoto.

These ingredients often contain glutamic acid:  carrageenan, bouillon, stock, maltodextrin, barley malt, protease, malt extract, soy sauce, and any protein that is fortified or fermented.  Additionally, these work with MSG to further enhance flavor:  Disodium 5’-guanylate; Disodium 5’-inositate; and Disodium 5’-ribonucleotides.  Wherever these three abide, it’s almost guaranteed that MSG is a companion.

Individual amino acids are not generally listed on the ingredients labels of food or health care products.  Binders and fillers may or may not contain MSG.  Believe it or not, MSG may also appear in cosmetics, including shampoos, soaps and hair conditioners.  If the words “hydrolyzed,” “amino acids,” or “protein” appear on the label, MSG could be in it.  Live virus vaccines may also have it.  Even though reactions to MSG are dose-dependent, you could react to a very small amount all of a sudden, when you never did so before.  Yes, MSG is natural, but so is arsenic.  To most of us, MSG does not cause problems.  MSG might make you want to eat more.  It might affect the state of your hypothalamus.  On the other hand, it’s not likely to make you wash your hair more often.  Is it?

Referneces

Am J Clin Nutr. 2011 Jun;93(6):1328-36. Epub 2011 Apr 6.
Consumption of monosodium glutamate in relation to incidence of overweight in Chinese adults: China Health and Nutrition Survey (CHNS).
He K, Du S, Xun P, Sharma S, Wang H, Zhai F, Popkin B
Departments of Nutrition and Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC.

Acta Physiol Hung. 2011 Jun;98(2):177-88.
Monosodium glutamate versus diet induced obesity in pregnant rats and their offspring.
Afifi MM, Abbas AM.
Department of Biochemistry, Zagazig University, Zagazig, Egypt.
Abstract

Am J Clin Nutr. 2011 Jun;93(6):1328-36. Epub 2011 Apr 6.
Consumption of monosodium glutamate in relation to incidence of overweight in Chinese adults: China Health and Nutrition Survey (CHNS).
He K, Du S, Xun P, Sharma S, Wang H, Zhai F, Popkin B.

Nutrition. 2005 Jun;21(6):749-55.
Monosodium glutamate in standard and high-fiber diets: metabolic syndrome and oxidative stress in rats.
Diniz YS, Faine LA, Galhardi CM, Rodrigues HG, Ebaid GX, Burneiko RC, Cicogna AC, Novelli EL.
Department of Clinical Cardiology, Faculty of Medicine, University of São Paulo State, Botucatu, Brazil.

Mol Pharmacol. 1989 Jul;36(1):106-12.
Delayed increase of Ca2+ influx elicited by glutamate: role in neuronal death.
Manev H, Favaron M, Guidotti A, Costa E.
Fidia-Georgetown Institute for the Neurosciences, Georgetown 4niversity, Washington, DC 20007.

Cell Calcium. 2003 Feb;33(2):69-81.
Calcium influx constitutes the ionic basis for the maintenance of glutamate-induced extended neuronal depolarization associated with hippocampal neuronal death.
Limbrick DD Jr, Sombati S, DeLorenzo RJ.

*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.

References

Arcand J, Steckham K, Tzianetas R, L’Abbe MR, Newton GE.
Evaluation of Sodium Levels in Hospital Patient Menus
Arch Intern Med. 2012;172(16):1261-1262.

Ascherio A, Rimm EB, Hernán MA, Giovannucci EL, Kawachi I, Stampfer MJ, Willett WC.
Intake of potassium, magnesium, calcium, and fiber and risk of stroke among US men.
Circulation. 1998 Sep 22;98(12):1198-204.

Barri YM, Wingo CS.
The effects of potassium depletion and supplementation on blood pressure: a clinical review.
Am J Med Sci. 1997 Jul;314(1):37-40.

Centers for Disease Control and Prevention (CDC).
Usual sodium intakes compared with current dietary guidelines — United States, 2005-2008.
MMWR Morb Mortal Wkly Rep. 2011 Oct 21;60(41):1413-7.

Cogswell ME, Zhang Z, Carriquiry AL, Gunn JP, Kuklina EV, Saydah SH, Yang Q, Moshfegh AJ.
Sodium and potassium intakes among US adults: NHANES 2003-2008.
Am J Clin Nutr. 2012 Sep;96(3):647-57.

Curhan GC, Willett WC, Knight EL, Stampfer MJ.
Dietary factors and the risk of incident kidney stones in younger women: Nurses’ Health Study II.
Arch Intern Med. 2004 Apr 26;164(8):885-91.

Denton D, Weisinger R, Mundy NI, Wickings EJ, Dixson A, Moisson P, Pingard AM, Shade R, Carey D, Ardaillou R, et al.
The effect of increased salt intake on blood pressure of chimpanzees.
Nat Med. 1995 Oct;1(10):1009-16.

Drewnowski A, Maillot M, Rehm C.
Reducing the sodium-potassium ratio in the US diet: a challenge for public health.
Am J Clin Nutr. 2012 Aug;96(2):439-44.

Dyer AR, Stamler R, Elliott P, Stamler J.
Dietary salt and blood pressure.
Nat Med. 1995 Oct;1(10):994-6.

Elliott P
Observational studies of salt and blood pressure.
Hypertension. 1991 Jan;17(1 Suppl):I3-8.

Elliott P, Stamler J, Nichols R, Dyer AR, Stamler R, Kesteloot H, Marmot M.
Intersalt revisited: further analyses of 24 hour sodium excretion and blood pressure within and across populations. Intersalt Cooperative Research Group.
BMJ. 1996 May 18;312(7041):1249-53.

He FJ, MacGregor GA.
Effect of longer-term modest salt reduction on blood pressure.
Cochrane Database Syst Rev. 2004;(3):CD004937

Hoorn EJ, Betjes MG, Weigel J, Zietse R.
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Nephrol Dial Transplant. 2008 May;23(5):1562-8.

Krishna GG, Chusid P, Hoeldtke RD.
Mild potassium depletion provokes renal sodium retention.
J Lab Clin Med. 1987 Jun;109(6):724-30.

Krishna GG.
Role of potassium in the pathogenesis of hypertension.
Am J Med Sci. 1994 Feb;307 Suppl 1:S21-5.

Larsson SC, Virtamo J, Wolk A.
Potassium, calcium, and magnesium intakes and risk of stroke in women.
Am J Epidemiol. 2011 Jul 1;174(1):35-43.

Levings J, Cogswell M, Curtis CJ, Gunn J, Neiman A, Angell SY.
Progress toward sodium reduction in the United States.
Rev Panam Salud Publica. 2012 Oct;32(4):301-6.

National Institute of Health
Jan. 26, 2009
Sodium/Potassium Ratio Linked to Cardiovascular Disease Risk
http://www.nih.gov/researchmatters/january2009/01262009hypertension.htm

Akira Okayama; Katsuyuki Miura; Tomonori Okamura; Nagako Okuda; Shigeyuki Saitoh; et al
Abstract MP077: Dietary Sodium Potassium Ratio as a Risk Factor for Stroke, Cardiovascular Diseases and All-cause Death Among Japanese: Nippondata80.
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Quanhe Yang, PhD; Tiebin Liu, MSPH; Elena V. Kuklina, MD, PhD; et al.
Sodium and Potassium Intake and Mortality Among US AdultsProspective Data From the Third National Health and Nutrition Examination Survey FREE
Arch Intern Med. 2011;171(13):1183-1191.

Lynn D. Silver, MD, MPH; Thomas A. Farley, MD, MPH
Sodium and Potassium Intake: Mortality Effects and Policy ImplicationsComment on “Sodium and Potassium Intake and Mortality Among US Adults”
Arch Intern Med. 2011;171(13):1191-1192.

Stofan JR, Zachwieja JJ, Horswill CA, Murray R, Anderson SA, Eichner E
Sweat and sodium losses in NCAA football players: a precursor to heat cramps?
Int J Sport Nutr Exerc Metab. 2005 Dec;15(6):641-52.

U.S. Department of Agriculture, Agricultural Research Service. 2012.
Total Nutrient Intakes: Percent Reporting and Mean Amounts of Selected Vitamins and Minerals from Food and Dietary
Supplements, by Family Income (as ! of Federal Poverty Threshold) and Age, What We Eat in America, NHANES 2009-2010. Available: www.ars.usda.gov/ba/bhnrc/fsrg.
USDA, Agricultural Research Services

USDA
Dietary Guidelines for Americans 2005
Appendix B-1. Food Sources of Potassium
http://www.health.gov/dietaryguidelines/dga2005/document/html/appendixb.htm

USDA. Downloadable pdf Tables.
What We Eat in America, 2009-2010.
http://www.ars.usda.gov/Services/docs.htm?docid=18349

Weinberger MH, Miller JZ, Luft FC, Grim CE, Fineberg NS.
Definitions and characteristics of sodium sensitivity and blood pressure resistance.
Hypertension. 1986 Jun;8(6 Pt 2):II127-34.

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

Mineral Balance: Copper-Zinc

copper-zinc-scaleThe last mineral topic we covered dealt with sodium and potassium. Important stuff, this mineral balance. Recall that the amounts of minerals needed by the body are not an indication of their importance, and that we probably can’t get all that we need from our foods because of untrustworthy practices from seed to table. Remember, too, that kids, especially, need to eat the plants to get the minerals. The recommended number of servings of fruits and vegetables is now nine to thirteen, up from five to nine. Either way, how many people do you know who eat that much?

Copper and zinc are antagonists, and the balance between them is an example of biological dualism. This does that, and that does this, and they often fight with each other. Kind of a simple explanation, but maybe you get it. Yes, it’s possible for there to be zinc toxicity and copper toxicity. In the past, it’s been copper toxicity and zinc deficiency. Today it might be just the reverse, considering that people take supplements without the faithful reading of labels. Both minerals play important roles in the body.

Copper is necessary for blood vessel formation, a strong heart and for stabilizing collagen. You know what collagen is…the glue that holds us together. We need copper for brain development and for communication between nerve cells in the brain. Copper is essential to a number of enzymes involved in energy production by the mitochondria.  It helps to make superoxide dismutase to get rid of reactive oxygen species (free radicals). Because it’s found in a number of foods, copper deficiency is not common. Meats, shellfish, nuts, and seeds are premier sources, followed by mushrooms, lentils, shredded wheat and chocolate. Daily intake by adults normally is a little more than a milligram, which is only a bit higher than the RDA of 0.9 mg. The tolerable upper limit for adults is 10 mg, while most supplements contain 2 mg. Infants fed a cow’s milk diet are the ones most likely deficient because milk has little copper, but people with malabsorption disorders are close behind. Anemia and low white blood cell count are signs of deficit. Take care to note that very high doses of vitamin C might interfere with copper-related enzyme efficiency (Finley, 1983). But that’s not written in stone. Zinc overdose, however, might be a legitimate cause of copper deprivation.

Now, here’s the rub with zinc. Concerns arise when you take several supplements that each contain zinc. The tolerable upper limit, the dose above which there may be adverse reactions, is 40 milligrams for an adult. Let’s see, Hmm, prostate formula contains 15 mg; cold/flu formula contains 15 mg; daily multi-vitamin contains 15 mg; nasal spray contains 5 mg; other zinc complexes aimed at myriad conditions contain more…  Can you see where we’re going?  Copper deficiency now becomes a possibility. The need for zinc hovers around 11 mg for a guy, about 8 mg for a non-pregnant female.

Zinc is needed for steroid hormone synthesis, being a well-known catalyst for testosterone manufacture as well as luteinizing hormone, the one that stimulates ovulation. Of all the body parts, the prostate contains the highest concentrations. More than a hundred different enzymes rely on zinc for their ability to catalyze chemical reactions in the body. It plays a structural role in the superoxide dismutase mentioned in the earlier paragraph and in the integrity of the cell membrane. In fact, the loss of zinc from biological membranes increases their susceptibility to oxidative damage (O’Dell, 2000). Then, we have these nifty little things called zinc fingers, which are transcription factors that bind to DNA and influence specific genes, which are stabilized by the presence of zinc. Taking too much zinc over a period of a few weeks will upset copper bioavailability, possibly resulting in hematology issues down the line. Meanwhile, the bioavailability of folate/folic acid/folinic acid is enhanced by zinc.

Zinc deficiency usually follows genetic disorders and is identified as such. Immune deficiencies, impaired healing, diminished sense of taste (and perhaps smell), night blindness, opacity of the cornea, behavioral disturbances, and delayed maturation are common signs of low zinc values. Deficiency in children is dramatic in that neuropsychological development is impeded and susceptibility to life-threatening infections is increased (Hambidge, 2000).

Do those zinc lozenges advertisements have any immune system merit? We know that zinc deficiency causes immune dysfunction, but there is mixed commentary on the efficacy of zinc mega-doses for colds and other viral infections in people with ample zinc stores (Baum, 2000) (Salqueiro, 2000) (Fraker, 2000). The immune system relies on more than just zinc for its competence. Essential amino and fatty acids, selenium and iron, folic acid and vitamins B6 and B12, and vitamins E, A and C have a say in the immune system’s function. Consider, too, that a deficiency in one of these is likely to follow a deficiency in one or more of the others. Intakes of nutrients in excess of the recommendations do not necessarily translate to a boost in all immune activity unless a deficiency has been identified. Even then, despite the disparity in research conclusions, mega-doses of one mineral can knock another one out of the ring. On the other hand, using zinc lozenges as soon as cold symptoms appear seems to reduce severity and duration, depending on the formulation (Singh, 2011).

Balancing copper and zinc, though vitally important, may not be as easy as expected. Exposure to other metals, especially to lead that may originate from ancient water pipes, contaminated ground water, the shooting sports, some toys and paints,and fishing sinkers, can push zinc out. Iron, particularly from a supplement, may inhibit intestinal absorption of both zinc and copper through competition for transport molecules located in the gut. Wilson’s disease, the inability to metabolize copper out of the body, requires a dietary change that precludes mushrooms, nuts, chocolate, shellfish and dried fruits, and includes zinc therapy (Chasapis, 2012). The testing for zinc and copper values is not completely established because reference ranges are based on statistical averages, not on optimum functional levels. As with other nutrients, availability from foods is too often questionable, but supplementation should to be considered under the guidance of a knowledgeablenutrition professional, such as a credentialed nutritionist or dietitian. A caveat: Don’t even think about drinking water from a galvanized container. There are reports of a family that had collected its drinking water from a brand new refuse container and suffered from zinc overdose. Some denture adhesives contain zinc. Be careful. Read labels.

References

Baum MK, Shor-Posner G, Campa A.
Zinc status in human immunodeficiency virus infection.
J Nutr. 2000 May;130(5S Suppl):1421S-3S.

Brewer GJ, Yuzbasiyan-Gurkan V, Lee DY.
Use of zinc-copper metabolic interactions in the treatment of Wilson’s disease.
J Am Coll Nutr. 1990 Oct;9(5):487-91.

Calder PC, Kew S.
The immune system: a target for functional foods?
Br J Nutr. 2002 Nov;88 Suppl 2:S165-77.

Chan S, Gerson B, Subramaniam S.
The role of copper, molybdenum, selenium, and zinc in nutrition and health.
Clin Lab Med. 1998 Dec;18(4):673-85.

Chasapis CT, Loutsidou AC, Spiliopoulou CA, Stefanidou ME.
Zinc and human health: an update.
Arch Toxicol. 2012 Apr;86(4):521-34.

Finley EB, Cerklewski FL.
Influence of ascorbic acid supplementation on copper status in young adult men.
Am J Clin Nutr. 1983 Apr;37(4):553-6.

Fraker PJ, King LE, Laakko T, Vollmer TL.
The dynamic link between the integrity of the immune system and zinc status.
J Nutr. 2000 May;130(5S Suppl):1399S-406S.

Hambidge M.
Human zinc deficiency.
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Hulisz D.
Efficacy of zinc against common cold viruses: an overview.
J Am Pharm Assoc (2003). 2004 Sep-Oct;44(5):594-603.

Jackson JL, Lesho E, Peterson C.
Zinc and the common cold: a meta-analysis revisited.
J Nutr. 2000 May;130(5S Suppl):1512S-5S.

McElroy BH, Miller SP.
Effectiveness of zinc gluconate glycine lozenges (Cold-Eeze) against the common cold in school-aged subjects: a retrospective chart review.
Am J Ther. 2002 Nov-Dec;9(6):472-5.

Milne DB, Davis CD, Nielsen F
Low dietary zinc alters indices of copper function and status in postmenopausal women.
Nutrition. 2001 Sep;17(9):701-8.

O’Dell BL.
Role of zinc in plasma membrane function.
J Nutr. 2000 May;130(5S Suppl):1432S-6S.

Perrone L, Di Palma L, Di Toro R, Gialanella G, Moro R.
Interaction of trace elements in a longitudinal study of human milk from full-term and preterm mothers.
Biol Trace Elem Res. 1994 Jun;41(3):321-30.

Salgueiro MJ, Zubillaga M, Lysionek A, Cremaschi G, Goldman CG, Caro R, De Paoli T, Hager A, Weill R, Boccio J.
Zinc status and immune system relationship: a review.
Biol Trace Elem Res. 2000 Sep;76(3):193-205.

Singh M, Das RR.
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Turnlund J, Costa F, Margen S.
Zinc, copper, and iron balance in elderly men.
Am J Clin Nutr. 1981 Dec;34(12):2641-7.

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

Salt’s At Fault? Now What?

too_much_saltFor years it was held that salt intake has a distinct influence on blood pressure and cardiovascular disease (CVD). In fact, in 2011 the American Heart Association issued a sweeping call for salt restriction (Appel, 2011), limiting intake of sodium to less than 1500 milligrams a day, which translates to approximately 3750 milligrams of sodium chloride. One teaspoon of salt, which is about 40% sodium and 60% chloride, has 2300 mg of sodium. Naturally found in most foods, sodium defies accurate measurement, but because men eat more food than women, they consume more. Nerve impulses depend on sodium for activation; otherwise you wouldn’t be able to open the link to this page. Overconsumption of sodium, however, can lead to calcium deficiency (Teucher, 2008). Once again, it’s a matter of balance…but not without at least a little controversy. Also in 2011, the Journal of the American Medical Association published a paper that discounts a relationship of salt intake to CVD. In a study that lasted for nearly eight years, researchers found the incidence of mortality and morbidity related to sodium intake to be minimal, with no translation to a greater risk of elevated blood pressure or CVD (Stolarz-Skrzypek, 2011). Contrary to conventional wisdom, low sodium was associated with elevated CVD risk. Now there, don’t jump for joy and a box of pretzels over one study. For every yin there’s a yang—potassium is the foil to sodium. Potassium is a mineral whose insufficiency is widespread. Most of us are fortunate if we get half the 4700 mg recommended every day. Maintaining the ratio, 2 to 1 in favor of potassium, offers considerable benefit to cardiovascular health (Yang, 2011). The bottom line in all this is that minerals need to be in, well, balance.

Still, excess salt intake is a way of life for some. In a fancy restaurant, you might be challenged to find salt and pepper shakers on a table, for fear of insulting the chef. At the corner diner, on the other hand… This temptation, or rather succumbing to the temptation, could be our downfall. Very recent papers published in the highly respected journal, Nature, deliver the news that salt intake may be associated with autoimmune diseases through a mechanism that turns certain of our immune cells into traitors. In autoimmune conditions, abnormal antibodies are produced and they attack the body’s own cells and tissues. Lupus, rheumatoid arthritis and type 1 diabetes are commonly known examples, but there are other disorders that have an autoimmune component. In each instance there will be a characteristic set of autoantibodies to attack normal cells. Sometimes the autoantibodies actually cause the tissue and organ damage; sometimes they’re only the markers of disease. Susceptibility to autoimmune disease could be blamed on environmental influences, genetic makeup, exposure to an infectious organism, or to a combination of these.

Newly identified in the study of autoimmune disease is a population of T cells called TH17, which produce an interleukin different from the run-of-the-mill T cells that assist other white cells in immunologic processes. Excessive numbers of TH17 cells are thought to play a vital role in autoimmune diseases (Harrington, 2005) (Stockinger, 2007), including multiple sclerosis, psoriasis, rheumatoid arthritis and Crohn’s disease. What these cells do is to fail to turn inflammation off. Inflammation is the body’s response to attack, whether from trauma, viral or bacterial infection, heat or whatever else might cause an insult. In this response a few things happen: blood vessels dilate, fluid may leak from the surrounding area and clot, cells swell, platelets get activated, macrophages show up to swallow damaged tissue, and the healing begins. We need inflammation to heal, but it has to stop before healing is complete. We take anti-inflammatory chemicals to stop the pain, but we also stop—or at least inhibit—the healing. TH17 cells are there to fight infections, normally targeting fungi and bacteria, but they need to control themselves. One of the factors found to instigate TH17 cells into aberrant activity is salt. In its presence, T helper cells are more likely to develop into TH17 cells that are pathogenic (Wu, 2013). Then they attack the body’s own cells.

Not surprising is that those who frequent fast-food joints were found to have elevated levels of TH17 cells. Why not, if this relationship is definitive?  Such establishments use salt to embellish flavor. Each of us has a gene that controls the physiological response to salt intake. In certain individuals, this gene is over-expressed by salt, leading to the pathogenicity of TH17 cells and subsequent inflammation (Wu, 2013). This effect is leading scientists to look more closely at low-salt diets in the treatment of autoimmune diseases. The good side of the original study is that several genes are implicated in the response, not just the one with the greatest impact. And it’s not likely that all are out of sync at the same time. Furthermore, the factors that initiate autoimmune disease need to be in concert. For most of us, they are not. For the rest, maybe hiding the salt shaker could make a difference. For those with type 2 diabetes, the difference would be substantial.

References

Appel LJ, Frohlich ED, Hall JE, Pearson TA, Sacco RL, Seals DR, Sacks FM, Smith SC Jr, Vafiadis DK, Van Horn LV.
The importance of population-wide sodium reduction as a means to prevent cardiovascular disease and stroke: a call to action from the American Heart Association.
Circulation. 2011 Mar 15;123(10):1138-43. doi: 10.1161/CIR.0b013e31820d0793. Epub 2011 Jan 13.

Charlton K, Yeatman H, Houweling F, Guenon S.
Urinary sodium excretion, dietary sources of sodium intake and knowledge and practices around salt use in a group of healthy Australian women.
Aust N Z J Public Health. 2010 Aug;34(4):356-63. doi: 10.1111/j.1753-6405.2010.00566.x.

Cook NR, Obarzanek E, Cutler JA, Buring JE, Rexrode KM, Kumanyika SK, Appel LJ, Whelton PK; Trials of Hypertension Prevention Collaborative Research Group.
Joint effects of sodium and potassium intake on subsequent cardiovascular disease: the Trials of Hypertension Prevention follow-up study.
Arch Intern Med. 2009 Jan 12;169(1):32-40. doi: 10.1001/archinternmed.2008.523.

Harrington LE, Hatton RD, Mangan PR, Turner H, Murphy TL, Murphy KM, Weaver CT.
Interleukin 17-producing CD4+ effector T cells develop via a lineage distinct from the T helper type 1 and 2 lineages.
Nat Immunol. 2005 Nov;6(11):1123-32. Epub 2005 Oct 2.

Su M. Metcalfe
Multiple sclerosis: One protein, two healing properties
Nature. (15 September 2011); 477: 287–288 doi:10.1038/477287a

John J. O’Shea & Russell G. Jones
Autoimmunity: Rubbing salt in the wound
Nature. 06 March 2013 doi:10.1038/nature11959

Steinman L.
A brief history of T(H)17, the first major revision in the T(H)1/T(H)2 hypothesis of T cell-mediated tissue damage.
Nat Med. 2007 Feb;13(2):139-45.

Stockinger B, Veldhoen M.
Differentiation and function of Th17 T cells.
Curr Opin Immunol. 2007 Jun;19(3):281-6. Epub 2007 Apr 12.

Stolarz-Skrzypek K, Kuznetsova T, Thijs L, Tikhonoff V, Seidlerová J, Richart T, Jin Y et al
Fatal and nonfatal outcomes, incidence of hypertension, and blood pressure changes in relation to urinary sodium excretion.
JAMA. 2011 May 4;305(17):1777-85. doi: 10.1001/jama.2011.574.

Teucher B, Dainty JR, Spinks CA, Majsak-Newman G, Berry DJ, Hoogewerff JA, Foxall RJ, Jakobsen J, Cashman KD, Flynn A, Fairweather-Tait SJ.
Sodium and bone health: impact of moderately high and low salt intakes on calcium metabolism in postmenopausal women.
J Bone Miner Res. 2008 Sep;23(9):1477-85. doi: 10.1359/jbmr.080408.

Chuan Wu, Nir Yosef, Theresa Thalhamer, Chen Zhu, Sheng Xiao, Yasuhiro Kishi, Aviv Regev & Vijay K. Kuchroo
Induction of pathogenic TH17 cells by inducible salt-sensing kinase SGK1
Nature. 06 March 2013 doi:10.1038/nature11984

Yang Q, Liu T, Kuklina EV, Flanders WD, Hong Y, Gillespie C, Chang MH, Gwinn M, Dowling N, Khoury MJ, Hu FB.
Sodium and potassium intake and mortality among US adults: prospective data from the Third National Health and Nutrition Examination Survey.
Arch Intern Med. 2011 Jul 11;171(13):1183-91. doi: 10.1001/archinternmed.2011.257.

Nir Yosef, Alex K. Shalek, Jellert T. Gaublomme, Hulin Jin, Youjin Lee, Amit Awasthi, et al
Dynamic regulatory network controlling TH17 cell differentiation
Nature. 06 March 2013 doi:10.1038/nature11981

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

Soda And Heart Risk: And We Thought It Was Only Teeth We Had To Worry About

soda-glassDid your mother ever say, “If you know what’s good for you, you’ll…?” Know what the matter is?  Even as adults who know what’s good for us, we drop the ball as if we didn’t know what’s good for us. Some of us even put the ball down on purpose from time to time. Hey, if we don’t know what’s good for us, how are we supposed to know what’s bad for us?

Catch this newsy tidbit. A lady in Monaco (you know, the place where Grace Kelly used to hang out) made her way to the ER with a palpitating heart that played syncopated rhythms. Intermittent fainting spells were included…free. After all was said and done, it turned out that the only thing she drank for the previous sixteen years was soda—a half-gallon a day, cola at that. If you’re thinking she got her 8 x 8 (eight, 8-ounce glasses of fluids a day), she really got more than she bargained for. The water part of soda is good; the other part isn’t so good.

Ingredients in soda are basically useless. The caramel color comes from heating corn or cane sugar until it reaches the desired color. Desired? By whom? The amount of sugar in a can of regular, non-diet, soda can reach twelve teaspoons. Would you let your child eat even ten spoons of sugar right from the bowl? If a person opts for diet soda, aspartame or some other fake sweetener is in the mix. That earns a chapter of its own. Phosphoric acid adds tang and tartness, but the label doesn’t say it also erodes tooth enamel (Brown, 2007), borrows calcium from bones, and is associated with kidney problems. “Natural flavors” don’t turn soda into health food. Caffeine, we are told, is added to enhance flavor, even to non-colas. Funny thing…a panel of trained tasters couldn’t tell the difference between caffeinated and non-caffeinated colas (Keast, 2007). It adds a slight bitterness and, of course, acts as a stimulant. Soda does, however, contain less caffeine than a cup of coffee.

Caffeine is a diuretic. You well know that a cup of coffee after, say 7 PM, is gonna make you get out of bed at three in the morning. A cola nightcap might do the same thing. Excess urine production—and maybe even diarrhea—will flush potassium from the body. That’s what seems to have happened to the Monaco Miss—potassium deficit. Well, now, does that make any difference? Let’s see what potassium is all about. It’s the number one positively charged ion in the fluid inside a cell, having a sodium counterpart on the other side of the membrane. Their concentration differences create an electrochemical gradient known as membrane potential, which allows a cell to work like a battery to provide power for its function. Simply, sodium tells your fingers to pick up a pencil; potassium says to let it go. Sodium contracts, potassium relaxes. If potassium is in short supply, muscle—including the heart—keeps trying to contract without being relaxed. Not good, right? Right. It’s bad enough that most of us are potassium shy because we fail to get the 4700 milligrams a day that we need, but it’s worse that soda can dissolve what’s left. Potassium helps the heart maintain a regular beat; deficiencies cause irregularities (Poole-Wilson, 1984).

Additional concerns about caffeine intake involve weight loss “miracles” that propose to suppress appetite and increase energy. Most of us are unaware that supplements can contain caffeine without it being listed on the label. A Brazilian tea that is marketed as an energy enhancing beverage, guarana, actually has twice the caffeine of coffee. While that can zoom you up, it can also induce seizures and blurred vision (Pendleton, 2012). O.K., so caffeine keeps you awake, that is, if you’re not accustomed to it. But it is related to sleep-disordered breathing if it comes from soda, though not coffee or tea (Aurora, 2012).

Through a process called osmotic diuresis, glucose and water are eliminated in urine. The kidneys normally reabsorb water and glucose, but excess sugar interferes with normal kidney function. The extra sugar attracts water, which has to go somewhere…the drain…and it takes potassium with it (Packer, 2008) (Sharma, 2013). And then there’s the likelihood that fructose will elevate uric acid levels and cause gout (Choi, 2008). Gosh, heart trouble or arthritic agony?  Choices, choices.

If you’ve been a heavy soda drinker for years, it only takes a week to set things straight. The CDC says that fewer than two percent of us get enough potassium (Cogswell, 2012). Potassium-rich foods aren’t that hard to find. Sweet and white potatoes, beet greens, tomatoes, bananas, orange, prune and tomato juices, spinach, sunflower seeds and molasses are some of the foods to consider. Keeping soda to less than a pint a day could keep you out of the ER. There are some places you really don’t need to be.

References

Aurora RN, Crainiceanu C, Caffo B, Punjabi NM.
Sleep-disordered breathing and caffeine consumption: results of a community-based study.
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Barri YM, Wingo CS.
The effects of potassium depletion and supplementation on blood pressure: a clinical review.
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Brown CJ, Smith G, Shaw L, Parry J, Smith AJ
The erosive potential of flavoured sparkling water drinks.
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Brown CM, Dulloo AG, Montani JP.
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Jee Woong J. Choi, Earl S. Ford, Xiang Gao, Hyon K. Choi
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Cogswell ME, Zhang Z, Carriquiry AL, Gunn JP, Kuklina EV, Saydah SH, Yang Q, Moshfegh AJ.
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Corti R, Binggeli C, Sudano I, Spieker L, Hänseler E, Ruschitzka F, Chaplin WF, Lüscher TF, Noll G.
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Fukumoto M, Yamashiro N, Kobayashi F, Nagasaka T, Takiyama Y.
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Griffiths RR, Vernotica EM.
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Lutsey PL, Steffen LM, Stevens J.
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O’Keefe JH, Bhatti SK, Patil HR, Dinicolantonio JJ, Lucan SC, Lavie CJ.
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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.

Taste Is In The Eye Of The Beholder

chicken-nuggetDo you realize how much and how often we put our faith and trust in other people? You trust that the car coming the other way won’t cross into your lane, and that the waiter washed his hands at least once before coming to your table. And you trust that your food is clean, whether from the supermarket, the butcher or the waiter.

When you bite into a crisp Delicious or Macintosh apple, you have the right to expect nothing more than apple skin, quercetin, some pectin, and vitamins and minerals. Do you know that apples are among the “dirty dozen” foods that are heavily sprayed with biocides? Yep, right up there with celery, grapes, peppers, strawberries and some greens, among others. Why do they have to do this to us? By our age, we’re expected to know the bottom line—money. With fruits and vegetables we have the advantage (If you can call it that) of being able to wash most of the junk off before we eat them. There’s a monumental difference, though, between what’s on a food and what’s in it. We can’t wash out whatever is inside a processed or prepared food…like some chicken nuggets.

The two best-known poultry purveyors in the United States have initials that rhyme with each other. One of them was a tad short of the truth when it announced several years ago that its product was antibiotic-free, only to announce later that it would stop using antibiotics in its chickens. The other company didn’t have to make such a declaration. Discounting husbandry practices and getting right to food preparation, we find that both of these companies have a comparatively pristine list of ingredients in their nuggets. The only question would be the definition of “natural flavor.”  The FDA publishes a Code of Federal Regulations, which we presume is what it says, but which we know is probably ignored to a hair’s breadth of compliance. We realize that, for some of us, a speed limit is merely a suggestion.

The “Code” says: “The term natural flavor or natural flavoring means the essential oil, oleoresin, essence or extractive, protein hydrolysate, distillate, or any product of roasting, heating or enzymolysis, which contains the flavoring constituents derived from a spice, fruit or fruit juice, vegetable or vegetable juice, edible yeast, herb, bark, bud, root, leaf or similar plant material, meat, seafood, poultry, eggs, dairy products, or fermentation products thereof, whose significant function in food is flavoring rather than nutritional. “

Unless a company has specified, you can’t tell what the natural flavor is. If you call a company, it is not obligated to disclose industrial secrets. See? Trust. With these two companies, the odds are in the consumer’s favor. A dyed-in-the-wool skeptic will know that a natural flavor can be duplicated in a lab because it’s the flavor that’s natural, not necessarily the ingredients that make it. Is anything straight anymore? Fast food nuggets are another story. (Wait until we get to the antibiotics part.)

Even the fast food monger that deals only in chicken uses an anti-foaming agent in its offerings. Dimethylpolysiloxane, used to make Silly Putty, is a vinegary-smelling silicone used to make caulk, certain adhesives and aquarium sealant…even silicone implants. It’s used in fast foods, including the fries, to keep the rancid, oxidized frying oil from bubbling over the pot. They call it preventing effervescence, which is the escape of gases from a solution. It prevents the embarrassing passage of gases through the gut, as well. If you forget the Beano, try a squeeze of Dap silicone. Next, tert-Butylhydroquinone (TBHQ) is added as an antioxidant to your happy meal, which makes the purveyor happy all the way to the bank because it enhances storage life. Forget that it’s used to stabilize diesel fuel (Almeide, 2011). If it makes you feel any better, the European Panel on Food Additives found no adverse effects of TBHQ in dogs (http://www.efsa.europa.eu/en/publications/efsajournal.htm). In humans, though, chronic exposure, as would be the case for people who eat fast foods every day, may induce carcinogenicity (Gharavi, 2005( (Hirose, 1993). Oh, well, as long as the FDA says it’s O.K. (Code of Federal Reg. 21(3). 2013).

Never let it be said that the fast food industry doesn’t keep up with the times. A relative rookie in the cast of nugget ingredients is sodium aluminum phosphate, a leavening agent (baking powder) that is new to the baking industry. It has a different performance profile from other leaveners, with a preferred buffering action for flour mixes (breading), where it works slowly outside the cooker, but hastens once heated. Funny, but it’s used to make explosives, porcelain, cement, and leather tanning. Yep. There’s no worry about the sodium part and, as long as you don’t overdo it, the phosphate part isn’t too bad, either. But the aluminum fraction…not so good. Food contributes more aluminum to the body than water, and this leavening agent plays a part (Yokel, 2008, 2006). It might be naturally abundant, the third most abundant element after O2 and Si, and the most abundant metal in Earth’s crust, but Al has no place in human biology. Aluminum has been implicated in the etiology of Alzheimer’s disease (Ferriera, 2008) because of its neurotoxic character, wherein it alters the function of the blood-brain barrier (Savory, 2006). The use of aluminum adjuvants in pediatric vaccines is suspected of increasing the rate of autistic spectrum disorders (Shaw, 2013). Whether these adversities come from autoimmune reactions remains to be discovered, but that’s little consolation to anyone.

A recent analysis of chicken nuggets found them to contain ingredients besides meat. Fat, skin, bone, nerve and connective tissue comprised a substantial mass of the finished product (Deshazo, 2013). This aroused a response from the industry, which decried the inspection of only two samples. Gosh, how could the researchers have taken the wrong two out of the thousands of samples available? Nonetheless, fast food has been labeled as unfriendly and unhealthy in more countries than we might have thought, especially since energy density varies from culture to culture (Stender, April 2007) and the fat profile leaves much to be desired (Stender, May 2007).

Antibiotics have been used in poultry farming since the 1940’s when it was accidentally learned that the drugs produced increased growth in the birds. What happens is that the bad intestinal flora are sequestered to such a degree that the good can prevent the inflammation that interferes with nutrient absorption and availability. Thus, the birds grow. There was a time when any and all antibiotics were permitted in poultry, but when it became evident that human pathogens became resistant to antibiotic treatment, the list of drugs approved for farm use shrank to those that demonstrated effectiveness only in animals.  Because antibiotics within their own groups share a similarity, micro-organisms that have developed immunity to one will eventually develop immunity to the others (Aarestrup, 1998, 2000).

After animals have been fed antibiotics over a period of time, they hold onto strains of bacteria that are resistant to the drugs. After proliferating in the animal, they can be transferred to others, thus forming a colony of resistant micro-organisms, spawned by spontaneous genetic mutations within a gene sequence. Now the drug can kill only the non-resistant bacteria, allowing the resistant ones to thrive. Next, through cell-to-cell contact, some germs can pass resistance to others by swapping DNA or by dispersing DNA throughout the environment after cell death, allowing it to be absorbed by a different strain. Antibiotics, effective or not, are supposed to be withheld a few weeks before a chicken meets its maker. The USDA says that compliance is good, but keep in mind that this agency exists to help farmers, not necessarily the consumer (http://www.fsis.usda.gov/wps/portal/fsis/topics/food-safety-education/get-answers/food-safety-fact-sheets/poultry-preparation/chicken-from-farm-to-table/CT_Index).

Regardless of what is done to protect the customer, chicken is still a breeding ground for pathogens. The drug-resistant Heidelberg strain of Salmonella recently sickened more than 300 people in twenty states since March, 2013. Foster Farms was reluctant to issue a recall. The USDA is not required to force the issue, since recalls for meat and poultry are voluntary (http://consumersunion.org/news/consumer-groups-urge-usda-to-strengthen-oversight-of-poultry/). Strains of Salmonella isolated from feed had been found to be the same as those isolated from packaged raw frozen nuggets and strips, but this still does not identify the ultimate source (Bucher, 2007, 2008). And now the CDC says that we’ve reached the end of the line on antibiotics, and that the superbugs have won. There’s no weapon left to defeat them. We’ve become overmedicated. Our foods have become overmedicated. After passing the buck to heretofore trustworthy bodies, we find it’s nobody’s fault. And nobody has cared until today.

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EFSA Panel on Food additives, flavourings, processing aids and materials in contact with food (AFC)
Type: Opinion of the Scientific Committee/Scientific Panel Question number: EFSA-Q-2003-141 Adopted: 12 July 2004 Published: 11 October 2004 Last updated: 14 October 2004.
http://www.efsa.europa.eu/en/publications/efsajournal.htm

FDA
[Code of Federal Regulations]
[Title 21, Volume 2]
[Revised as of April 1, 2013]
[CITE: 21CFR101.22]

FDA
[Code of Federal Regulations]
[Title 21, Volume 3]
[Revised as of April 1, 2013]
[CITE: 21CFR172.185]

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USDA
FSIS
Chicken from Farm to Table

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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.