Depression and B vitamins

Whilst the area of nutrition is often discussed only in terms of physical health, a vast amount of research links the use of dietary supplements with positive effects on behaviour and mental health. A recent study of more than 2000 people found low plasma vitamin B-12 concentrations were associated with higher depression scores, and low vitamin B-6 concentrations were associated lower attention and executive function. ¹

In another study from the University of Sheffield regular supplementation of hospitalised older people with multivitamins and minerals improved mental health, compared to a placebo.² The prospective, double-blind, placebo-controlled study included 225 hospitalised, acutely ill older people with an average age of 75.6. Participants received either a normal hospital diet plus multivitamin and mineral supplements providing 100% of the Reference Nutrient Intakes for six weeks or a normal hospital diet plus a placebo for six weeks. Levels of folate and vitamin B12 in red blood cells and plasma, respectively, increased significantly in the supplement group but decreased in the placebo group. Beneficial effects for symptoms of depression scores were observed for patients in the supplementation group regardless of the initial level of depression of the individual. The authors wrote, “Many epidemiological and case-control studies have shown associations between folate and vitamin B12 deficiency and depression. In a study of 3,500 over-65-year-olds in Chicago over an average of 7.2 years of follow-up, the researchers noted that increased intakes of vitamins from food and supplements B6 and B12 were associated with a ‘decreased likelihood of incident depression.’” Vitamin B12 is involved in the synthesis of monoamines, some of which act as neurotransmitters and may also inhibit the accumulation of the amino acid homocysteine, which may lead to toxic reactions that enhance depression. For every 10-milligram increase in the intake of vitamin B6 and for every 10-microgram increase in vitamin B12, the risk of developing symptoms of depression was decreased by two percent per year.³

1            http://jn.nutrition.org/content/early/2012/06/26/jn.112.161828.abstract

2            Gariballa and Forster 2007

3            Skarupski et al. 2010

Feed Your Brain

Children have lots of study to do but are rarely shown effective study techniques, let alone how to study without stress. As an ex- school teacher, academic and a life long student, I've spent a great deal of time refining my study habits to make them not only effective, but good for my health! I've also spent time teaching myself learning skills such as speed-reading and improving my memory and note taking skills using mind maps and another technique a friend of mine taught me called CapMaps. The little bit of time I've spent learning these techniques has been repaid many times over. I now teach these skills to my students, pensioner groups and corporate executives.

So to begin, let's get rid of words like home work and make it home play. We'll do a whole lot more and a lot more easily if we enjoy doing it, so let's make it as pleasurable as possible - starting with the words we use.

To study effectively you need good health and a good blood supply. Your brain uses more than 20 per cent of your body's energy, so it has to have the right nutrients all the time. When you study, don't scrunch up over the desk. It stops you breathing deeply and slows oxygen getting to your brain. Remember to stretch frequently, put your shoulders back and take a deep breath. This will help feed your brain.

Food for Thought

A nourishing diet is essential to give your brain the right nutrition and will increase your levels of concentration. Even small decreases in glucose can cause significant "brain fog", while shortages of antioxidants and excess bad fats lead to short-term and long-term memory problems. Not good for study. Here are some useful pointers to ensuring you eat well to make your study time effective:

* Eat breakfast. It provides glucose for your brain. In fact, not eating breakfast causes you to be 20 - 40 per cent "dumber" in studying and exams. People who don't eat breakfast also put on more weight and are unhealthier than people who do.  Raw muesli or porridge with nuts is a terrific way to fire up your brain. Add a piece of chopped fruit. Don't add sugar, but add as much fruit and crushed nuts and seeds as you like. Or maybe even an old fashioned cooked breakfast with some tomato, mushroom, spinach and beans thrown in.

* Don't eat and study at the same time. Take a break. Focus on one task at a time.

* In between meals nibbling on raw (not cooked) nuts and dried fruit will feed your brain. Leave the chocolate for after the exams and forget the potato chips.

* Decrease bad oils including butter and margarine, oils in bread and greasy foods such as takeaways. They block your arteries and thicken your blood, slowing the amount of fuel getting to your brain (ie oxygen and glucose). They also contribute to some long-term damage in the brain.

* Decrease sugar and processed foods. They create a short-term glucose high in the blood and a long-term glucose low, causing foggy thinking.

* Increase good oils high in Essential Fatty Acids (EFAs) and include fish oils and flaxseed. Sixty per cent of your healthy brain is made up of fats and these EFAs are the biggest part.  Good fats = good thinking. They provide the building blocks for the brain, the infrastructure for you to be smarter.

* Increase dark green vegetables such as spinach, silver beet, broccoli and bok choy. They provide essential vitamins and minerals for your brain to function and think clearly. One study found better memory results from eating greens. They put muscles in your brain.

* Eliminate over processed grain products.  Eat only wholegrain and wholemeal grains; they contain essential minerals and vitamins for your brain. Rye bread gives you the lowest sugar hit. Even better go for the new range of sprouted breads.

* A little coffee or tea is okay, but don't have it after 4 pm to keep you awake and certainly don't have it at night to keep studying. If you need coffee to keep you awake at night in order to keep studying, you're fooling yourself about your level of effectiveness. Good sleep is the best way of dealing with exams. If you have a deadline, wake early and start when your mind is really alert.

* Drink lots of water

* Avoid sugary soft drinks, particularly just before an exam.

* Supplement with brain vitamins and minerals (speak to your naturopath or health food store), especially Vitamin C for it's antioxidant action

* Gingko Biloba taken for two to three weeks has been shown to improve memory and thinking.

* Vitamin Bs are very good for feeding your nervous system, especially if you're feeling stressed.

During  periods of study, exercise at least 45 minutes each day. Exercise gets blood flowing to your brain, supplying oxygen, antioxidants and glucose.  It also releases substances such as noradrenalin in your body to prepare you for exams and reduce stress. Research shows that small bouts of exercise in between study and before exams can make a significant difference in performance.

During periods of intensive study you need hourly breaks (or even 30 minute breaks). Make your break a brisk 10 minutes walk. It will help everything you have done sink into the powerful, subconscious part of your brain.  After two hours, take a 20 minute brisk walk and give yourself a good break. Don't fool yourself that you're still working well. You're probably functioning at around or less than 50 per cent. It's okay for mundane tasks, but not if you need really focused concentration.

Set regular study patterns. Don't do everything late at night.  Your brain is already getting tired. The morning is the best time to study and that is not just after midnight. Learn how to use your brain effectively.

Do a memory course or a mind-mapping course. It can make remembering specific information so much easier, and will improve your general memory as well. After a memory course you can learn more than a hundred facts and figures in less than an hour, have fun doing it and have perfect recall.

Talk about the ideas and information you have learnt with friends, a study buddy. It will help lock it into your long-term memory and you'll learn new information from each other.

Learn to Relax

Taking deep breaths is an important start, because it sends relaxation messages to your brain. There are many other things you can do. Best learning occurs in the alpha and theta brain wave states. These are when you are most relaxed and not stressed. When you are in a stressed busy state you are in an beta state and you cant learn well. A simple meditation can take only five to ten minutes and can prevent you stressing and get you into an alpha brain wave learning state. Try sitting still, and slowly, with each breath, count from 50 to one. Focus on the numbers only. If you get distracted, go back to the last number and keep going.

Be aware of your posture while you're studying - don't hunch over the desk. It stops you breathing deeply and slows down the flow of oxygen to your brain. Remember to stretch. Put your shoulders back and take a deep breath regularly. Being hunched over a desk also tells your brain that you are tired and not very positive, so that's how it starts to respond.

I always tell my students to start studying and exams with the biggest smile you can make. Sounds strange, maybe even funny, but it sends positive messages to your brain. It increases the feel good chemicals in the brain, increases blood flow to the brain and immediately reduces stress. Research shows it also increases your creativity, and it's fun.

Plan your study and plan to study well.  By having the right attitude and planning your study, you can save hours and hours of what may otherwise be wasted time.

* Set goals for the amount of time and the quality of time for your period of study. 

* Set goals for each study period, the exams and for the year. These will help to focus and motivate you.

* Write down your goals - what you want to achieve, how you are going to achieve it and why it's important to achieve it.

* Put your list of goals on the wall in your study.

* Don't wait for deadlines to motivate you, get in early.

* Visualise yourself being successful when you study.

* Visualise yourself in the exam feeling positive and writing the right answers. See yourself coming out of the exam and feeling really positive.

* After your exams or long periods of study reward yourself (but not with junk foods).

* There are many other things you can do to improve your thinking but the best one is to use your logic and commonsense.

To learn effectively you need to have a study environment that's positive, enjoyable and free from distractions. It also has to be a healthy environment.

* Study in an enjoyable environment. 

* Put on some gentle music. Baroque music, such as Bach and the music of Mozart has a very positive effect on brain waves and helps you to learn. It may not be cool but you will be smarter.

* Open the doors and windows to the study. Fresh air is critical to good brain function. Stuffy air or chemical smells will affect your brain's ability to focus. One gas in particular, carbon monoxide, reduces the oxygen available to the brain. Carbon monoxide is found in high concentrations in car exhaust and tobacco smoke.

* Don't smoke, and especially don't smoke in your study.  It has hundreds of chemicals that attack your brain cells.

* Get rid of distractions. Despite what you may think, you can only concentrate on one thing at a time. Don't waste your time by studying at 10 per cent. Turn off  the phone, television and all other distractions, with the exception of quiet, light background music.

* Wherever you study, make it a positive place. Decorate it in pleasing colours, have good light, pictures and photographs on the walls, and put up messages, quotes and photographs that inspire you.

Controling diabetes type 2 with nutrients

With the exception of diet and lifestyle changes the current treatment for diabetes are ineffective. The problem gets worse and you need to take more medication untill one o the side efects kills you. However diabetes type 2 is not a fixed sentence. Just last week I saw a person who described to me that they used to have diabetes type 2. He had lost 20 kilograms and had gone on a nutrient dense, no carbohydrate diet and changed their attitude to their illness and their lifestyle. Almost every week I hear of people reversing their diabetes not to mention the dozen or so books and DVDs on the topic. .

Despite the fact that we know the causes of diabetes type 2 as lifestyle and diet factors the rate of this disease continue to skyrocket. The prevalence of diabetes and in-particular type 2, which accounts for 90-95% of all diabetes cases, is rapidly increasing world wide. It is estimated that in 1995 there were around 118-135 million people world wide living with diabetes, predominately type 2. World Health Organisation projections are for increases in the incidence of type2 diabetes from 171 million to 366 million people globally by the year 2030 but these estimates are probably underestimated because they are based on current rates of obesity. Other reports have put the figure at around 400 million by the year 2025, "(Halban et al. 2006)". A major Australian study found the prevalence of diabetes in Australia has doubled over the past 20 years to over 7% of adult Australians with around 90% of those cases being type 2.

The current surge in diabetes mellitus appears to have emerged around 30 years ago; particularly worrying is the increase in juvenile type 2 diabetes that was almost unheard of 20 years ago. At the same time the incidence of associated factors like obesity and pre‑cursers such as metabolic syndrome have also risen. In 1992 Diabetes type 2 in children only accounted for 2-4% of diabetes but by 1994 it accounted for 16% of diagnoses in children, particularly in ethnic minority group. 

Perhaps it is time we took some action. So here are some solutions below including a report from the orthomolecular medicine group. I have reprinted it with their permission and with a link to their website. It is well worth a visit and to get their newsletter.

But to start with the simplest solution. Some friends of mine Rob and Ellen recently asked me why does sodium bicarbonate (baking soda) decrease their blood sugar. Interestingly there is a lot on the internet on this topic and well worth a try.

 http://orthomolecular.org/resources/omns/index.shtml

---

Substituting Vitamins and Supplements for Pharmaceuticals in Type 2 Diabetes 

Commentary by Stuart Lindsey, PharmD

(OMNS May 28, 2012) Just when you thought it was safe to go back into the drugstore, we are going to question authority yet again. Readers may remember Dr. Stuart Lindsey as the Frustrated Pharmacist (http://orthomolecular.org/resources/omns/v08n05.shtml). He's back and at it once more, this time presenting an important supplement-based approach to type 2 diabetes. This essay presents ideas that are very possibly a large part of the solution. As with all OMNS releases, it is not meant to substitute for medical advice. Persons should consult their own doctor before making any health decision. - Andrew W. Saul, Editor

The current treatment of diabetes is among the least successful in medicine, despite billions of dollars spent on research. Many scientists make a career of studying diabetes. Medicine has succeeded in making diabetes very expensive for the patient while making the disease a cash cow for the numerous businesses that cater to the diabetic. We should expect to see some improvement in diabetic treatment, but in fact the basic protocols haven't changed much in twenty years. Is research getting close to a solution? In my opinion as a practicing pharmacist, the answer is no.

For fifteen years I was the pharmacy manager for an independent neighborhood drug store. I saw the results of many people over the long term as they were introduced to the "sugar-med treadmill." After prolonged consumption of their diabetic medications, their health did not improve. This was disturbing to me. The long term diabetics all seemed to have the same group of symptoms: they were overweight (due to hyper-insulinemia), edematous (having swelling under the skin), and they all suffered from poor exercise tolerance and had a generally unhealthy appearance. Many of them had peripheral neuropathy (malfunction of nerves), often associated with pain in their hands and feet. Only rarely did they believe their diabetes treatment was actually improving their health.

My interest in the lack of results from standard treatment of diabetes came into sharp focus when pain in my feet led to my being diagnosed with type 2 diabetes. From my observations at work, I already knew that the drug treatments for peripheral neuropathy were questionable. Introducing amitriptyline, gabapentin and Lyrica, which are sedatives and pain killers, made the people sleep a lot. Medically, it's obvious that sedating nerves doesn't solve anything. When such patients step up to daily long term narcotics and finally get some pain relief, they still haven't solved their problems.

Current medical practice relies on the HgbA1c (glycated hemoglobin) level as a measure of blood sugar over several months. The glycated hemoglobin is caused by high levels of sugar binding to hemoglobin inside red blood cells. When it builds up, this means that the body's biochemicals and organs are being damaged by too much sugar. It was interesting to note how many of the diabetic patients were in the normal range (i.e. HgbA1c < 6.5) but were still in agony over their feet. The problem was that seeing a normal value of HgbA1c, the doctor would hesitate to change the treatment. Apparently, severe foot pain wasn't a symptom that needed attention.

I decided to explore the whole HgbA1c issue. The biggest argument you see in diabetes is that diabetes is a 'disposal' issue. A high level of blood sugar is a type of metabolic malfunction that needs to be corrected. Blood sugar has a geography problem. The body seems driven to urinate the sugars out of the body instead of jamming the sugars across supposedly malfunctioning membranes and burning the sugars intracellularly. Medical practice can apply insulin and many types of drugs to insure that the body's tissues metabolize the sugars. Most current diabetic research is targeted at 'breaching the barrier' and making the supposedly malfunctioning membranes more permeable to carbohydrates. When those extra sugar calories are crammed into cells you get advanced glycation end-products (AGE's) that are a threat to the body.

In 2005, a UK researcher named Paul Thornalley wrote a paper detailing how many diabetic symptoms are due to a deficiency of thiamine (B-1).[1] Elevated blood sugar promotes a type of toxicity in the kidneys that causes thiamine to be excreted by the kidney at a rate much higher (sixteen to twenty-five times higher) than normal, leading to an acute deficiency of thiamine. From other studies, it is known that deficiencies in all B vitamins, as well as vitamin C and D are common in diabetics.[2] This can cause most of the symptoms of type 2 diabetes, which include: polyneuropathy, nephropathy (kidney damage), retinopathy (eye damage) and eventually heart failure. This raises the question of whether the symptoms are from diabetes or acute beriberi?

When I was diagnosed with type II diabetes, I immediately balked at taking the standard diabetic drugs. My doctor wanted to place me on statins, metformin and Byetta, all of which I refused to take. Having researched Dr. Thornalley's theory of diabetes being an acute thiamine deficiency, I started a regimen of vitamin and mineral supplements. Although the pain in my feet was quite severe, I wanted to avoid the regular drug regimen because it relied upon taking lots of pain killers that don't cure the problem. I reasoned that when the body's B vitamin levels are depleted due to high blood sugar, replenishing body stores through diet alone is difficult, so supplementation will be necessary.

I started taking a dietary supplement of thiamine (benfotiamine, 250mg 4x/day). I also added of vitamin B-6 (250mg/day) and pyridoxal 5 phosphate (P5P, 100mg/day) magnesium (aspartate, citrate, malate, or chloride) and acetyl-l-carnitine (1000 mg/day) depending on the severity of my peripheral neuropathy symptoms. More recently I've learned of the importance of taking vitamin C to reduce inflammation and prevent oxidation from high blood sugar levels.[2] My doctor did not approve of my self-treatment but was curious. I told him that I was willing to go back to the standard of care if this didn't work.

"Positive factors for treating type 2 diabetes are magnesium, exercise, weight control, chromium, dietary fiber, the B-vitamins, vitamin E, vanadium, vitamin C, and complex carbohydrates. I have been using the positive factors for the past 40 years. When patients followed such a program, the results are very good." Abram Hoffer, MD, PhD [3]

The most overt of the neuropathy symptoms started to subside rapidly. Within a week, the shooting pains in my ankles were mostly gone. All of the other symptoms of numbness of the toes and overall pain of the feet including the "boot effect" (the feeling that you have your boots or socks on) were mostly gone in three weeks. Now I know this treatment may not be a cure for diabetes. But it is a valid and reasonably inexpensive way to control the symptoms, which are held at bay as long as you keep your thiamine levels high. If you quit taking thiamine and the other B vitamins, the symptoms come roaring back.

I looked for the inevitable deterioration of my health that had been predicted. Ignore your blood sugar levels at your peril I was told. I was going to have kidney problems, my pancreas would stop cooperating and my vision would become blurry as the elevated sugars damaged my retinas. But the only sign of an active problem was the neuropathies in my feet which were quite painful at times: numbness of my toe area and shooting pains in my foot joints. I also had the feeling that the circulation of my feet was poor as my feet were always cold.

After two years I finally got blood tests. I still felt very good having lost some weight, with no vision problems, and my energy level and psychological attitude were all fine.I was actually afraid to look at the results and finding out that I had finally outsmarted myself and got hurt. There is a quite a propaganda machine built around the treatment of diabetes. As I drove over to retrieve my blood tests I did a mental check of how I felt. I decided I couldn't have a lot wrong with me as I just felt too good. My blood tests were amazingly free of problems related to elevated blood sugar, and I had few other related discernible health defects. This thiamine treatment did not change my HgbA1c (which is currently 9.1, and that is high) or my resting blood sugars (fasting blood sugars still between 180-190, and those also are high). Values like these are supposed to indicate a poor quality of health. My recent blood tests indicated:

Creatinine, urine 86.7mg/dl. Scale 20-370; low normal.
Microalbumin/Creatinine ratio 9.2mg/GCr. Scale 0-30; low normal.

Creatinine and microalbumineria values are the so called "Canary in the Coal Mine" indicators. The kidneys are supposed to go first when Advanced Glycation Endproducts (AGEs) have started your march to health failure because you didn't keep your HgbA1c values within range. I think my two-plus years is long enough for this to play out. I had my eyes checked for sugar damage to my retinas. I have no sugar damage to my eyes whatsoever. I am 61 years old and have 20-25 vision in both eyes. Jonathan Wright, MD, is among those who have noted that skin tags may be connected to diabetes; interestingly enough the skin tags on my arms have all disappeared.

However, my health hasn't failed due to hyperglycemia, although it is still a problem. In my case, the unusual positive results are evidently due to my nutritional approach. I substituted supplements of several essential nutrients for pharmaceuticals and stayed in relatively good health. And I continue to try supplementing with other nutrients such as antioxidants which are known to help prevent diabetes. [2] This suggests that the health issues are actually caused by nutritional deficiencies that can be easily prevented.

I am hoping this simple (and non-toxic) experiment on myself will lead the field to discussing the validity of substituting vitamins in diabetes treatment. The treatment of diabetes as it now stands is complicated and expensive. I am spending about $130/month on supplements, and during this two year experiment I have not given my doctor a single dime for advice on how to regulate my HgbA1c value. I imagine I've saved more than twice that amount by avoiding paying for drugs and doctor visits. Is this justified? If my health remains good and I have no other serious problems, I believe it is.

If all diabetics would supplement with B vitamins and vitamins C, D, and E, and minerals such as calcium and magnesium, they would lessen their problems with insulin and blood sugar, and the other serious symptoms of diabetes.[2] The reason is that most people in our society, especially including diabetics, have deficiencies of these essential nutrients that are known to be related to diabetes. But this essay is also an attempt to unseat some basic tenets of the medical fiasco known as diabetes. The prevalence in 2011 of type II world-wide according to the World Health Organization (WHO) is 346 million, and some 3.4 million people dies in 2004 as a consequence of the disease. The WHO predicts that the deaths attributable to diabetes will double between 2005 and 2030. [4] With this kind of projection a "Manhattan Project" kind of response seems necessary.

So what is the intellectual problem that seems so intractable to the medical research community? The standard treatments to lower blood sugar and HgbA1c were recently tested in medical trials. The ACCORD trials were meant to validate once and for all that the closer a patient got to a HgbA1c level of 6% the healthier a person became. Instead there was 22% increase in mortality from heart failure.[5] This unexpected value caused the FDA to terminate the trial midstream. Is it possible that the HgbA1c value should not be a primary goal in evaluating diabetes treatments?

If you go to PubMed and enter the keywords "thiamine deficiency" and "diabetes" you will get dozens of references that describe how many symptoms of diabetes are caused by a thiamine deficiency it generates. Deficiencies of B vitamins and other essential nutrients are important in diabetes.[2] This should be required reading for all doctors who treat or research diabetes. Currently in conventional management of diabetes, supplement based nutrition therapy is utterly neglected. The National Diabetes Fact Sheet reported that in 2007, the direct medical costs of diabetes nationally was estimated at $116 billion (USD). [6]

Diabetic patients can feel overwhelmed by a diagnosis of hyperglycemia, but are often comforted by the complicated explanations and sudden increase in activity and attention directed at them. The possibility that they are being misled just doesn't come up. Even if patients decide to do their own research it can be confusing. The cause of diabetes is basically unknown, but they are told that with some major alterations to one's lifestyle and lots of drugs liberally applied they can lead a relatively normal life. However for the truly curious, a large block of mainstream nutrition ideas of which the doctors are mostly ignorant can be freely accessed on the internet. When a patient presents this alternative information to the doctor today, they are comforted and told that they are already getting the cutting edge treatment. But even three years after the revelations of the ACCORD trials there has been no major correction of the type II treatment protocols that addresses the unexplained mortality issues revealed by the trials.

Even if my vitamin arguments are only partially correct, the implications for mainstream medicine are staggering. These ideas need wide discussion the field, because patients with diabetes need some new ideas.

For further reading:

Melvyn R. Werbach's Nutritional Influences on Illness contains a valuable review of research indicating the therapeutic value of supplements, and their specific dosages, for diabetics. Third Line Press, 2nd Edition, 1996 ISBN-10: 0961855053; ISBN-13: 978-0961855055.

Endocrinologist and Professor of Medicine (University of Kentucky) J. W. Anderson is perhaps the world's leading researcher on fiber and diabetes. http://www.doctoryourself.com/biblio_anderson.html

As much a book about fiber as it is about overconsumption of sugar, The Saccharine Disease by T. L. Cleave (1975) is available in its entirety for free online at http://www.cybernaut.com.au/optimal_nutrition/information/library/saccharine_disease.pdf and also at http://journeytoforever.org/farm_library/Cleave/cleave_toc.html

References:

1. Thornalley PJ: The potential role of thiamine (vitamin B-1) in diabetic complications. Curr Diabetes Rev, 2005; 1:287-298

2. Brighthope IE (2012) The Vitamin Cure for Diabetes: Prevent and Treat Diabetes Using Nutrition and Vitamin Supplementation. Basic Health Publications ISBN-13: 978-1591202905.

3. http://www.doctoryourself.com/diabetes.html

4. World Health Organization. Diabetes. Retrieved from [ http://www.who.int/mediacentre/factsheets/fs312/en/index.html ]

5. Action to Control Cardiovascular Risk in Diabetes Study Group, Gerstein HC, Miller ME, Byington RP, et al: Effects of intensive glucose lowering in type II diabetes. N Engl J Med, 2008; 358: 2545-2559.

6. National Diabetes Fact Sheet, 2011. Retrieve from: www.cdc.gov/diabetes/pubs/pdf/ndfs_2011.pdf

(Much of this article is drawn from Lindsey SL Substituting vitamins and supplements for pharmaceuticals in type 2 diabetes J Orthomolecular Med 2012, 27:1; p 5-8. We thank the Journal for permission to reprint it here in edited form .)

Vitamin D

Vitamin D is one of the essential nutrients required by the human body. Unlike most vitamins, it is one that we can manufacture on our own, given the right conditions. Despite this, vitamin D is showing up increasingly in populations as the most widespread and critical nutrient deficiency; this deficiency is linked to many diseases and disorders, costing billions of dollars each year. Our changing lifestyles, including increased indoor living and campaigns warning people to stay out of the sun have meant that most people don’t get enough vitamin D. The resulting deficiency is compounded by the consumption of modern and processed foods devoid of any vitamin D.

Vitamin D refers to two biologically inactive precursors: D3, also known as cholecalciferol (made from cholesterol), and D2, also known as ergocalciferol. Vitamin D is the only nutrient that can actually be synthesized by the human body, which technically means that it is not a vitamin. The synthesizing of vitamin D in the body can be achieved through contact with solar ultraviolet B radiation emitted by the sun. Without the presence of this solar radiation the only way to get vitamin D is through diet—hence, it is still classified as a “vitamin.”

It is becoming increasingly common to find low levels of vitamin D in Western populations. Vitamin D uptake from the sun is not affected so much by seasonal changes but by how much time people spend in the sun. People require between 70nmol/L to 100nmol/L of vitamin D and in winter, when people spend less time outdoors, it is difficult to achieve these levels. Furthermore, current sun avoidance advice combined with the dietary habits of the general populous make the situation much worse—the average level in adults is around 25nmol/L - not even half the recommended level. Populations particularly at risk are seniors and infants but also any person spending too much time inside.

In addition to vitamin D obtained through UVB exposure to the sun, this vitamin can be found in foods such as eggs, butter and fortified milk, with the highest levels found in fish. Remember, we evolved as fisher- hunter gatherers and fish used to be an essential part of our nutrition. Vitamin D can also be provided by supplements. Numerous studies have concluded that sensible sun exposure and supplementation are the most effective ways of increasing vitamin D levels.

Once in the body, vitamin D is either stored in the body’s fat adipocytes or enters the liver. The vitamin D gets broken down in the kidneys for the regulation of calcium and dozens of metabolic functions. The broken-down vitamin D then interacts with vitamin D receptors in the small intestine and on osteoblasts to regulate calcium and phosphorous metabolism. It not only assists calcium uptake in the bones but also works as an immunity modulator. It continues to be metabolised in various tissues and cells for regulating cellular proliferation and differentiation as well as in the functioning of the immune system and macrophages. In addition, circulating concentrations of the broken-down vitamin D may help increase insulin production and alter fat metabolism.
Deficiencies in vitamin D have been linked with a range of problems with the musculoskeletal system including low bone and muscle problems, as well as cardiovascular disease, diabetes and metabolic syndrome, cancer and impacts on the immune system, Parkinson’s Disease, asthma, pain, and pre eclampsia.

Low levels of vitamin D can reduce the amount of calcium uptake in the bones which, over time, can lead to a loss in bone density. Pregnant women with vitamin D deficiency have been found to give birth to children who are at greater risk of being unable to store calcium in their bones, reducing their bone density and increasing the risk of bone fractures. In addition, these children experience higher level of dental caries. Low vitamin D in children will prevent them from reaching their bone mineral density and therefore increase their risk of osteoporosis and fracture later in life. In a study of 206 pregnant women during their second trimester, researchers reported that only 10.5% of the women had adequate levels of vitamin D.

In a study of 23,423 would-be first time mothers, the risk of pre-eclampsia was 27% lower in women who consumed vitamin D supplements with daily doses of 10 to 15 micrograms, compared to women who did not take supplements. Pre-eclampsia, affecting 2% to 3% of all pregnancies is estimated to be responsible for about 60,000 deaths each year worldwide.

Vitamin D deficiency is inversely related to a range of diseases, including respiratory infections such as influenza. In support of these findings, clinical trials have shown that vitamin D supplementation can reduce the risk of reactivation of latent tuberculosis infection. Vitamin D (in particular, D3) stimulates neutrophils, monocytes (natural killer cells) and the epithelial cells lining the lungs and protecting them from infection. So come winter-time and flu season get out and get a bit more sun along with some cod liver oil.

Studies have indicated that vitamin D supplementation may reduce the risk and difficulties associated with autoimmune disorders. In particular, there is strong evidence that vitamin D reduces the risk of multiple sclerosis and type 1 diabetes mellitus, and weaker evidence for rheumatoid arthritis, osteoarthritis, systematic lupus and erythematosusstar. There is no doubt about the link between vitamin D shortage and multiple sclerosis. There is a 41% decrease in MS risk for every 50 nanomoles per liter increase in 1,25-hydroxyvitamin in the blood. Vitamin D deficiency also predisposes to insulin resistance and pancreatic beta cell dysfunction. In a study of 10,366 Finnish children those given 2,000 IU of vitamin D3 per day throughout the first year of life experienced a 78% reduced risk of type 1 diabetes.

Over time, vitamin D deficiency leads to osteopenia, precipitates and exacerbates osteoporosis, which causes the painful bone disease osteomalacia and leads to increased muscle weakness. Notably, vitamin D deficiency is also associated with an increased risk of falling and fractures. Frail older people confined to institutions may sustain fewer hip fractures if given vitamin D. A study of 302 women (average age 77.2) living in Perth, Australia found after 12 months of supplementation significantly more falls in the placebo group than in the vitamin D2 group (62.9% versus 53%, respectively). A study of 124 nursing home residents taking a daily vitamin D supplement of 800IU for five months reduced the number of falls among nursing home-dwelling elderly people by 70%. Lower blood concentrations of vitamin D increase the likelihood of hip fracture among menopausal women by up to 70%.

Numerous studies have shown that vitamin D deficiency is strongly associated with an increased risk in developing cardiovascular disease. Epidemiological studies report that the rates of coronary heart disease, higher rates of diabetes, hypertension and elevated LDL cholesterol, are strongly correlated with decreased vitamin D status. Vitamin D appears to be necessary to maintain adequate apolipoprotein A-I concentrations, the main component of HDL (good) cholesterol.
Vitamin D deficiency increases the risk of “all-cause mortality” and is associated with a 122% increase in the risk of “cardiovascular mortality” compared to the highest average Vitamin D levels. Researchers also found that low levels were linked to higher levels of inflammation markers, such as C-reactive protein (CRP) and interleukin-6 (IL-6), which are important markers for chronic illnesses, including cardiovascular disease (These inflammation markers are a much better predictor of cardiovascular disease than cholesterol levels).

Deficient or insufficient vitamin D levels have been documented in patients with myocardial infarction, stroke, heart failure, and peripheral arterial disease. A study of 13,331 initially healthy men and women found that low levels of vitamin D may increase the risk of death from all causes by 26% when the lowest and highest average vitamin D levels were compared. In an examination of 1,739 participants in one study, low levels of vitamin D were associated with a 62% increased risk of cardiovascular events like heart attack, heart failure or stroke. The study also found that 28% of subjects had blood levels lower than 15 nanograms per millilitre (ng/mL). Only 10% of the participants had levels in the optimal range above 30 ng/mL.

Low vitamin D levels are linked with the formation of atherosclerosis. When researchers exposed macrophage cells (white blood cells) with and without vitamin D, they found that vitamin D inhibits the uptake of cholesterol by the macrophage cells. When people are deficient in vitamin D, the macrophage cells take in more cholesterol, and they can't get rid of it. The macrophages get clogged with cholesterol and become foam cells, which are one of the earliest markers of atherosclerosis. Macrophage activation is higher in people with diseases such as diabetes, and when found in combination with low vitamin D levels, the macrophages become loaded with cholesterol and eventually stiffen blood vessels and block blood flow.

A number of studies have also shown a link between low vitamin D and diabetes and metabolic syndrome. In a study of 15,088 subjects Vitamin D levels were inversely associated with hypertension, diabetes mellitus and hypertriglyceridemia. Other cross-sectional studies have confirmed the links between vitamin D deficiency and both hypertension and diabetes. One study reported that a daily intake of 800 IU of vitamin D compared with a daily intake of less than 400 IU of vitamin D reduced the risk of type 2 diabetes by one-third. A number of studies have shown a close link between vitamin D deficiency and metabolic syndrome. Vitamin D appears to be necessary to maintain adequate apolipoprotein A-I concentrations, the main component of HDL (good) cholesterol. One study found similar results with the lowest levels of vitamin D being associated with a 31% prevalence of metabolic syndrome, compared to only 10% for people with the highest average levels. The results also showed that vitamin D blood levels were associated with HDL cholesterol levels. Each increase of 10 ng/mL in 25(OH)D was associated with an increase of 3.8 to 4.2 mg/dL in HDL-C. An increase of just 1 mg/dL increment in HDL-C is associated with a 4% to 6% reduction in coronary heart disease risk.

There is now overwhelming evidence that supports increased vitamin D to lower the risk of developing and dying of prostate, breast, colon, ovarian, esophageal, non-Hodgkin's lymphoma and a variety of other lethal cancers. In a 10-year study of 1,179 healthy, postmenopausal women, researchers found that those taking large amounts of vitamin D3 had a 60% or higher chance of not getting cancer compared to their peers. In a review of data from 177 countries, extrapolation of results showed that as many as 50% of breast and colon cancer cases could be prevented by increasing vitamin D intake. According to the study, the median adult intake of vitamin D in the US is only 230 IU per day, versus the researchers' recommended 2000 IU per day. For every increase of 25 nmol/L in people’s blood, there was a 34% cancer risk reduction, with the most common cancers being those of the lung, colon and pancreas.

Vitamin D can protect women with pale skin from breast cancer and it can reduce the risk of pancreatic cancer especially in young men. In fact vitamin D appears to reduce the risk of other cancers as well such as colon-, prostate-, Hodgkin’s Lymphoma and lung cancer. A recent study of vitamin D intakes found increased intakes of the vitamin were associated with a 24% reduction in the risk of developing estrogen and progesterone positive breast tumours.

One explanation for cancers being reduced by vitamin D is vitamin D receptors (VDR). These are found in the tissues of the body and help maintain cellular growth and prevent cells from becoming malignant. Studies on both colon cancer cells and healthy prostate cells have demonstrated protective effects of vitamin D at a cellular level.

Vitamin D deficiency is widespread in developed countries such as the US, UK, Australia, New Zealand and Europe. US studies have found vitamin D deficiency is present in approximately 30% to 60% of the general population. Increasing vitamin D levels just a small amount would outweigh the benefits of most of the medication people take for chronic illness including medication taken for cardiovascular disease.

Considering the evidence, there is an overwhelming agreement between vitamin D researchers that current recommendations of 200 IU per day for children and adults up to 50 years of age for vitamin D need to be increased to 800 IU to 1000 IU vitamin D3. Numerous studies have shown supplementation to be effective in raising blood levels of Vitamin D levels with no evidence of intoxication reported in either the short- or long-term trial.

Sensible sun exposure (or UVB irradiation) along with supplements are required to satisfy the body's vitamin D requirement. To achieve adequate levels of vitamin D we need to get one to two hours of sensible sun exposure a day. This should be during the morning or late afternoon. While it is prudent to avoid too much sun it is important to remember that the costs of vitamin D deficiency far outweigh the cost of skin cancer and some sun may also be necessary to reduce skin cancers. Remember, we did evolve in the sun but maybe not the hot midday sun, especially for those with fair skin.

Multiple Sclerosis (MS) a preventable disease

Just over a year ago a student of mine motivated me to look into multiple Sclerosis. Bruce put up a slide quoting the official authorities saying there was no link between MS and nutrition. He then presented a slide with more than 40 peer reviewed scientific papers on the link between MS and nutrition. Along with Bruce it continually confuses me as to why such supposed authorities continue to deny the existence of nutritional treatments and even worse the role of poor nutrition in the causes. Since inspiring me I have now seen dozens of people suffering from MS begin a new life through really simple changes in nutrition and one of the simplest changes follows on from one of my earlier articles on vitamin D. Many Australians just don’t get enough sun anymore. But more on that later. What is even more important is that this information can help prevent the development of MS in the beginning.

There is now overwhelming evidence of the risk of developing MS is linked to a number of environmental factors such as excessive dietary intake of saturated fats and deficiencies in polyunsaturated fatty acids, vitamin D and antioxidants (1,2). As a result of these findings good nutrition appears critical in limiting the development and ongoing effects of MS and enhance quality of life while limiting the risk of secondary conditions (3).

Over the past 200 years MS has significantly increased in incidence and prevalence. MS is a disease that effects an estimated 2.5 million people worldwide with over 18, 000 people in Australia with the disease, the incidence rate in Australia is increasing by 7% each year and financially costs approximately 2 billion dollars each year 4. It is twice as common in females (who have lower vitamin D than males) as in males and is the most frequent neurodegenerative disease in young adults 5,1. Geographically MS is common across northern Europe, Scandinavia and across the US and is much higher in incidence among whites then other racial groups (5).The disease is very rare in Japan, the Indian subcontinent and is unknown to black Africans however these groups are at significant risk to developing MS, when they go to other places to live, which supports the concept that an environmental factor is responsible for MS (5).

MS is a chronic, degenerative and autoimmune initiated inflammatory disease of the central nervous system, which may involve the brain, optic nerve or spinal cord and is characterized by demyelination (5,6). That is the myelin, that wraps around and insulates the nerve axons in the central nervous system, suffers self-destruction and degeneration (7). This means damaged myelin results in damaged nerve axons and causes the various disabilities of MS (7). It is worth noting here that myelin is around 80% lipids (fats) and cholesterol (which I have written on in past articles) makes up an indispensable component of myelin membranes (8). The inflammatory reactions are poorly controlled and result in substantial damage to the myelin (7). As a result of demyelination MS patients suffer functional impairments such as abnormal walking mechanics, poor balance, muscle weakness and fatigue which result in individuals reduced ability to perform activities of daily living (9).

The single most important factor linked to the development of MS is a reduced supply of vitamin D (7), which I have written on extensively in the past. Research has shown that the active hormonal form of vitamin D, 1,25-dihydroxyvitamin is a natural immune system regulator with anti-inflammatory action (10). Vitamin D is received from two sources, diet and sunshine, however it is considered diet provides insignificant amounts and therefore sensible exposure to sunlight is considered the most effective source (11). Even Scandinavian diets (rich in oily fish) scarcely exceed a few hundred IU/d of vitamin D (12). Sunshine is therefore the principal natural source of vitamin D, providing approximately 90% of requirements. Sunbathing can provide 10,000–20,000 IU in 15–30 min, but this will only last a few weeks before it needs to be replenished (13,14). It is interesting to note that women generally have lower serum levels than men (15,16) and have significantly higher levels of MS.

There is a 41% decrease in MS risk for every 50 nanomoles per liter increase in vitamin D (1,25-hydroxyvitamin) in the blood. The prevalence of MS is highest where environmental supplies of vitamin D are lowest (18). There is significant epidemiological data from Australia that shows a very strong correlation between vitamin D supply from ultraviolet (UV) radiation and MS prevalence (7). The correlation is indeed stronger than that of UV radiation exposure and melanoma development (7). Globally countries of high latitudes with insufficient UV radiation for most of the year report a higher incidence of MS 19,20. One case-control study has also shown that vitamin D status in individuals at the time of diagnosis of MS is significantly lower then healthy controls, indicating a further link (19).

It is theorized that vitamin D deficiencies may lead to an increase in T-helper cell autoimmune responses and therefore resulting in excessive damage to the myelin and MS symptoms (21).

Vitamin D supply through dietary intake also appears critical, as it has been reported that through vitamin D supplements there is an inverse relationship with MS (19). The role of vitamin D is supported by animal studies where mouse models have shown that vitamin D deficient mice succumb faster to MS but once administered with vitamin D the symptoms diminish (22).

The idea that an increase in saturated fats in modern diets may result in increased risks for MS (and diabetes type 2) has been known since the early 1950’s and reinforced on several occasions (23). Epidemiological studies in Norway have shown inland farming communities with high intake of animal products had higher MS incidence rates then coastal communities where consumption of fish is high while subsequent studies have also shown a negative correlation between MS and the consumption of fish, fruits and vegetables (23). Any wonder the rates of MS are increasing so fast in Australia knowing the poor diet most kids are having. It has been shown that MS sufferers have deficiencies in essential polyunsaturated fatty acids (PUFA), primarily the omega 3 fats which is demonstrated in that the lipid and fatty acid composition in plaque tissue from the MS brain is altered compared to the normal brain white matter (1).

It is believed that humans evolved on a diet with a ratio of omega-6 to omega-3 of approximately 1:1 where as in western diets the ratio is varied between 15:1 – 20:1 24. We just have too much vegetable oil (omega 6) in our diet. It is literally added liberally to all processed foods.

A large study conducted over a 35 year period showed MS patients on a diet with low saturated fat and supplementation with cod liver oil provided long term benefits on mortality, relapse severity and disability, particularly if initiated during the earliest stages of MS (25). The results of this have shown that MS patients can expect to survive and be ambulant and otherwise normal to an advanced age if following an extreme low fat diet and omega-3 supplementation (26). The rarity of MS in the Japanese, whose diet consist of low saturated fat and high omega-3 fatty acids is another indication of the role of omega 3 oils in MS (27). There is now significant evidence to show it is a contributing factor to the development of the disease in conjunction with other environmental factors (7).

The development of MS is also believed to be linked to oxidant stress in the body from a lack of antioxidants (28). Along with other possible environmental factors the actual role of oxidative stress in patients with MS is poorly understood (29). The brain and nervous system are particularly susceptible to oxidative damage due to the low content of antioxidants in this area of the body due to them having to be imported (30).

Studies have shown that oxidative stress causes an activation where the production of pro-inflammatory chemical messengers called cytokines occurs which then contributes to the process of demyelination (31). Having sufficient antioxidants therefore ensures neuroprotection through suppression of inflammation, this limits the effects of MS (29,31,32).

Oligodendrocytes, a particular type of brain cell, that produce the extensive myelin sheaths are known to be particularly vulnerable to oxidative stress, this helps explain the lack of remyelination during remission stages 1. Oxidation (free radicals) literally stops the repair work on any damage to the myelin sheath.

In helping to prevent and restrict the development of MS there are a number of recommendations that can be applied as determined through scientific studies:
• Regular moderate sun exposure (15-30 min/day)
• Decreased intake of saturated fat and omega-6 PUFA accompanied with an increased consumption of omega-3 PUFA through consumption of fish and supplementation
• Daily supplement of vitamin D to ensure circulating level of vitamin D remains between 100 – 150 nanomoles per liter
• Consume at least 5-7 serves of antioxidant rich fruits and vegetables each day and supplement.

Acknowledgements. Bruce Greatwitch

References:
1. Meeteren et. al. 2005
2. Liuzzi et. al. 2007
3. Timmerman, Stuifbergin 1999
4. MS research Australia 2008
5. Undurti 2003
6. Kanwar, 2005
7. Embry 2004
8. Saher et al 2005
9. White et. al. 2004
10. Van Amerongen 2004
11. Cantorna, Mahon 2004
12. Mark and Carson, 2006
13. Hollis, 2005
14. Vieth, 2007
15. Yetley, 2008
16. Zadshir et al 2005
17. Anonymous 2007
18. VanAmerongen et. al. 2004
19. Barnes et. al. 2007
20. Kampman et. al. 2007
21. Toohey 2004
22. Mandavilli 2007
23. Nordvik et. al. 2000
24. Simopoulos 2002
25. Swank cited in Weinstock-Guttman et. al. 2005
26. Swank, Goodwin 2003
27. Undurti 2003
28. Lutskii, Esaulenko 2007
29. Koch et. al. 2006
30. Syburra, Passi, 1999
31. Gonsette 2008
32. Gilgun-Sherki et. al. 2004

Salt

Is salt the real problem that it is made out to be? It seems that by oversimplifying the information on salt and its relationship to health we complicate what is a really simple and important issue. After reviewing more than 100 scientific papers it became clear that salt is not the public enemy that it is made out to be, rather it appears to be an imbalance of minerals as a result of eating processed foods. And some very simple changes can make a lot of difference. This does not mean you go out and lather salt on all your food and justify it from my article, instead it means back to some common sense dietary changes.

Salt, in the form of sodium chloride, has been consumed by humans since the late Palaeolithic period, when it was used to preserve and flavour food. In modern times, however, some very limited studies and an incomplete understanding of nutrition have led to salt being labelled “public enemy number one” when it comes to blood pressure and cardiovascular disease. But is salt really so bad?

Salt in the human diet has been the subject of a great deal of research. Health professionals have, for many years, recommended reduction or even elimination of salt intake. This is mainly due to findings that link the excessive salt in the modern human diet to health problems such as high blood pressure. Yet it would be shortsighted to simply accept or reject such recommendations, as there are other factors involved requiring further investigation.

Salt intake is widely recognised by public health and medical organisations as the leading cause of blood pressure disparities (1). However, it is simply not valid to state that reducing salt intake will lower our prevalence of hypertension; the truth is that a number of factors, including lifestyle and nutrition, play an important role.

Sodium

Sodium is essential for many functions in the human body. The average human body contains around 90 grams of sodium, most of which is in the fluids that surround cells, some in bones and the rest retained in the cells (2). Sodium is passively absorbed and hence excess intakes are easily achieved. Sodium is excreted mainly by the kidneys; therefore a high sodium intake must be balanced with a large intake of water and other fluids. Sodium is the main component of the body’s extracellular fluids; it helps carry nutrients into and waste products out of the cells, regulates body functions such as blood pressure and fluid volume and works on the lining of blood vessels to keep the pressure balance normal (3). So you can see it is pretty important.

Chloride (Cl), the other half of the salt molecule (NaCl), is just as important as sodium yet often ignored. Chloride is essential for the production of hydrochloric acid, which is necessary to digest proteins in the gut and is essential for destroying bacteria and other potentially toxic microbes.
How much salt?

In terms of the adequate amount of daily intake of salt, various organizations, including the National Academy of Sciences’ Institute of Medicine, have published recommendations for daily sodium intake between 1,500 milligrams (mg) and 2,400mg per day for healthy adults (4)

The main regulators of sodium levels in the body are the kidneys. If sodium levels drop too low, the hormone aldosterone is released and this increases the amount of sodium held in the body by reducing the amount lost in urine. Excessive sodium loss is very rare, but low sodium levels in the body can be dangerous if not treated. Some people do not get rid of enough sodium through their urine; this causes the body to retain water, resulting in swelling of the body and, with the increased blood and fluid volume, in turn causes high blood pressure (5). The high blood pressure puts a strain on the heart, which must work harder to pump the increased volume of blood (Fox 2007). This is one reason that many health professionals recommend a reduction of salt intake—to reduce the risk of excess sodium in the blood; they believe that lower sodium intake has a beneficial effect on blood pressure. Thus people with existing hypertension and kidney disease may benefit from a reduction in salt intake.

Health problems

While there is evidence to suggest that salt plays a role in hypertension, it is a bit simplistic to target salt and ignore information that contradicts this. It is critical that we assess all the information available. It is important to take a multidimensional approach and look at the whole body. The increase in blood pressure as a result of increased salt intake may be due to the human kidney’s inability to excrete large amounts of (6,7,8). Results from various studies—including epidemiological, animal and migration studies as well as randomised trials—support the claim that as dietary salt increases, blood pressure increases (6). However, in humans at least, individuals seem to vary significantly in how they tolerate salt. Some people appear to be salt sensitive or have certain conditions that predispose them to hypertension.

High dietary salt intake in some individuals has been shown to contribute to cardio vascular conditions including the incidence of stroke (9). Research has found that individuals with a high salt sensitivity (in particular those with hypertension) have an increased risk of cardiovascular disease and death (10). High dietary salt intake can increase the risk of osteoporosis because of high urinary calcium excretion. In particular, it has been found that individuals with hypertension excrete high levels of calcium in their urine (11,12). However, provided that intake of calcium and potassium are at recommended levels, the risk of osteoporosis is low (13).

Salt is not the problem

So what is the problem? Research dating back to 1964 contradicts the simplicity of the link between salt and hypertension (14). In one study, a significant blood pressure decline was observed as a result of acute dietary salt increase (14). While limited studies of salt levels and blood pressure support the salt-hypertension link, the data are somewhat contradictory (14-23). It appears that this link affects only those with existing health conditions, not healthy persons. The question that remains is whether beneficial hypertensive effects of sodium restriction will outweigh its hazards.

Inadequate salt intake has also been associated with undesirable metabolic situations such as alteration in plasma lipoproteins and inflammation (24), a potential increase in cardiovascular stress, and increased serum cholesterol, triglycerides and insulin resistance (25). Contrary to common belief, the effects of low-salt diets—the unfavourable effects on blood coagulation, inflammatory and metabolic disturbances—outweigh the benefits of lowered blood pressure (Nakandakare et al. 2008). One study found that low-salt diets can actually cause harm to people with high blood pressure (26,27). So too little salt has greater adverse effect on health than too much salt. Epidemiological evidence suggests that a reduction in salt can decrease the risk of coronary disease significantly for overweight patients (28); however, low-salt diets are not warranted in patients with normal blood pressure (24).

Many studies show that hypertension is not related solely to dietary salt intake but to other factors such as a sedentary lifestyle, alcohol consumption, protein intake and lack of potassium, calcium and magnesium (29,30,31). The most realistic strategy for preventing and treating hypertension is not focusing on one risk factor but instead on a combination of interventions to reduce a number of risk factors (30). A proven effective intervention is Dietary Approaches to Stop Hypertension (DASH), which is a diet rich in fruit and vegetables, therefore rich in potassium, magnesium and other minerals (30,32). Not only has the DASH diet shown a beneficial effect on lowering blood pressure but also it is accompanied by the benefits of cholesterol-lowering and high antioxidant content, which could improve overall health and lower the risk of other diseases (32).

Studies indicate that only about 12% of subjects in a society with a high salt intake (eight grams to 12 grams of salt per day) will become hypertensive (33). According to a Tufts University research group (1997), only people with high blood pressure should be advised to limit sodium. Data from several large studies show that when adults meet or exceed the recommended dietary allowance of calcium, potassium and magnesium, the simultaneous ingestion of a diet high in sodium chloride is not associated with high blood pressure (34).

Overall there is only a weak relationship between dietary salt intake and high blood pressure in the general population (10). The effects of dietary salt on blood pressure are governed by “salt sensitivity” of individuals where large blood pressure changes can occur due to varying levels of salt intake (Franco and Oparil 2006). To compound the issue, research shows that sodium reduction in younger people frequently results in increased blood pressure, whereas those over 45 generally experience decreased blood pressure when sodium intake is restricted (34,35). Diet can also affect the response of dietary salt intake on blood pressure. An appropriate diet and a high potassium intake can curb the rise in blood pressure associated with an increase in dietary salt intake (10,37). More than 25 separate studies show that increasing potassium intake (without decreasing sodium) is an effective way to lower blood pressure. One of those studies demonstrated that with just one daily serving of a potassium-rich food the risk of death by stroke may be cut by as much as half (21). So why don’t we take this approach?

An eight-year study found those on low-salt diets had more than four times as many heart attacks as those on normal-sodium diets—the exact opposite of what the “salt hypothesis” would have predicted 38. Scientists at the University of Toronto concluded that limiting salt in the diet has no effect on people with normal blood pressure. In another study, 269 medical students were tracked; about 50% had no change in blood pressure when salt intake was increased by 12 times 39. Half of the remainder had a rise in blood pressure and the other half experienced a drop in blood pressure.

Data from the National Health and Nutrition Examination Survey found that individuals with the lowest sodium intake had a 20% higher chance of dying from a cardiovascular cause than individuals with the highest sodium intake (40). An earlier study also found an independent relationship between levels of sodium measured in urine and subsequent heart attacks and strokes: the lower the levels, the higher the rate of heart attacks and strokes (41). So not enough salt may kill you.

In support of this most of the big observational studies indicate an inverse relationship between salt intake and health outcomes (21). That is more salt less overall poor health. While a low salt diet may reduce blood pressure, it isn’t necessarily good for one’s overall health. It may make things worse (21) and could be outweighed by its negative effects on other health outcomes (21). In one of the big studies on hypertensive patients those who took in the least amount of salt were most likely to have heart attacks (21). A low-sodium diet also increases your resistance to insulin (21).

When salt is not salt

Some types of salts are: mine salts, sea salt and refined salt. The difference between sea salt and salt from saltshakers is that sea salt is richer in minerals such as magnesium, although it does not have iodine (42). Sea salt contains 84 different mineral elements but, during the process of refining sea salt to make “table salt,” 82 of the 84 mineral elements are extracted (43). Thus refined salt or table salt is not a healthy choice as it contains mainly sodium chloride.

The solution

Rather than viewing sodium as the direct culprit leading to various diseases, it may be more useful to look at sodium as an indicator of diets that are low in calcium, potassium and magnesium (44) while containing too many overly processed foods and soft drinks.

No single universal prescription for sodium intake can be scientifically justified (40). A healthy person can regulate a reasonable excess of salt especially if the diet contains a balance of other essential minerals. People with existing health problems may require a reduction in salt from their diet based on their individual needs and advice by health professionals but it is probably more important to increase their other mineral levels.

Rather than eradicate salt from the diet altogether, it makes more sense to restrict the ingestion of salt to a feasible level while encouraging consumption of organic sodium salts in conjunction with good nutrition to control blood pressure, promoting vascular health and preserving bone density (45). It is easy to increase the potassium in your diet. High potassium fruits include apricots, bananas, melons and citrus fruits. Vegetables with good amounts of potassium are mushrooms, spinach, asparagus, potatoes, green beans, avocados, lima beans, winter squash and cauliflower. Other foods high in potassium include whole grain products, seafood and dry beans such as peas and lentils. All these foods contain significant amounts of magnesium and calcium, which will also contribute to the lowering of blood pressure.

It is too simplistic to target salt as the enemy. Rarely is anything simple when we are dealing with the human body. If we adopt a healthy diet with the nutrients we need and reduce our intake of processed foods and soft drinks, we reduce not only blood pressure but also many other forms of chronic illness including all forms of cardiovascular disease. What I don’t understand is why we don’t target the real culprits? We need to adopt a multidimensional view of health and illness rather than looking at just one aspect. For the sake of our health, we must look at the entire picture.

References
1. Antonios and MacGregor 1996
2. Reavley 1998
3. Greeley 1997
4. Mayo Clinic 2007
5. Fox 2007
6. Appel 2008
7. Menton et al. 2005
8. Havas et al. 2008
9. Sergei and Mongin 2007
10. Franco and Oparl 2006
11. Gilbert and Heiser 2005
12. Navidi et al. 1995
13. Heaney 2006.
14. Brown et al. 1964
15. Freedman et al. 2001
16. Alderman 2000
17. Cassels 2008
18. McCarron et al. 1997 and 1998
19. Freeman and Petitti 2002
20. Graudal et al. 1998
21. Cohen et al. 2006
22. Meneton et al. 2005
23. Taubes 1998
24. Nakandakare et al. 2008
25. Ivanovski et al. 2005
26. Rivera 1999;
27. Grassi et al. 2002
28. McCarty 2003
29. Boyles 2003
30. Suter et al. 2002
31. Cann 2005
32. Beilin et al. 2001
33. Finn 1999
34. McCarron et al. 1997
35. Ian and Robertson 2003
36. Overlack et al. 1993
37. Appel 2008
38. Young 2008
39. Freeman and Petitti 2002
40. Alderman 2000
41. Alderman 1995
42. Largeman 2006
43. Dearing 2008
44. Boyles 2003
45. McCarty 2003

Aggression and Omega 3 supplements

A very recent article in the journal of Aggressive Behaviour (Volume 36, Issue 2, Pages 117-126), yes there is such a journal, found that supplements which included omega-3s, vitamins and minerals were associated with a 34 per cent reduction in violent incidents, while the placebo group (received no supplements) had a 14 per cent increase in the number of reported incidents. This is following on from a study of young violent offenders reported in the British Journal of Psychiatry, in 2002 which found a 39% reduction in violent offences when they supplemented with a similar mix of nutrients. This is understandable if you look into a bit of the brain chemistry and the role of fatty acids and nutrients involved in healthy brain function.

Imagine we could reduce the violent behaviour out there in the community by getting people to eat well and supplement. Next time someone gets angry at you go tell them to take some supplements. The only real difference is that these people in the study are in prison. I know many kids who probably eat a lot worse than those in prison.