Chocolate

Chocolate is known to contain a wide variety of minerals and trace elements including magnesium, phosphorous, potassium, calcium, iron, zinc, copper and manganese. It is also a rich source of antioxidants and has been identified as a potent antioxidant for LDL cholesterol. The phenalyic content of chocolate is 20 times higher than tomatoes, 3 times that of grapes, and twice the level of garlic. Dark chocolate contains more than twice the level of phenyls compared to milk chocolate while white chocolate contains no anti-oxidants. A bar of milk chocolate (45 grams) was found to contain approximately the same level of phenyls as 150 mill glass of red wine. Chocolate contains a higher concentration of phenyls than either red wine or green tea on a weight basis.

And just in time for Easter. A study out this week found, believe it or not, chocolate consumption was associated with a lower Body Mass Index (weight). Chocolate has shown favorable metabolic associations with blood pressure (BP), insulin sensitivity, and cholesterol level.

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

Reduce your heart attack without cholesterol lowering drugs

A recent Swedish study of 31671 woman found that multivitamin use was associated with a reduction in the rate of heart attack (myocardial infarction). This should have been front page news around the world but it did not seem to even get a look in. This is one of the dozens of studies that show a strong link with supplementation and health benefits. The study was broken into two groups. Women with a history of CVD and woman without any history of CVD. During the average of 10 years of follow-up the woman without any history of CVD and who took multivitamin supplements had a 27% in heart attacks over the period. That is better than any stain drug to lower cholesterol. The use of multivitamins over a 5 year period, that is, those who took them the longest, saw a reduction of 41%. Wow. This is so simple and so cheap. However in the CVD group use of multivitamins was not associated with any decrease in the rate of heart attack. So if you already had a heart attack low doses of multivitamins don’t appear to help at all. The levels were what you would find in a standard multivitamin supplement such as 400ug for folic acid. Perhaps it is my bias but the levels were probably so low for someone who already had a heart attack to make any difference. Better still make sure you don’t have a heart attack. (Am J Clin Nutr (September 22, 2010). doi:10.3945/ajcn.2010.29371)

Interestingly I have been doing a lot of reading on magnesium lately and there is a lot of research on the link between heart attack, atherosclerosis, angina and most other forms of CVD and low magnesium levels. That is low levels are associated with increased risks so if you want to lower your risk increase your magnesium. This may be obvious but the highest concentration of magnesium is in heart muscle and magnesium is essential for relaxing muscles. Magnesium also stops calcification of arteries and build up of plaque (no it is not all cholesterol, it is mostly calcium blocking your arteries). Another simple hint would be to have lots of water. It sounds simple but most of us don’t drink enough of it.

What amazes me as I read the volumes of research is why our medical system doesn’t tell us this.

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.