Advice for Heart Health: What to Eat, What to Do
Well-intentioned health practices can inadvertently lead us down the path of booby - traps - unexpected pitfalls in health that impair health, rather than enhance it.
I encounter these health booby traps every day in my experiences with patients. Let me list some of the most common.
Public health messages urge us to reduce salt and sodium in our diet, since overuse of salt increases blood pressure, causes fluid retention, and can accelerate osteoporosis.
Curiously, for the first half of the 20th century, the public health message was to increase salt usage. Why? Because public health officials recognized that goiters (enlarged thyroid glands from iodine deficiency) were rampant, affecting nearly a third of the population, resulting in fatigue, weight gain, poor mental performance in schoolchildren, and even mental retardation. In 1924, the FDA introduced a program of salt iodization as a solution to deliver iodine through a commonly used food vehicle, table salt. And it worked: goiter essentially disappeared, the extremes of thyroid dysfunction with it.
In 2009, the public health message has changed to reduce salt and sodium - but what happened to the iodine? No surprise, iodine deficiency is increasing, with 11.3% of the U.S. population now severely deficient (National Health And Nutrition Examination Survey, 2003-2004), a quadrupling since the 1970s. Goiters are now coming back, along with an increase in thyroid disease.
Avoid tap water
Many Americans, leery of the quality of their city tap water due to fear over pesticide contamination, the presence of chlorine or fluoride, organisms like Cryptosporidium, or simple bad taste or smell (e.g., sulfur), have turned to bottled water in some form. Some have resorted to the single use bottles purchased in bulk quantities, while others use large containers of bottled water purchased or delivered to the home or workplace.
Bottled water packs a three-punch hit to our health: 1) Bottled water has been found to be commonly contaminated with organic chemicals (Environmental Working Group, 2008); 2) Much bottled water is filtered or distilled, meaning minerals have been removed, especially magnesium, an essential mineral that is increasingly deficient in Americans; and 3) plastic water bottles, especially the large ones used for water coolers, are frequently made with polycarbonate, the plastic that leaches out bisphenol A (BPA), shown to be associated with increased likelihood of heart attack, diabetes, abnormal liver tests, and disruption of thyroid function.
Dermatologists advise us to avoid sun. Some say avoid it altogether, while others say just avoid the midday sun when it is at its most intense. They say that exposure to the ultraviolet radiation increases risk of skin cancers, including melanoma. They advise use of sunscreens if you are out in the sun.
But this is surely a case of well-intended advice backfiring. While there might be a reduction in the incidence of some skin cancers (like the relatively benign squamous cell carcinoma, which rarely spreads or causes death), sun avoidance causes (or, more likely, worsens) vitamin D deficiency. Anyone who has been following the fascinating vitamin D discussion knows that deficiency leads to heightened risk for colon, breast, and prostate cancers; osteoporosis and arthritis; higher blood sugars and diabetes; higher risk for heart attack; greater risk for multiple sclerosis; winter "blues" and depression; and inflammatory diseases.
Humans evolved in the bright tropical or semi-tropical sun. Total avoidance is sure to worsen the already flagrant deficiency of vitamin D in modern Americans. Although data do support the warning that a sunburn is bad for health, not so with sun exposure without burning.
Who hasn't heard the "cut your saturated fat" or "eat low-fat" mantra over and over again?
This message has been repeated countless times over the last 20 years by "official" agencies like the USDA, American Heart Association, and others. They have found willing partners in the food industry, who have populated grocery shelves with all manner of low-fat cookies, breakfast cereals, salad dressings, and the like.
The corollary to the eat low-fat advice is to eat plenty of "healthy whole grains." Americans have complied. This false notion arose from the clinical studies of the 1970s and 1980s that showed that replacing foods made with white enriched flour with whole wheat or other whole grain flour led to reduction in colon cancer, diabetes, and heart disease. That's true. What is not true is to assume that if a very bad thing (white enriched flour products like white bread and buns) are replaced with a less bad thing (whole grain products), then more and more of the less bad thing must be better. It clearly is not.
With this health booby trap, we've suffered the worst epidemic of obesity and diabetes the world has ever seen. Plenty of "healthy whole grains" increases appetite, triggers insulin to extremes, skyrockets blood sugar, provokes inflammation (like c-reactive protein), makes you gain weight.
Coming next: Solutions to the health booby traps