New evidence shakes up perceptions of salt

  • Author: Health Informer
  • Filed under: Health News
  • Date: Oct 15,2009

Recent data analysis questions scientific basis of national efforts to regulate salt content

As the 2010 Dietary Guidelines for Americans are currently under development and regulations surrounding sodium consumption are being considered, an analysis of evidence released online today in the Clinical Journal of the American Society of Nephrology (CJASN) questions the scientific logic and feasibility of the decades-long effort to limit salt intake in humans.

After examining data from sodium intake studies worldwide and a critical body of neuroscience research on sodium appetite (innate behaviors that drive us to consume salt), researchers from the Department of Nutrition at the University of California, Davis and the Department of Anatomy and Neurobiology at Washington University found compelling evidence indicating that humans naturally regulate their salt intake within a narrowly defined physiologic range.

This new analysis, “Can Sodium Intake Be Modified by Public Policy,” is timely as two expert panels convened by the U.S. government are considering nutrition policies that would lower current sodium intake recommendations and set in motion policies regulating the amount in food. The issue of whether sodium intake is a physiologic parameter which public policy cannot change has never before been considered. This study challenges the relevance of regulatory or legislative intervention by identifying evidence which must be taken into account as U.S. guidelines are being reevaluated and even more restrictive policies considered.

“If sodium intake is physiologically determined, then our national nutrition guidelines and policies must reflect that reality,” said David A. McCarron, M.D., an adjunct professor with the Department of Nutrition at UC Davis and lead author. “It is unrealistic to attempt to regulate America’s sodium consumption through public policy when it appears that our bodies naturally dictate how much sodium we consume to maintain a physiologically set normal range. To do otherwise will expend valuable national and personal resources against unachievable goals.”

Study Analysis Finds Sodium Consumption Is Not at Extreme Levels

The researchers evaluated 24-hour urinary sodium excretion, the standard measure of daily sodium intake, from 19,151 individuals collected in 62 previously published surveys from 33 countries worldwide. In contrast to the widely held notion that salt intake has reached extreme levels in Western societies, the analysis indicates that daily sodium intake across a wide range of “food environments” tracks within a relatively narrow range: 117 mmol-212 mmol (2,700-4,900 mg). In addition, previous studies provide supportive evidence that adult humans naturally seek this range of sodium intake.

Further, the authors highlight neuroscience research in animal models demonstrating that sodium intake is tightly controlled by critical pathways in the brain to maintain optimal function of many physiologic functions.

“Decades of neuroscience research have revealed highly sophisticated brain circuits which regulate sodium appetite by facilitating communications between the brain and multiple organs throughout the body,” said Joel C. Geerling, M.D., Ph.D., formerly of Washington University and a co-author of this study. “One purpose of these pathways is to ensure that the body is obtaining adequate sodium from the diet to fulfill physiologic needs.” Dr. Geerling is currently a physician at New York-Presbyterian Hospital/Columbia University Medical Center.

The importance of the question posed by this article is further highlighted by the efforts of national agencies and municipal departments, such as the British Food Standards Agency (FSA) and the New York City Department of Health, which have set in motion campaigns to mandate food companies and restaurants to lower the sodium content of foods.

In the course of their analysis and included in this article, the UC Davis investigators statistically assessed government-sponsored surveys of 24-hour urinary sodium excretion completed at 13 sites within the United Kingdom and Ireland involving more than 6,000 subjects since 1982. This assessment indicates that there has been no change during the past 25 years in the dietary sodium intake of individuals living in the UK and Ireland and is at odds with FSA’s recent public claims of a significant reduction following that agency’s multi-million pound campaign to restrict salt intake in the UK.

Is Regulation Necessary in the Battle Against Salt?

The 2010 Dietary Guidelines Advisory Committee and an Institute of Medicine (IOM) Panel on Strategies to Reduce Sodium Intake are working to determine what the 2010 sodium intake guideline will be and how to implement strategies — including regulatory and legislative actions — to further lower Americans’ sodium intake.

However, the current daily intake guidelines call for a maximum daily intake of 2,300 mg of sodium, the equivalent of one teaspoon of table salt. These recommendations are already 17 percent lower than the lowest level of worldwide sodium intake (2,700 mg) and 38 percent lower than the worldwide average sodium intake (3,700 mg).

According to Judith Stern, Sc.D., professor of nutrition at UC Davis and a past member of the 1985 Dietary Guidelines Advisory Committee, “If this body of evidence is not taken into account, updates to the Dietary Guidelines or regulatory actions are based on partial science. Clearly, before dietary sodium intake can or should be modified, additional discussion and analysis are required.”

References

McCarron DA, Geerling JC, Kazaks AG, Stern JS. Can Dietary Sodium Intake Be Modified By Public Policy? Clin J Am Soc Nephrol, 2009.

Trials of Hypertension Prevention Collaborative Research Group: Effects of weight loss and sodium reduction intervention on blood pressure and hypertension incidence in overweight people with high-normal blood pressure. The Trials of Hypertension Prevention, Phase II. Arch Intern Med 157: 657-667, 1997.

McCarron DA, Weder AB, Egan BM, Krishna GG, Morris CD, Cohen M, Oparil S. Blood pressure and metabolic responses to moderate sodium restriction in isradipine-treated hypertensive patients. Am J Hypertens 10: 68-76, 1997.

Source: UC Davis


Expert Panel Offers Three-Step Plan to Guide People Toward Recovery of Depression

A new survey of 2,001 adults living with depression revealed that despite being diagnosed for an average of 12 years, many unknowingly took actions that could have sabotaged their chances of getting well.(i) Furthermore, on average, it took about six years for respondents to seek diagnosis from a health care professional, suggesting these adults may have been coping with depression for as long as 18 years.(i)

Depression, which includes a variety of symptoms,(ii) is a highly treatable illness,(iii) but it can become more difficult to treat the longer it goes undiagnosed or undertreated.(iv) The survey showed that among those who waited six months or more to be diagnosed, 69 percent reported they delayed diagnosis because they lacked knowledge about depression or lacked basic facts about available depression treatments and where to go for help.(i) Additionally, among those who wanted more information about depression treatment at the time of diagnosis, 64 percent said they wanted to know what it means to “get well.”(i) Surprisingly, 91 percent have been prescribed an antidepressant for depression, but among them, just seven percent felt very knowledgeable about all basic aspects of the treatment.(i)

The survey is part of a new depression educational program called Missing Pieces, which was developed by leading mental health experts and supported by Eli Lilly and Company to help people identify the information they need to better understand depression. Overall, the survey demonstrated that many adults with depression are engaging in unhealthy behaviors that may jeopardize recovery,(i) such as:

– Nearly three in five (57 percent) of those who delayed seeking a diagnosis felt they could manage their own depression symptoms.(i)
– Among respondents who had taken antidepressants for depression, nearly half (47 percent) did not discuss when it might be necessary to change medications with their doctor, despite the fact that they were still experiencing depressive symptoms.(i)
– Among those who have stopped taking antidepressants, about two in five (41 percent) did so without telling their doctor.(i)
– More than 70 percent (71 percent) noted that talk therapy should always be part of a depression treatment plan, yet only 22 percent were currently enrolled in talk therapy.(i)

“The survey strongly suggests that many people living with depression are unaware or are ‘missing pieces’ of vital information that may be preventing them from getting well,” said Dr. Susan Kornstein, professor of psychiatry and obstetrics and gynecology at Virginia Commonwealth University. “Depression needs to be treated by a health care professional.(iii) To increase the likelihood of recovery from depression, it’s important that people with depression have a comprehensive treatment plan that may include medications, psychotherapy and lifestyle changes.(iii,v) The goal is to help them to recovery.”(iv)

Three-Step Action Plan

The survey revealed key areas of information that people with depression are missing. In response,

The Missing Pieces expert panel recommends three simple steps to help guide people from diagnosis to recovery of depression:

Step One: Two Week Rule for Diagnosis of Depression

Current American Psychiatric Association guidelines state that adults experiencing at least five of the symptoms of depression for two consecutive weeks, and at least one of them is depressed mood or loss of interest, they should talk to a health care professional.(ii) Additional symptoms of depression can also include feelings of guilt or worthlessness, thoughts of death or suicide, restlessness, trouble concentrating or making decisions, fatigue, lack of energy and changes in weight or sleep patterns.(ii) Additional symptoms of depression may include pain, irritability and anxiety.(ii)

Step Two: Six Week Rule for Seeing Improvement in Depression Symptoms

To get fully well, it is important to address all of the symptoms of depression.(iv,vi) Experts recommend that individuals on any type of treatment plan for depression who are unsatisfied with their level of improvement should consider consulting with their doctor about making changes to their treatment plan.

Step Three: Managing Your Depression Treatment Plan When Feeling Better

If an individual has found a depression treatment plan that is addressing many of their depression symptoms, they should continue on that treatment for at least another four to nine months to help prevent the return of their symptoms. Some individuals will also need long-term maintenance treatment to help prevent future episodes of depression.(vii,viii)

In addition to this three-step plan, Missing Pieces offers an educational Web site, found at www.MissingPiecesProgram.com, which provides more survey details and in-depth information about depression. The Missing Pieces program was driven by a multi-disciplinary expert panel that helped shape the development of all educational materials including the national survey and Web site content:

– Dr. Susan Kornstein, professor of psychiatry and obstetrics and gynecology at Virginia Commonwealth University
– Dr. Sally Edwards, family practice doctor at Woodinville Primary Care in Seattle, Washington
– Dr. W. Clay Jackson, clinical assistant professor of psychiatry at the University of Tennessee College of Medicine
– Dr. Thomas Wise, professor of psychiatry, George Washington University School of Medicine

The Missing Pieces survey was conducted online within the United States by Harris Interactive® on behalf of Eli Lilly and Company from April 23 to May 7, 2009 among 2,001 U.S. adults ages 18 and older who have been diagnosed with depression. Results were weighted as needed to the U.S. adult population diagnosed with depression. Propensity score weighting was also used to adjust for respondents’ propensity to be online. No estimates of theoretical sampling error can be calculated. Full methodology is available through Harris Interactive. Patient input garnered from the survey played a pivotal role in shaping all Missing Pieces materials.

Notes:

(i) This survey was conducted online within the United States by Harris Interactive on behalf of Eli Lilly and Company April 23 to May 7, 2009 among 2,001 U.S. adults ages 18 and older who have been diagnosed with depression. Results were weighted as needed to the U.S. adult population diagnosed with depression. Propensity score weighting was also used to adjust for respondents’ propensity to be online. No estimates of theoretical sampling error can be calculated; a full methodology is available through Harris Interactive.

(ii) Diagnostic and Statistical Manual of Mental Disorders. 4th ed., Text Revision. Washington DC. American Psychiatric Association; 2000. 345-428.

(iii) National Institute of Mental Health. “How is Depression Detected and Treated.” Available at: http://www.nimh.nih.gov/health/publications/depression/how-is-depression-detec ted-and-treated.shtml. Accessed on July 28, 2009.

(iv) Keller, Martin B. “Past, Present, and Future Directions for Defining Optimal Treatment Outcome in Depression.” JAMA 2003; 289 (23): 3152-3160.

(v) Gomez-Pinilla, Fernando. “The influences of diet and exercise on mental health through hormesis.” Ageing Research Reviews 2008 (7); 49-62.

(vi) Rush JA, et al Neuropsychopharmacology 2006;31:1841-1853.

(vii) American Psychiatric Association. “APA Practice Guidelines: Treatment of Patients With Major Depressive Disorder.” April, 2000.

(viii) Suehs B, et al. “Texas Medication Algorithm Project Procedural Manual: Major Depressive Disorder Algorithms.” Texas Department of State Health Services. July, 2008. 26-27.

Source: Eli Lilly and Company


Miniaturized surgery treats pain with reduced recovery time

Endoscopic surgery has steadily gained in popularity since it was developed in the 1980s. Dr. Richard Siegfried has teamed with Dr. Louis Quartararo one of only a handful of surgeons who have been trained to perform endoscopic surgery on the spine.

Drs. Siegfried and Quartararo perform endoscopic spine surgery using a video telescope and miniaturized instruments through a tiny incision. By minimizing the disturbance to surrounding tissue, postoperative discomfort is reduced and recovery time dramatically shortened.

Dr. Siegfried says, “We’ve had patients who’ve been out of work for six months to a year-and-a-half who’ve been able to return to work. We’ve had patients who were on narcotic painkillers who are off their medications and have really gotten their life back.”

The Endoscopic Microdiscectomy procedure removes a tiny portion of the disc in the spine so that the disc is no longer pressing on the nerve root. Rather than creating a 3-inch or larger incision, as would be the case in traditional surgery, this procedure is performed through a tiny 1/2-inch incision. The combination of a miniaturized video camera, live x-rays and sophisticated neurological monitoring guides the surgeon so he can successfully remove a tiny piece of the disc without cutting surrounding nerves, muscle and bone. The patient goes home within a few hours with one or two band-aids on their back.

Drs. Quartararo and Siegfried also offer another form of miniaturized surgery called Endoscopic Lumbar Fusion. This newer procedure has only been around for a few years. It is recommended for patients with disc disease who have back pain with or without leg pain. Traditional lumbar fusion surgery would require an 8- to 10-inch incision and would involve significant post-operative pain. But with endoscopic surgery, there are only two incisions that are 2-1/2 inches in length on either side of the spine for a bar to hold the spine in place during healing. Rather than a 4- to 5-day hospital stay, the patient can go home between 12 and 23 hours after the procedure.

“I am very fortunate to work with a surgeon who has performed hundreds of these procedures and studied under the physician who invented the surgery,” Dr. Siegfried says. Dr. Quartararo heads the endoscopic surgery team. He is a board-certified Orthopedic Surgeon with advanced training in the fields of Orthopedic Trauma and Spine Surgery from the prestigious John Hopkins University. Dr. Siegfried is a board-certified pain management specialist and former Director of The Pain Management Center at Columbia-Presbyterian Medical Center in New York.

But Dr. Siegfried cautions, “The important thing to remember when it comes to this specialized type of surgery is that it requires training not only in endoscopic surgery but also in spine surgery. Patients should ensure that their physician has credentials in both areas. In the absence of a trained Spine Surgeon on the team, the patient is at great risk in the unlikely event of a complication during or after surgery.”

With every new procedure that comes along, Dr. Siegfried says he has more to offer patients who in the past would have no hope for pain relief. “I went into this field to help people. For the right patients, endoscopic spine surgery can make a remarkable difference. We have successfully performed surgery on patients who have been turned away by other surgeons with no hope whatsoever. Being able to offer this type of pain relief is extremely rewarding.”

Source: Richard N. Siegfried, M.D., L.L.C., Comprehensive Pain Management


New tips for sidelining Swine Flu

While Americans anxiously await the arrival of the H1N1 Flu Vaccine in their area, many are seeking new methods to try to keep their homes germ free and their families healthy during this flu season. HAAN, the Steam Cleaning Experts, offer fast and effective ways to easily maintain a sanitized home without the use of harsh chemicals. The company’s full line of steam cleaning products for the home uses the power of 212 degrees F steam to kill 99.9% of bacteria, simply with the use of water.

HAAN urges Americans to embrace the new, clean and effective technology to clean with the power of steam. With this in mind, HAAN offers a few simple tips to help keep you and your family healthy during this flu season:

– Blow-dry Before Bed and Blow Away Germs: Falling asleep with wet hair not only creates unwanted morning bed head, but a pillow case full of germs and dust mites.
– Kill Cabin Fever: Cold weather means more indoor play-dates for children. Help prevent illness by using non-toxic cleaning tools like HAAN’s HS20 Handheld Steamer to kill bacteria on toys, or the MS30 Multi-Function Steam Cleaner to sanitize floors and play areas with just the power of steam.
– Conquer Computer Contamination: Hefty amounts of homework equals multiple people logging long hours on the house computer.  irty hands and fingers can unknowingly easily pass germs from one family member to the next. Wipe down computers with sanitizing cloths.
– Wallop Bacteria out of Wet Winter Hats, Scarves and Gloves: Many don’t realize that that pile of wet hats, gloves and scarves left in a heap by the front door are the perfect breeding ground for bacteria. For a quick and effective fix, HAAN, the Bacteria Beating Specialists, suggest using their HS20 Handheld Steamer to blast away bacteria at 212 degrees F. Hold the steamer one inch away from the items, and simply steam away the bacteria on contact.
– Hand Sanitizers for the Home: Dirty hands can spread germs and bacteria throughout your home. In addition to promoting hand washing
among family members, keep hand sanitizers strategically placed in each room of the house for easy accessibility. Additionally, provide each family member with a travel sized bottle to carry in their purse, backpack or briefcase.
– Dust mites and dreams do not make good bed partners: Invisible dust mites and bacteria that live in your mattress can make you ill even when you sleep. HAAN’s GS60 Steam Station kills these living organisms on contact by passing the head of the steamer over the entire mattress, leaving you assured that all you’ll get is a good night’s sleep!

Source: HAAN, the Steam Cleaning Experts


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