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Blood Pressure: Exercise and Healthful Diet More Important than Salt Restriction

A recent report from the University of London in the UK warns that a high-salt diet is associated with increased risk for stroke, heart attacks and premature death (Journal of Human Hypertension, January 2009). The authors feel that taking in too much salt is the major risk factor for high blood pressure, associated with 62 percent of strokes and 49 percent of heart attacks. They are correct about the association between high salt intake and high blood pressure in some people. However, the association with heart attacks is much stronger between eating meat and processed foods (both high food sources of salt) than it is with added salt. Other studies show that eating meat increases inflammation that causes heart attacks (reported in my eZine on November 9 and November 16, 2008).

The highest association between high blood pressure and risk for heart attacks is in people who have a systolic (heart contraction) blood pressure that does not drop below 120 in the evening. I recommend getting a wrist blood pressure cuff (about $30 in drug stores) and taking your blood pressure in the evening. If your systolic blood pressure is above 120 before you go to bed, you are at increased risk for premature death and need to check with your doctor, make lifestyle changes and perhaps take medication.

Data associating a high-salt diet with disease is reported only in people who are not heavy exercisers. In 1942, James Gamble of Harvard Medical School showed that salt is the only mineral you lose in significant amounts with exercise. If you are a regular exerciser and run low on salt, you can become too tired to work out every day and be at increased risk for muscle cramps and injuries.

Eighty percent of people with high blood pressure can be cured with diet alone (see my explanation of the DASH diet). Regular exercisers who have bedtime blood pressures below 120 probably do not need to restrict salt. If they suffer muscle cramps, injuries or chronic fatigue, they should get blood sodium (normal is above 135 nmol/L) and chloride (normal is above 98 nmol/L) levels. If either test result is low, they may need to take in more salt.


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Dear Dr. Mirkin: Why is it better to have fat stored in the legs and hips than in the belly?

Two recent studies show that fat stored underneath the skin in the buttocks and legs helps to prevent diabetes (Cell Metabolism, December 2008) and heart attacks (Nutrition, Metabolism & Cardiovascular Diseases, January 2009). Eighty percent of diabetics die of heart disease. The vast majority of diabetics have too much insulin because their cells are not able to respond adequately to insulin. Fat underneath the skin on the hips, not the belly, sends out a yet-undiscovered hormone that makes cells sensitive to insulin. Thus storing fat on the lower part of your body helps to prevent diabetes and heart attacks. On the other hand, fat around your organs and in your belly blocks cells’ ability to respond to insulin and therefore contributes to diabetes. That why people shaped like pears have a low incidence of diabetes and heart attacks, while those shaped like apples have a high risk.


Dear Dr. Mirkin: Does caffeine increase heart attack risk?

Probably not. In a ten years of follow-up of 1354 elderly people who did not have high blood pressure, those who drank one or more cups of caffeinated coffee per day had a 43 percent lower risk of coronary heart disease than those who did not drink caffeinated coffee (From the Framingham Heart Study, reported in the American Journal of Cardiology, December 2008).

Nobody really knows why, but it may be that caffeine causes muscles to burn more fat to preserve sugar stored in muscles. This gives people greater endurance and helps them to exercise longer. Regular exercise helps to prevent heart attacks. However, since caffeine can increase blood pressure in people who already have high blood pressure, those with high blood pressure probably should restrict caffeine.


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June 22nd, 2013
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About the Author: Gabe Mirkin, MD

Sports medicine doctor, fitness guru and long-time radio host Gabe Mirkin, M.D., brings you news and tips for your healthful lifestyle. A practicing physician for more than 50 years and a radio talk show host for 25 years, Dr. Mirkin is a graduate of Harvard University and Baylor University College of Medicine. He is board-certified in four specialties: Sports Medicine, Allergy and Immunology, Pediatrics and Pediatric Immunology. The Dr. Mirkin Show, his call-in show on fitness and health, was syndicated in more than 120 cities. Read More
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