Archive for October, 2012

The Skinny On Salt

October 26, 2012


Andrew Siegel, M.D.   Blog # 81

Most of us adore our saltshakers and put them to frequent use.  Salting our foods enhances taste—imagine how bland French fries, scrambled eggs or popcorn would be without salt (aka sodium).  Salt also serves a function as a food preservative and played an important role as such in the days before refrigeration was widely available.  Historically, salt has been a valuable commodity. Think for a moment of all of the salt idioms used in our English language, many of which that convey the value of this essential mineral: “Salt of the earth”; “Worth one’s salt”; “Back to the salt mines”; “Rub salt in a wound”; “To salt away.”

Sodium is an important mineral, a critical electrolyte in terms of regulating fluid exchange within the body compartments, including membrane permeability in cells, nerve conduction, and muscle cell contraction of skeletal, smooth and cardiac muscles. However, when consumed in excess, it can wreak havoc on our bodies. Unfortunately, the majority of Americans consume more than twice the recommended upper limit of sodium, with most of us eating/drinking about 3400 mg sodium daily.

Excessive sodium intake increases our blood volume, which causes increased pressure within the arterial walls, known as hypertension.  Hypertension within the arterial walls contributes to the following serious ailments: coronary artery disease; aneurysms; stroke; congestive heart failure; and kidney disease.  These cardiovascular diseases are the leading causes of death in the USA.  So clearly, excess sodium intake contributes to the hypertension present in at least one of three Americans; this hypertension in turn is linked to cardiovascular disease and death.  Excess dietary sodium also promotes fluid retention and edema.

Although the recommended daily allowance of sodium is 2300 mg (one teaspoon), our bodies actually only require 500 mg of sodium daily, and most Americans would do well to consume no more than 1500 mg daily.

Sources of sodium include table salt, pickles, olives, canned soups, luncheon meats and deli products, cheeses in general and cottage cheese in particular, and bread.  Pizza is very high in sodium.  Snack foods such as chips, pretzels, and popcorn pack a load of sodium.  Condiments and salad dressings are major culprits as are processed, prepared foods, fast foods and many sauces including tomato, soy, Worcestershire and Tabasco. Chinese food and Mexican food are often bathed in salt.  Flavor enhancers such as Accent, for example, are mono-sodium glutamate and are thus very high in sodium.  Restaurant meals are a major source of sodium.  That gyro that I consumed for dinner the other evening was so salt-laden that I was thirsty all evening and the following morning I had trouble getting my wedding ring on!

Generally speaking, roughly 80% of our sodium comes from processed foods and restaurant dining, 10% occurs naturally, 5% is added at the table and 5% is added during cooking.

What To Do:

Lowering salt intake is an inexpensive and practical way to make a major impact on our overall cardiovascular health and avoid morbidity and mortality:

  • Increase potassium intake by eating more potassium-rich foods including root vegetables; sweet potatoes; green, leafy vegetables; grapes; yogurt; and tuna. (Increasing our potassium intake helps to lower blood pressure by blunting the effects of sodium.)
  • Use salt substitutes such as potassium chloride.
  • Read food labels carefully and compare brands—you might be shocked at how many foods that you would not expect have very high levels of sodium.
  • The less processed the better in terms of sodium content—in general, the more highly processed foods have more ingredients, are touched by more hands, and are usually located in the central area of supermarkets.
  • Avoid “instant” foods that are often high in sodium, e.g., Ramen noodles and Rice-a-Roni.
  • Use alternative flavors: think spicy (like chili or red peppers) instead of salty.
  • Eat fresh foods including fresh fruits and vegetables, which are extremely low in sodium.
  • Any animal product will have some degree of sodium as sodium it is a vital chemical to biological existence. Even a glass of milk will have over 100 mg of sodium.
  • Rinse off canned vegetables, tuna, etc.
  • The DASH diet (Dietary Approaches to Stop Hypertension) can be a very effective approach to lowering sodium consumption.

Take everything you read with a grain of salt, but trust me on this one—take your salt in moderation and your body will thank you!

Andrew Siegel, M.D.

Author of Promiscuous Eating: Understanding and Ending Our Self-Destructive Relationship with Food:

Available on Amazon in paperback or Kindle edition

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Kidney Stones…Ouch!

October 19, 2012

Andrew Siegel, M.D.   Blog # 80


I have chosen kidney stones as a topic since they are a very prevalent problem that I treat on an everyday basis, and a condition often related to our dietary habits, the quantity of fluids that we drink, and our weight status.

If you have ever suffered with a kidney stone, you truly know what excruciating pain is.  Many women who have experienced both passage of a kidney stone and natural childbirth without any anesthesia will report that the childbirth was the less painful of the two!

Stones are a common condition that has occurred in humans since ancient times; kidney stones have even been found in an Egyptian mummy dated 7000 years old.   The good news about stones is that most of them will pass spontaneously without the necessity for surgical intervention. The other welcome news is that if surgery is required, it is minimally invasive—open surgery for kidney stones has virtually gone by the wayside.

Kidney stones form when minerals that are normally dissolved in the urine precipitate out of their dissolved state to form solid crystals. This crystal formation often occurs after meals or during periods of dehydration. The lion’s share of kidney stones manifest themselves during sleep, at a time of maximal dehydration.  Dehydration is also why kidney stones occur much more commonly during hot summer days than during the winter. This past summer—one of the hottest on record—kept urologists very busy in terms of caring for patients with kidney stones.   Anything that promotes dehydration can help bring upon a stone—including exercise, saunas, hot yoga, diarrhea, vomiting, being on bowel prep for colonoscopy, etc.

In addition to dehydration, another factor that can contribute to kidney stone formation is excessive intake of certain vitamins. The biggest culprit is Vitamin C, also known as ascorbic acid.   When metabolized by the body, Vitamin C is converted into oxalate, one of the components of calcium oxalate stones, the most common variety of stone.  The problem is that vitamin C is a water-soluble vitamin, so any excessive intake is not stored in the body but appears in the urine in the form of oxalate. Additionally, excessive dietary protein intake, fat intake, and sodium are all associated with an increased risk for kidney stones. Having inflammatory bowel disease or previous intestinal surgery can also increase the risk for stones.     Urinary infections with certain bacteria can promote stone formation. Having a parathyroid issue and high circulating calcium levels is another cause of kidney stones.  Obesity is also a risk factor for kidney stones. Some stones have a genetic basis, with a tendency to affect many family members.  My uncle is currently plagued with a stone lodged in his ureter and is scheduled for stone surgery on Monday, and both my father and brother have passed stones.  What does that bode for me?  So far I have been lucky.

A kidney stone starts out as a tiny sand particle that grows as the “grain” is bathed in urine that contains minerals.   These minerals are deposited and coalesce around the grain.  They can grow to a very variable extent so that when they start causing symptoms they may range from being only a few millimeters in diameter to filling the entire kidney.

Some stones are “silent” because they cause no symptoms and are discovered when imaging studies are done for other reasons.  However, most stones cause severe pain known as colic. Colicky pain is often intermittent, originating in the flank area and radiating down towards the groin.  It often causes an inability to get comfortable in any position, and is associated with sweating, nausea, and vomiting. Kidney stones can also cause blood in the urine, sometimes visible and, at other times, only on a microscopic basis. When a stone moves into the ureter (the tube running from the kidney to the bladder), it can become impacted and block the flow of urine. Stones can sometimes cause lower urinary tract symptoms such as urgency and frequency, particularly when the stone approaches the very terminal part of the ureter that is actually tunneled through the wall of the bladder.

Kidney stones are usually any easy diagnosis to make, based upon their rather classical presentation, although on occasion, a stone causes no symptoms whatsoever and is picked up incidentally on an imaging study such as an ultrasound, a CAT scan, or an MRI.   The imaging study of choice for evaluating a kidney stone is an unenhanced CAT scan (without contrast).   A plain x-ray of the abdomen is very useful for stones that contain calcium, and thus are readily visible on an x-ray.

Most stones will pass spontaneously without intervention given enough time.   Conservative management involves hydration, analgesics and the use of a class of medications known as alpha-blockers that can help facilitate stone passage by relaxing the ureteral smooth muscle.   As long as the pain is manageable and there is progressive movement of the stone seen on imaging studies, conservative management can continue to be an option.  Intervention is mandated under the following circumstances: intolerable pain; refractory nausea and vomiting with dehydration; larger stones that are not likely to pass; failure of a stone to pass after a reasonable amount of time; significant obstruction of the kidney; a high fever from a kidney infection that does not respond to antibiotics; a solitary kidney; and certain occupations that cannot risk impaired functions such as an airline pilot.

There are a number of minimally invasive means of treating kidney stones depending upon the size of the stone, its location, and the degree of obstruction of the urinary tract.  Gone are the days when treating a kidney stone required a painful incision and a prolonged stay in the hospital.  Most kidney stones now are managed on an ambulatory basis. Shockwave lithotripsy is commonly used to treat stones in the kidney or upper ureter.  Typically done under intravenous sedation, shockwave lithotripsy uses shockwaves directed at the kidney stone via x-ray guidance to fragment the stones into pieces that are small enough so that they then can then pass down the ureter, into the bladder and out the urethra with the act of urinating.  Another means of managing stones, particularly amenable to stones in the lower ureter but also applicable to any stone, is ureteroscopy and laser lithotripsy.  This procedure is done under general anesthesia. A narrow lighted instrument known as a ureteroscope is passed up the ureter to visualize the stone under direct vision.  A laser fiber is then utilized to break the stone into tiny particles.  The largest fragments are removed using a special basket. A ureteral stent is often left in place after this procedure to allow the ureter to heal as well as to prevent obstruction of the kidney.

You are at high risk for kidney stones if you:

  • Don’t drink enough fluids
  • Have an occupation that requires working in hot environments, such as a chef
  • Exercise strenuously without maintaining adequate hydration
  • Are a male, since the male to female ratio of kidney stone incidence is 3:1
  • Had a previous kidney stone, since about 50% of people who have a stone will experience a recurrence
  • Have a family history of kidney stones
  • Have a urinary tract obstruction
  • Have an excessive intake of oxalate, calcium, salt, protein and fat
  • Take excessive amounts of vitamin C, A, and D
  • Have an intestinal malabsorption
  • Have gout
  • Have parathyroid disease

The key to preventing kidney stones is to stay well hydrated, particularly when exposed to hot environments or when exercising for prolonged periods of time. It is also important to avoid overdoing it with certain vitamins—particularly vitamin C—a major risk factor for kidney stones.  The two biggest risk factors for kidney stones are, in fact, dehydration and excessive intake of vitamin C. Chances are that if you have a healthy diet, you have more than adequate intake of vitamin C and any extra is potentially dangerous. A good sign of adequate hydration is the color of your urine: the urine of a well-hydrated person will look light in color like lemonade, whereas the urine of a dehydrated person will look like apple juice.

So drink up, particularly on hot days…and eat an orange instead of popping a vitamin C supplement…your kidneys will thank you!

Andrew Siegel, M.D.

Author of Promiscuous Eating: Understanding and Ending Our Self-Destructive Relationship with Food:

Available on Amazon in paperback or Kindle edition

Blog subscription: A new blog is posted every Saturday morning.   On the lower right margin you can enter your email address to subscribe to the blog and receive notifications of new posts by email. Please avail yourself of these educational materials and share them with your friends and family.

For a nice booklet on kidney stones in PDF, go to and click on patient education and then on ABCs of Kidney Stones

Untangling Twisted Health Messages

October 12, 2012


I just finished reading a fascinating book published by Beacon Press entitled: The Cure For Everything: Untangling Twisted Messages About Health, Fitness, And Happiness.  It is authored by Timothy Caulfield, a health law and policy researcher who holds appointments at the Faculty of Law and School of Public Health at the University of Alberta, and challenges and invalidates many of the “myths” of health crazes. I wholeheartedly recommend picking up a copy of this very worthwhile read that I found to be educational, engaging, entertaining  and confirmatory of many of my own thoughts and feelings.

The following words are verbatim from pages 185-188 of the book, essentially a summary of his concluding remarks:

The results of my research point to a disheartening conclusion, which is, basically, that nothing works. Despite the immense diet, fitness, and remedy industries, very little actually does what it promises to do. A scan of your genes will not tell you what will happen in your future; for most of us, it’s no more useful than the numbers we get from a scale or blood pressure cuff. It is nearly impossible to transform your body through exercise alone. You cannot get sexy abs instantly or even after weeks of intense work.  There is no such thing as toning, and virtually every fitness gimmick is just that: a gimmick. To lose weight you have to eat fewer calories than you burn. Sadly, we don’t need many calories. There is no shortcut to weight loss.  And even if you can take off the pounds, keeping them off is the real challenge.  The failure rate is so high that some experts I interviewed thought that sustained weight loss is… sigh… impossible.

 Finally, most of the remedies offered by alternative practitioners work no better than a placebo, and the pharmaceutical industry has such a tight grip on the production of the relevant science that is difficult to trust any available information about any drug, when it comes from an advertisement, your physician, or even a respected medical journal.

 In short, there are no magical answers. This should not come as a surprise, of course. If it were easy, we would all be healthy. If alternative therapies worked, we would have verifiable data demonstrating their efficacy.  If losing weight and getting fit could be attained by utilizing a metabolism-enhancing, colon–cleansing yoga move, we would all be slim, cut, and have pristine innards. Alas, this is not the world we live in.

 On the other hand, there’s another way to look at the results of this inquiry. This is the glass half full view. If you want to optimize your health, the steps are, in fact, surprisingly simple. The steps are not easy – real effort is required – but they are straightforward. It isn’t complicated.

 This is a liberating realization. It means you can shut out most of the noise. Ignore the advertisements. Ignore the miracle–cure promises made by alternative practitioners. Ignore any marketing message that includes the word detoxify, cleanse, metabolism, enhance, boost, energized, vitalize, or revitalize.  Ignore the twist! Don’t get fooled by the sexy abs images that are such a huge part of Western culture. Don’t worry about the genetic predispositions that have been handed to you in the biological lottery of life. Unless you have one of the rare single gene disorders, like cystic fibrosis, or one of the relatively uncommon highly predictive mutations, genetic information is simply not that valuable.  Don’t get suckered into buying useless potions and practices that are wrapped inside an ideologically fuzzy and truth–obscuring blanket. It will only empty your wallet. And don’t get too excited when the media reports some big health breakthrough, especially if the story is based on a single study. True breakthroughs are rare.  Think of science as a slow and iterative process. As geneticist Jim Evans told us, science is a slog. Two steps forward, one and a half steps back. 

 What, then, are the straightforward steps to maximum health?  First, exercise often and with intensity (intervals work best) and include some resistance training. Second, eat small portion sizes, no junk food, and make sure 50% of what goes in your mouth are real fruits and vegetables.  Third, try your best to maintain a healthy weight – yes this is insanely tough, but we should at least try. Fourth, do not smoke, and drink only moderate amounts of alcohol. And fifth, take all the well-known and simple injury-prevention measures, such as wearing a seatbelt in the car and a bicycle helmet when you go riding.

Once you cut through the twisted messages that saturate our world, you find out all the available evidence tells us that these five steps are by far the most important elements of a healthy lifestyle. One expert I corresponded with for the diet chapter, Walter Willett from Harvard, figures that healthy food choices, physical activity, and not smoking could prevent over 80% of coronary artery disease, 70% of stroke, and 90% of type II diabetes.

 There are other measures, such as getting a good night’s sleep, that are important, and future research might compel me to add them to the list. And we should be conscious about eating certain other foods in addition to fruits and vegetables, like fish, berries, and whole grains.  Also, there are things that should probably be avoided, such as sodium and trans fats. But, in the big picture, these five actions remain essential. All the other stuff
– such as the alleged importance of various supplements and the craze for organic foods – will likely have only a marginal impact on individual health.  If you’re not doing all the big five, worrying about the details – such as a slightly increased genetic predisposition to some common disease or the cleanliness of your colon– is ridiculous.

There are no magical cures or programs. But the simplicity of the untwisted truth has an almost magical quality.


 Andrew Siegel, M.D.

Author of Promiscuous Eating: Understanding and Ending Our Self-Destructive Relationship with Food:

Available on Amazon in paperback or Kindle edition

Blog subscription: A new blog is posted every week.  In the lower right margin you can enter your email address to subscribe to the blog and receive notifications of new posts by email. Please avail yourself of these educational materials and share them with your friends and family.



What’s Up With Probiotics?

October 6, 2012

Andrew Siegel, M.D.  Blog # 78


Probiotics (literally meaning “for life”) can be defined as live microorganisms that, when administered in adequate amounts, confer health benefits upon the host. Probiotics are the healthy and friendly bacteria that are present in fermented foods such as yogurt, buttermilk, kefir, soy products (including tempeh, miso and soy sauce), pickles, pickled vegetables and sauerkraut. Some probiotics provide an immune function whereas others optimize our intestinal function by improving the balance of microbes and inhibiting the presence of pathogens and toxin-producing bacteria.  Our intestines actually make up an important part of our immune system and in the event of an intestinal injury or infection, dangerous bacteria and/or their toxins can get into our blood and cause serious illness.

Dr. Elie Metchnikoff was a Nobel laureate who is regarded as the father of modern probiotics—in the early twentieth century, he made a seminal observation that the regular consumption of lactic acid bacteria in fermented dairy products was associated with enhanced health and longevity in Bulgarian peasants.

Probiotics may consist of bacteria strains as well as yeast strains.  Lactobacillus acidophilus is probably one of the most commonly known probiotics;  Bifidobacterium bifidus is another.  Sacchararomyces boulardi is a common yeast probiotic also known as nutritional yeast.

Probiotics themselves rely upon food in our diet for sustenance.  These food sources for probiotics are known as prebiotics.  This fuel for the probiotics consists of non-digestible food components, particularly fiber.  Thus, it is important to consume fiber regularly in order to maximize the benefits of any probiotics that we eat.

At birth, our intestinal contents are sterile. This changes at birth, when we depart the sterile environment of the womb.  Our initial exposure is to our mother’s vaginal flora or skin flora, depending upon whether the delivery is vaginal or via C-section.  This primes our immune system and provides us with our own micro-cosmos of healthy bacteria that will help us survive and thrive.  One of the key residents of a pregnant woman’s vagina is Lactobacillus. During vaginal delivery, the baby is exposed to an abundance of these bacteria, theorized to prepare the baby to be able to digest breast milk, as the bacteria produce lactase, an enzyme that helps break down the sugar in milk, aka lactose. Colonization of the gut is dependent upon our mode of feeding, whether it is breast-feeding or bottle-feeding.  Breast milk plays a very important role in stimulating our immune system. Breast-feeding further charges up the colonies of good bacteria in our gut, since breast milk contains hundreds of species of healthy bacteria.  In the first few years of life, our intestinal ecosystem gets increasingly complex as new microbes are added through contact with family members, our diet, and exposure to our environment including animals and other human beings

Probiotics can help us to optimize our health. They may reduce atopic dermatitis and infections during infancy. Lactobacillus has been shown to reduce vaginal yeast infections and may aid in modulating cholesterol levels, as well as reducing the incidence of obesity in pregnant females.  Lactobacillus produces lactase, so in the lactose intolerant population, these bacteria can help to digest milk products.  Lactobacillus increases the acidity of our intestines and can mitigate diarrhea because its presence crowds out pathogenic bacteria. Probiotics also serve a role in helping to repopulate the gut with healthy bacteria when we take antibiotics, which kill many of the bacteria in our intestinal tract.

So, in order to maintain optimal immune function as well as intestinal health, it is important to get sufficient amounts of prebiotics and probiotics. Synbiotics refer to nutritional supplements combining both prebiotics and probiotics that work together in a synergistic fashion.

Plentiful intake of fiber from whole food sources will ensure getting enough prebiotic sources. In terms of a source of probiotics, it is as simple as adding fermented foods to one’s diet. Live probiotic cultures are present in fermented dairy products and probiotic-fortified foods, as well as tablets, capsules, and powders containing the bacteria in freeze-dried form.

A great source of probiotics is yogurt, particularly Greek yogurt.  Its thickness and creaminess lends itself to using it in place of many recipes that call for sour cream, including salad dressings, toppings for baked potatoes, and dips. In terms of whole food sources of probiotics versus supplement sources of probiotics, it is clear that  whole food sources trump pills and supplements.  With respect to supplements, there are purity and standardization issues as well as the question of whether live bacteria formulated in a pill will survive the harsh conditions in our stomach.  Under the circumstances of one disliking yogurt and other fermented foods as well as fiber, consideration for probiotics in pill and supplements should be a consideration.

Andrew Siegel, M.D.

Author of Promiscuous Eating: Understanding and Ending Our Self-Destructive Relationship with Food

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A special thank you to Professor Roberta H. Anding, RD, LD, CDE, CSSD of Baylor College of Medicine and Texas Children’s Hospital, Houston, Texas for providing much of this information via her awesome DVD series: Nutrition Made Clear, published by THE GREAT COURSES, Chantilly, Virginia. This DVD series consists of 36 thirty-minute lectures on nutrition that are comprehensive, enjoyable, and accessible and are a wonderful source of useful and practical information.