There is one key thing about nutrition that modern Western Medicine gets wrong over and over and over. 
I call it the "all or nothing" approach to nutrition. Basically, every food group, ingredient, or nutrient is either good for you (eat it all the time!) or bad for you (never, ever, ever eat that!). When the medical research seems to indicate a connection between a particular food item and a health condition, the response is to reduce the intake of that food down to as close to zero as possible. There have been many vilified foods: saturated fat in the recent past, carbohydrates currently, and for many people, ever since a high blood pressure reading at the doctor's office, salt. For a long time the recommendation has been to reduce intake of sodium as low as possible, with a maximum of 1,500mg/day for those with hypertension or cardiovascular disease. The problem is that nutrients don't work like that. Nutrients work in a  way that has been described by many as "The Goldilock's Principle".


In 2013 the National Academies of Science's Institute of Medicine undertook a massive evaluation of all the available evidence. They combed through hundreds of studies on the relationship between sodium intake and cardiovascular disease, kidney health, blood pressure and blood lipid levels. What they found should change how we think about salt intake. (here's a link to the study)

Just right...What they found is that reducing your sodium intake down to 1,500mg/day doesn't provide additional benefits to blood pressure. It also increases the risk of adverse effects. It leads to an increase in triglyceride levels, negatively impacts insulin levels, and increases the risk of chronic heart disease when compared to those consuming a more moderate level of sodium. Reducing sodium intake IS an appropriate intervention only IF your sodium intake is extremely high, (say 5,000mg/day or more) but if you are getting the typical amount for an American (2,900-4,200mg/day) you are unlikely to gain additional benefits by further reducing your sodium intake. That's because optimal sodium intake, like most nutrients, is defined by "the Goldilock's principle" (you thought I'd never come back and explain that, didn't you?) Basically, you could draw the optimal intake for sodium as a bell curve with an optimal range somewhere in the middle. Get a lot more, or a lot less than that optimal range and symptoms start to pop up. You want it to be "just right.". (there are a few genetic variants for which sodium restriction will have a more pronounced effect, the bell curve moves to the left for people with these genetic variants. These "salt-sensitive" people are identified by our genetic consultations.) When you do consume salt, it's a good idea to move around the world (Himalayan sea salt this month, Mediterranean sea salt next month) as each region will produce salt with slightly different trace mineral content; mixing it up will optimize your intake of these trace minerals.

*A Little Aside: To Iodize or not to iodize? 
The presence of iodine in the absence of sufficient selenium (rampant in America) can trigger autoimmune thyroid disease. Iodization of our salt coincided with a 4 fold increase in auto-immune thyroid disease. However, Americans are often also iodine deficient. What to do? My recommendation to my patients is to get your iodine by regularly consuming seafood and seaweed (sources that contain both iodine and selenium), and to avoid iodized salt. 

So, what is the optimal Nutritional Approach to High Blood Pressure
There is, however, a large body of evidence supporting increasing potassium intake to improve blood pressure. (Here's a massive meta-analysis) This isn't surprising as sodium and potassium work in a push-pull relationship, controlling cell membrane gradients, and influencing kidney excretion of one another. Adequate intake for potassium is 4,700mg/day for adults. In addressing high blood pressure in patients, I've often had them track their daily potassium intake. The majority of my patients found they were consuming in the neighborhood of 2,000mg/day, or less than half of the recommended daily intake. Once they bring their potassium intake up, blood pressure drops. It is a great intervention because it is rapid, reliable, and simple to implement. Track your potassium intake for 1 week and maintain at least 4,700mg/day. By the end of the week you can expect your blood pressure to be down by around 15 points (seriously).

Two other important nutrients for blood pressure control are magnesium, and soluble fiber. You can get potassium, magnesium, and soluble fiber in plentiful amounts with a single intervention: eat more fruits and veggies. Aim for at least 6 servings per day. It's easy: reach for a fruit or veggie instead of potato chips or a granola bar when you want a snack. Have a fruit or veggie with each meal. 

Just a few short years ago, everyone was taking Fish Oil. 
Now it doesn't seem nearly as popular, and for good reason. The studies are not consistent on the impact Fish Oil has on the body. We'll cover what happens when Fish Oil goes in the body and why too much may be a bad thing. 
Here's why we take it: 
Fish Oil provides Omega 3 fatty acids (so termed because they have a double bond located 3 carbons from the end of the molecule.) You may have heard of Omega 6 fatty acids? Yep, you guessed it, 6 carbons from the end in that case. This fairly simple difference changes how easily these molecules bend, The Omega 3s are more flexible, and make structures built out of them more flexible The Omega 6s are stiffer and make structures more stiff. 

Ok, so? Omega 3 and Omega 6 fatty acids have very different impacts on the body. They integrate into the cell membranes and influence the viscosity of the cell wall. They also become the precursors for hormones called prostaglandins. If there are more Omega 3s, then it will be more likely that an anti-inflammatory prostaglandin will be formed. If there are more Omega 6s, then the prostaglandins that are made are more likely to induce inflammation. 

It's all about the ratio.Our evolutionary ancestors consumed between 1:1 and 3:1 omega 6s to 3s. The typical American diet, because of its reliance on certain types of oils and grains, runs closer to 20:1. Now you know why that's a bad thing, and means a lot more inflammation.  

Omega Fats are fragileOkay, so omega 3s are good for you. But only up to a point. They are also very fragile molecules. If not sourced from from high quality fish oil, omega 3s can actually cause some harm. Not only that, but your total intake should be pretty low. (they should only make up about 1% of your total caloric intake, about 1 teaspoon) Chris Masterjohn (PhD in lipid biochemistry) likens Omega 3s to wine glasses. They are fragile, so you'd rather not have them all over your house. A few is good, more is not better.  
Okay, so what should you do?Quick and simple, here's the take home: 

1. Try to influence your omega 3 to omega 6 ratio by reducing your omega 6 intake rather than increasing your omega 3 intake. Avoid using industrial oils (Canola, vegetable oil, corn oil, etc) and use coconut oil, butter and ghee instead whenever possible. Increase your intake of grass fed meat and wild fish, fruits and vegetables and reduce your intake of grains.
2. If you do take Fish Oil, say to reduce blood pressure, reduce inflammation, lower your triglycerides, or improve mental/emotional health (all good uses backed up by solid research!) make sure you TAKE HIGH QUALITY FISH OIL! Do not buy it at the drug store or Costco. Instead, get it from a practitioner or a reputable store. Bad or sloppy manufacturing processes result in oxidized omega 3 molecules that damage your health. 
3. Store your Fish Oil in the fridge, not on the counter and definitely not in the cabinet above your stove.
4. Or better yet, take Fermented Cod Liver Oil instead of Fish Oil 

Do you have a favorite brand? 
I'd love to hear about your experience, questions or comments.

All the best, 

Sometimes surgery is a necessary step in healing. What can you do to help make sure it is successful?There are some dietary and supplement strategies you can use prior to surgery to improve the success rate and reduce the risk of complications. Here's a step by step guide.

It's all about building your reserves. Surgeons are understandably a little wary about their patients taking supplements prior to surgery. Vitamins, supplements and herbal products can alter the way the liver breaks down medications, impact clotting ability, or create synergistic effects with anesthesia drugs. You should always follow the recommendations of your surgeon regarding avoiding supplements prior to your surgery. However, the few months leading up to your surgery are all yours. It's during these few months that you want to build up your stores and support the cell-level availability of these nutrients. 

ZincZinc deficiency is especially common in America (I covered this topic earlier in this newsletter). Take 30mg per day for 6-8 weeks leading up to your surgery. Zinc is helpful prior to surgery because: 

• It is essential for wound healing
• It helps regulate post surgical hypoglycemia to speed recovery
• It supports healthy immune response to reduce your risk of infection

Fish OilThe omega 3 fatty acids derived from fish oil incorporate first into your cell membranes where they are then utilized as needed to synthesize important hormones in the body called prostaglandins. The more omega 3 fatty acids you have stored up in your cell membranes the more your prostaglandins will reduce inflammation. Think of it like stacking the deck for health. Start about 3 months before your surgery and take 2,000 mg/day. If you are curious about how well set up your system is with omega 3s already, there is a simple blood test that most alternative medicine practitioners can do to see what your omega 3 to omega 6 ratio is. Fish Oil is a tricky supplement to buy, because while good fish oil protects you, bad fish isn't just neutral, it is actually really bad for you. You want to make sure your fish oil is high quality, and you want to store it in your refrigerator. Here’s the product that I use for my patients. I have a newsletter article coming up on selecting good fish oil so stay tuned. 

• Helps the body respond correctly to the trauma of surgery
• Reduces inflammation
• Helps manage blood pressure

Vitamin DVitamin D is crucial for both infection reduction and to support healing. Vitamin D has been shown in studies to reduce the risk of antibiotic resistant hospital acquired infections such as MRSA. An optimal approach would be to do blood work to identify your vitamin D level, then supplement based on your needs. If blood testing isn't an option for you, take 4,000iu per day for a month before your surgery. 

• Reduces risk of MRSA and other infections
• Speeds healing

SeleniumTopical iodine wash is still used in the majority of surgical preparations. Enough iodine is absorbed through the skin by pre-surgical antiseptic wipes that iodine excretion in urine is 7 times higher the day after surgery. (study)  Iodine is a benign mineral in many people, but in those with inadequate selenium stores, a sudden increase in iodine can exacerbate or trigger an autoimmune attack against the thyroid gland. Selenium is also a cofactor in the synthesis of the body's main antioxidant, glutathione (study). Take 200mcg per day for a month leading up to surgery. I prefer this product for its bioavailability. Brazil nuts are also very high in selenium.

• Safeguards the body against iodine damage to thyroid
• Supports antioxidant function

Magnesium Magnesium improves perfusion by regulating blood vessel dilation. It supports healthy muscle contractions, helps to maintain regular heart rhythm, and is depleted by physical stressors (such as surgery)

• Supports healthy heart rhythm
• Supports a healthy recovery
• Reduces post surgical muscle cramping

ProbioticsPost surgical infection is one of the most common complications impacting patient recovery and surgical outcomes. Because of this risk, the importance of antibiotics in surgery is hard to overstate. However, those antibiotics can result in their own side effects. The most serious concern from antibiotic use is infection by an opportunistic pathogen called Clostridium Difficile. When the healthy bacteria in the gut are wiped out by antibiotics this unhealthy bacteria can take over resulting in long lasting and serious complications following surgery. Prior to surgery a product such as Ultra Flora Balance would be best to build up numbers of healthy bacteria. Following surgery, a stronger formulation such as Ultra Flora Intensive Care is more appropriate. 

• Helps to support gut health
• Reduces the risk of developing post-surgical complications such as C. Difficile infection. 

CollagenThis one is more appropriate after surgery, although, most people would benefit from adding collagen to their general supplement line-up as well. Collagen powder provides the building blocks to repair tissue. Collagen figures into the structure of most of our tissues: bones, skin, hair and, of course, cartilage. The main amino acids found in collage are proline and glycine, which are non-essential amino acids (meaning your body can make them from other amino acids.) However, the demand for these building blocks is so high during surgical recovery that it is likely that demand outstrips supply. Adding collagen speeds healing, and ensures scars heal more smoothly. Glycine (one of the amino acids found in collagen) also figures prominently in other body systems including neurotransmitter function and synthesis. When it is deficient, adding it back in usually has a calming effect. 

• Speed healing of tissue
• Helps to supplement post surgical protein intake 

Carb-LoadingBecause surgery is a physiologically stressful event for the body, there are several natural responses that take place. Stress hormones shoot up in response to surgery. These stress hormones mediate various effects, one of them is the rapid increase in blood glucose. Remember that glucose isn't all bad. It is a problem when it is elevated for a prolonged period of time, such as in diabetes or metabolic syndrome, but in the short term this increase in glucose is valuable. Glucose is the fuel the body uses to power the machinery of healing. The glucose is converted into ATP in the cells. The more healing that needs to take place, the more glucose and ATP is needed. When athletes carb load they are trying to fill the glycogen stores (where glucose is squirreled away for future use.) It's a good idea to spend the day before your surgery filling these storage sites as well. In fact many surgeons are beginning to relax their recommendations on fasting prior to surgery, sometimes suggesting a clear, sugar containing drink in the 6 hours prior to surgery. (Please ask your surgeon before adding this to your preparation) There have been several studies (study, study, study) examining the benefits of pre-surgery carb loading. Some of the benefits include:

• Faster healing
• Shortened post surgical hospital stays
• Improved inflammatory response

RelaxationStarting off your surgery in a mentally relaxed state improves both short term and long term outcomes. Cardiac surgery patients have poorer outcomes if they were exposed to high stress prior to their surgery (study). Mental and emotional stress also reduce both immunological function and the healing response (study). Stress is associated with an increased risk of post-surgical complications, and poorer pain control. The clear take-home message is to stay relaxed prior to your surgery. Bring some headphones with your favorite music to get ready for your surgery. Bring along the people that calm you down. Take a nice walk the morning of your operation. Of course, staying calm before a surgery is easier said than done. However, the ability to relax at will is something that can be cultivated. Engaging in a regular, daily relaxation practice (prayer, meditation, etc.) for a month or two prior to your surgery will help to improve your ability to keep your cool when it counts. 

​Happy to help.
I hope you find this information useful.  Feel free to hit the reply button and let me know about your experience, or any additional questions you have. 

PS: Here's a link to an exercise you can do after your surgery if you (like many people) experience post surgical ileus (a common surgical complication where the intestines don't immediately start moving again). It was a great help to me after surgery. ​