Icon WebMD Expert Blogs

The Heart Beat

with James Beckerman, MD, FACC

Heart disease can be prevented! Your personal choices have a big impact on your risk of heart attacks and strokes. Dr. James Beckerman is here to provide insights into how making small, livable lifestyle changes can have a real impact on your heart health.


The opinions expressed in WebMD User-generated content areas like communities, review, ratings, or blogs are solely those of the User, who may or may not have... Expand

The opinions expressed in WebMD User-generated content areas like communities, reviews, ratings, or blogs are solely those of the User, who may or may not have medical or scientific training. These opinions do not represent the opinions of WebMD. User-generated content areas are not reviewed by a WebMD physician or any member of the WebMD editorial staff for accuracy, balance, objectivity, or any other reason except for compliance with our Terms and Conditions. Some of these opinions may contain information about treatments or uses of drug products that have not been approved by the U.S. Food and Drug Administration. WebMD does not endorse any specific product, service or treatment.

Do not consider WebMD User-generated content as medical advice. Never delay or disregard seeking professional medical advice from your doctor or other qualified healthcare provider because of something you have read on WebMD. You should always speak with your doctor before you start, stop, or change any prescribed part of your care plan or treatment. WebMD understands that reading individual, real-life experiences can be a helpful resource, but it is never a substitute for professional medical advice, diagnosis, or treatment from a qualified health care provider. If you think you may have a medical emergency, call your doctor or dial 911 immediately.


Wednesday, November 9, 2011

A Salt and Battery

By James Beckerman, MD, FACC

Doctors don’t like to be told they may be wrong.

During my medical training and subsequent experience as a cardiologist in clinical practice, I find it striking how despite our track record of innovation and research, we as a profession are not too crazy about the threat of paradigm shifts, particularly when it comes to the definition of a “heart-healthy” diet.

Low in cholesterol. Low in saturated fat. Low in trans fats. Low in refined carbohydrates. Low in processed meats. And the list of lows goes on. When we look back upon the evolution of heart-healthy recommendations, some of our guiding principles are based more on common sense than on long-term research data, and more recent approaches — though sometimes more scientific — sometimes arise from the popular press as well as from scientists breaking from the “party line.”

How do we continue to advance our recommendations in accordance with science, yet avoid providing mixed messages to the public, let alone our physicians?

By now, you have probably heard about the American Journal of Hypertension meta-analysis of 167 studies that was published today. Its purpose was to estimate the effects of various levels of salt in our diets on various markers of cardiovascular risk, like high blood pressure, lipids, and some stress hormones. The conclusion was that despite a small reduction in blood pressure, a lower-salt diet was associated with a worsened lipid profile and higher levels of stress markers of future heart disease.

So what’s a salt-shaker to do?

I probably wouldn’t invest in a salt mine quite yet. While this study does ask some interesting questions, it is a meta-analysis as compared to a placebo controlled prospective study. This means that researchers combined the results of many very differently constructed research studies to form their results. The downside of this design is that some conclusions can occur as the result of chance. In general, we try to avoid making medical recommendations based upon this approach.

The other concern is that we still don’t have very good evidence for or against sodium with respect to its actual impact on heart attacks or other hard endpoints. We tend to measure its impact on risk factors instead, as they are easier to study.

However, I believe that it would be a mistake to ignore this research. I think that this study presents an opportunity for other scientists to create new proposals to readdress the low-salt diet question — and hopefully be able to draw additional conclusions. This report reignites the issue.  Sometimes we forget, but that’s a good thing in science. Even if it does sometimes make us feel uncomfortable.

Posted by: James Beckerman, MD, FACC at 10:30 am


Leave a comment

Subscribe & Stay Informed

Heart Health

Sign up for the Heart Health newsletter and keep up with all the latest news, treatments, and research with WebMD.


WebMD Health News