Healthier Salt Substitutes

As I discuss in my video Shaking the Salt Habit, the two most prominent dietary risks for death and disability in the world are not eating enough fruit and eating too much salt. Eating too little fruit kills nearly five million people every year, and eating too much salt kills four million.

There are three things we can do to lower our salt intake. First, don’t add salt at the table. One third of us add salt to our food before even tasting it! Second, stop adding salt while you’re cooking. At first, the food may taste bland, but within two to four weeks, “as the sensitivity of the salt taste receptors in the mouth become more sensitive to the taste of salt in the usual concentrations”—believe it or not—you may actually prefer the taste of food with less salt. Some of the flavorings you can use in the meanwhile instead of salt include “pepper, onion, garlic, tomato, sweet pepper, basil, parsley, thyme, celery, lime, chilli, nettle, rosemary, smoke flavoring, curry, coriander and lemon.” Even if you did add salt while cooking, though, it’s probably better than eating out, where even at non-fast food restaurants, they tend to pile it on. And, finally, avoid processed foods that have salt added.

In most countries, only about half of sodium intake comes from processed foods, so there’s more personal responsibility. In the United States, however, even if we completely stopped adding salt in the kitchen and dining room, it would only bring down salt intake a small fraction. This has led public health commentators to note how challenging it is for everyone to reduce their salt intake, since so much of our sodium intake is out of our control. But is it? We don’t have to buy all those processed foods. We can choose not to turn over our family’s health to food corporations that may not have our best interests at heart.

If we do buy processed foods, there are two tricks we can use. First, try to only buy foods with fewer milligrams of sodium listed on the label than there are grams in the serving size. So, if it’s a 100-gram serving size, it should have less than 100 mg of sodium. Or, second, shoot for fewer milligrams of sodium than there are calories. For example, if the sodium is listed as 720 and calories are 260, since 720 is greater than 260, the product has too much sodium.

That’s a trick I learned from Jeff Novick, one of my favorite dieticians of all time. The reason it works is that most people get about 2,200 calories a day. So, if everything you ate had more calories than sodium, you’d at least get under 2,300 milligrams of sodium, which is the upper limit for healthy people under age 50. Of course, the healthiest foods have no labels at all. We should try to buy as much fresh food as possible because it is almost impossible to come up with a diet consisting of unprocessed natural foodstuffs that exceeds the strict American Heart Association guidelines for sodium reduction.


Not eating enough fruit as a leading killer? For more, see my video Inhibiting Platelet Aggregation with Berries.

In my latest sodium series, I lay out the evidence and dive into the manufactured controversy to expose salt industry shenanigans. See:

In health,
Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my free videos here and watch my live, year-in-review presentations:

Raw vs. Cooked Garlic and Onions for Blood Thinning

As we age, our arteries stiffen. In my video Inhibiting Platelet Activation with Garlic and Onions, you can see charts showing measurements of the stiffness of our aorta, the main artery coming off the heart, as we get older and older. “As the aorta stiffens it leads to a range of linked pathphysiological changes,” such as exposing our brain and kidneys to greater pressure fluctuations, which may increase the risk of stroke and impairment of kidney function.

However, those who consume garlic—less than a quarter teaspoon of garlic powder a day—appear to have less stiffness in their aortas. We think this is because garlic seems to improve the function of the inner lining of our arteries, which helps our arteries relax. But the protective mechanisms of garlic against cardiovascular diseases are multiple, and include a combination of anti-clotting, clot-busting, antioxidant, and blood pressure- and cholesterol-lowering effects. The latest review suggests that long-term garlic intake may drop bad cholesterol levels about 10 percent, and the blood-thinning effects are such that the American Society of Anesthesiology recommends garlic intake be stopped a week before elective surgery.

Or, presumably, you could just cook it to death. Unlike the anticlotting components concentrated in the yellow fluid around tomato seeds, which are heat stable, the antiplatelet activity in garlic and onions is lost with cooking. When comparing  platelet inhibition, garlic appears about 13 times more potent than onion, and eating garlic raw appears to be better than cooked. This suggests that “garlic and onion could be more potent inhibitors of blood [clotting] if consumed in raw than in cooked or boiled form.” So, it might be good to cook garlic right before surgery, but what about the rest of the time when we’re trying to suppress platelet over-activity to decrease the risk of heart attacks and stroke? “As garlic and onion are normally consumed in cooked food, their efficacy as preventive herbs in cardiovascular disease may be doubtful.” But, we can put some raw onion on salads and raw garlic in salsa, dressings, dips, or pesto, right?

Or, we can crush or chop it, wait ten minutes, and then cook it. Researchers demonstrated the platelet-inhibiting power of raw garlic. If you cook it for just a few minutes, it does fine; but after cooking for about five minutes, the benefit is abolished. If, however, you pre-crush the garlic and wait, some of the antiplatelet activity is retained a bit longer. That’s because the enzyme that makes the antiplatelet compounds is activated by crushing but destroyed by heat faster than it creates the compounds. So, by crushing first and letting the enzyme work its magic before cooking, one can delay the loss of function.

Even better, though, is that, (as I discussed in my video Second Strategy to Cooking Broccoli with mustard powder), the addition of a little raw garlic juice to cooked garlic can restore the “full complement of antiplatelet activity that was completely lost without the [raw] garlic addition.”

When onions are cooked, the antiplatelet activity is similarly abolished within ten minutes, but then something strange happens. After 20 or 30 minutes of cooking, the effect on platelets is reversed and appears to make matters worse. Significant pro-platelet activation effects are seen, “suggesting that extensively cooked onions may stimulate rather than inhibit” platelets. That was in a test tube, though. Thankfully, when tested in people, even when onions are dropped in boiling water, fried for 10 minutes, and then left to simmer for 30 minutes, platelet activation drops within one to three hours after eating onion soup.


For background on what platelets are, what they do, and why we should care, see Inhibiting Platelet Aggregation with Berries and Inhibiting Platelet Activation with Tomato Seeds.

What else can garlic do? Check out:

What was that about mustard powder boosting the benefits of broccoli? See my Second Strategy to Cooking Broccoli video. Broccoli is also a potent activator of our liver’s detoxifying enzymes. Learn more in my Best Food to Counter the Effects of Air Pollution video.

Wondering whether it’s better to cook vegetables or eat them raw? See Best Cooking Method and for a surprise update, The Best Way to Cook Sweet Potatoes.

In health,
Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my free videos here and watch my live, year-in-review presentations:

Best Food for MGUS to Prevent Multiple Myeloma

Multiple myeloma is one of our most dreaded cancers. It’s a cancer of our antibody-producing plasma cells, and is considered one of our most intractable blood diseases. The precursor disease is called monoclonal gammopathy of undetermined significance (MGUS). When it was named, it’s significance was undetermined, but now we know that multiple myeloma is almost always preceded by MGUS. This makes MGUS one of the most common premalignant disorders, with a prevalence of about 3% in the older white general population, and about 2 to 3 times that in African-American populations.

MGUS itself is asymptomatic, you don’t even know you have it until your doctor finds it incidentally doing routine bloodwork. But should it progress to multiple myeloma, you only have about four years to live. So, we need to find ways to treat MGUS early, before it turns into cancer. Unfortunately, no such treatment exists. Rather, patients are just placed in a kind of holding pattern with frequent check-ups. If all we’re going to do is watch and wait, researchers figured they might as well try some dietary changes.

One such dietary change is adding curcumin, the yellow pigment in the spice turmeric. Why curcumin? It’s relatively safe, considering that it has been consumed as a dietary spice for centuries. And, it kills multiple myeloma cells. In my video Turmeric Curcumin, MGUS, & Multiple Myeloma, you can see the unimpeded growth of four different cell lines of multiple myeloma. We start out with about 5000 cancer cells at the beginning of the week, which then doubles, triples, and quadruples in a matter of days. If we add a little bit of curcumin, growth is stunted. If we add a lot of curcumin, growth is stopped. This is in a petri dish, but it is exciting enough to justify trying curcumin in a clinical trial. And six years later, researchers did.

We can measure the progression of the disease by the rise in blood levels of paraprotein, which is what’s made by MGUS and myeloma cells. About 1 in 3 of the patients responded to the curcumin with dropping paraprotein levels, whereas there were no responses in the placebo group. These positive findings prompted researchers to commence a double-blind, randomized, controlled trial. The same kind of positive biomarker response was seen in both MGUS patients, as well as those with so-called “smoldering” multiple myeloma, an early stage of the cancer. These findings suggest that curcumin might have the potential to slow the disease process in patients, delaying or preventing the progression of MGUS to multiple myeloma. However, we won’t know for sure until longer larger studies are done.

The best way to deal with multiple myeloma is to not get it in the first place. In my 2010 video Meat & Multiple Myeloma, I profiled a study suggesting that vegetarians have just a quarter the risk of multiple myeloma compared to meat-eaters. Even just working with chicken meat may double one’s risk of multiple myeloma, the thinking being that cancers like leukemias, lymphomas, and myelomas may be induced by so-called zoonotic (animal-to-human) cancer-causing viruses found in both cattle and chickens. Beef, however, was not associated with multiple myeloma.

There are, however, some vegetarian foods we may want to avoid. Harvard researchers reported a controversial link between diet soda and multiple myeloma, implicating aspartame. Studies suggest french fries and potato chips should not be the way we get our vegetables, nor should we probably pickle them. While the intake of shallots, garlic, soy foods, and green tea was significantly associated with a reduced risk of multiple myeloma, intake of pickled vegetables three times a week or more was associated with increased risk.

For dietary links to other blood cancers, see EPIC Findings on Lymphoma.

The turmeric story just never seems to end. I recommend a quarter teaspoon a day:

Why might garlic and tea help? See Cancer, Interrupted: Garlic & Flavonoids and Cancer Interrupted, Green Tea.

More on the effects of NutraSweet in Aspartame and the Brain and acrylamide in Cancer Risk From French Fries.

In health,

Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my free videos here and watch my live, year-in-review presentations:

Image Credit: Sally Plank / Flickr. Image has been modified.