A Conversation with Judith Levine, R.D., M.S.
Topics related to diet and nutrition have never been more in the news than they are today. In February, for example, the Institute of Medicine, a division of the National Academy of Sciences that sets desirable nutrient intake levels, announced that healthy adults between the ages of 19 and 50 should consume no more than 5.8 grams of salt (a little more than one teaspoon) per day, and that adults older than 50, African-Americans and people with chronic diseases such as hypertension and diabetes should consume even less than 5.8 grams per day.

And in early March, a study which found that treatment with high doses of cholesterol-lowering statin drugs reduces the risk of heart attack, bypass surgery and chest pains was published in the The New England Journal of Medicine. This finding is now being touted by some proponents of the Atkins and other low-carbohydrate diets that sanction unlimited consumption of protein and saturated fat to address concerns that these diets boost cholesterol levels and elevate the risk of heart attack, stroke and other health problems.

For perspective on these issues, Bay Area Summit spoke in March 2004 with Judith Levine, a registered dietician and consulting nutritionist with the American Heart Association in San Francisco.

Bay Area Summit (BAS): What is your take on the recent statins study, which indicates that high doses of drugs like Lipitor are very effective in reducing cholesterol and the risk of heart attack? Is this a kind of silver bullet that means people can essentially stop worrying about their cholestreol levels and eat whatever they want?

Judith Levine (JL): That would be a mistake in my opinion. The main issue is you're taking this [statin] medication to lower your cholesterol, so why would you want to start putting saturated fats back in your body? Furthermore, people forget that avoiding saturated fats is not just about keeping your cholesterol down. More and more studies are linking consumption of saturated fats with higher risk of diseases like breast cancer, colon cancer and prostate cancer. Eating foods that are high in fat also causes weight gain, which isn't healthy.

BAS: So you're not a big fan of diets like the Atkins that avoid carbohydrates and emphasize consumption of protein and fat?

JL: No, I'm not a fan. Low carbohydrate diets eliminate a nutrient that people need. The recommended daily allowance for carbohydrates is 130 grams for people of all ages. That's not much - a piece of fruit has about 20 grams of carbohydrate and a cup of rice or noodles has about 50 grams - but it's essential. For one thing, people need the glucose that results when carbohydrates break down for brain metabolism. Eating a high protein diet also means you're missing out on the fiber, antioxidants and other chemicals found in fruits and vegetables.

I also disagree with high protein diets because protein is the only nutrient that contains nitrogen. When our bodies break down nitrogen, it is excreted by the kidneys. So the extra nitrogen that comes with a high protein diet puts a bigger burden on the kidneys, which isn't healthy. My position is that a balance of nutrients is best.

BAS: Let's turn now to the Institute of Medicine's new guidelines for salt consumption, which call on healthy adults to consume about two-thirds of a teaspoon of salt per day and advise against eating more than a teaspoon. Given that consumption of too much salt increases the risk of high blood pressure, which in turn elevates the risk of strokes, heart attacks and other health problems, are you advising your clients to conform to these guidelines?

JL: We have to look at this recommendation seriously because more and more Americans are developing high blood pressure and it's not healthy. However, we also have to look at the practicality of this recommendation. The vast majority of Americans are consuming way more salt than the institute is recommending, and it's not very likely that someone who consumes 10,000 milligrams of sodium per day is going to cutback to 1,500 milligrams [the recommended level for healthy adults aged 19 to 50]. So to answer your question, I'm not advising my clients, unless they already have problems with high blood pressure, to cut back to 1,500 milligrams of sodium per day. It's not practical and it just sets people up to fail. I'm more likely to advise cutting back to about 3,000 milligrams of sodium per day, which is what the American Heart Association recommends.

BAS: That's still a pretty dramatic reduction for folks who are used to eating a diet that contains 10,000 milligrams daily. How do you advise your clients to cut back on salt?

JL: Make sure you read food labels and compare brands. You can do a lot to reduce the amount of salt you eat by choosing lower sodium products and fewer processed foods in general. It also helps to take the salt shaker off your table. Flavor the foods you prepare with spices instead of salt and avoid cooking with soy sauce and other salty products.

Disclaimer: The views and opinions expressed by the subject of this interview are not necessarily those of Bay Area Summit's staff or its sponsors.

(This article originally appreared in the Spring 2004 issue of Bay Area Summit)

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