Gil Carvalho's Sources

“We know potassium plays a role, so it's clearly not all on sodium.”

“The first intervention was a salt replacement. The regular salt, sodium chloride, was swapped with a substitute that is about 25% potassium chloride and the remaining 60% or so is regular sodium chloride.”

“The salt substitute saw a reduction in their blood pressure. Systolic blood pressure came down by an average of 7 points, and diastolic blood pressure came down by 2 points.”

“The average potassium level of the participants receiving the salt substitute went up.”

“Whenever they detected somebody with hyperkalemia, with high potassium level, they stopped the substitute for that individual.”

“People sometimes with some health issues like chronic kidney disease can have a harder time eliminating potassium, and it can accumulate in the blood and its levels can rise.”

“If you have kidney disease, please talk to your doctor before starting a potassium salt.”

“The reduction of blood pressure brought by these salt substitutes can also have a protective effect on the kidney and the heart.”

“This has to be weighed against the risk of hyperkalemia.”

“Some medications can raise potassium levels. So some blood pressure lowering meds, for example, can do this.”

“Also talk to your doctor before you start a potassium salt.”

“People receiving the substitute had on average lower sodium.”

“They didn't see an increase in cases of hyponatremia.”

“People receiving the salt substitute had 34% less combined cardiovascular events: heart attacks, strokes, heart failure, or cardiovascular death, all combined.”

“Cardiovascular deaths alone were lower by 36%.”

“They saw lower blood pressure, lower risk of events, but they also saw significant reduction in total mortality.”

“The actual estimated intake of sodium and potassium from salt didn't significantly change.”

“It doesn't mean that salt reduction can't work for anyone. Some people get it to work and stick to it long-term, and we have trials reducing salt and seeing changes in blood pressure.”

“Moderating or reducing salt without talking about replacements... that advice might not stick because people can't comply.”

“Those assigned to the salt substitute had lower blood pressure average by the end of the trial than those receiving the regular salt.”

“They also had 40% lower risk of developing hypertension, starting blood pressure meds, or having a cardiovascular event, all combined.”

“They did not see a higher risk of hypotension, of low blood pressure in these people.”

“The replacement salt in this group didn't so much push their blood pressure even lower. What it did was prevent the rise seen in the control group receiving the regular salt.”

“These salt substitutes don't have that downside.”

“People who exercise never or only occasionally saw a 54% reduction in hypertension, starting blood pressure meds, or having a cardiovascular event, all combined.”

“For those who exercised often or daily, the reduction was 32%, but it didn't reach statistical significance.”

“There would be less room for improvement from a salt swap.”

“The evidence for salt substitutes with some potassium chloride seems quite promising. They help prevent the development of hypertension, for people who already have high blood pressure, they help lower that a bit, and prevent actual cardiovascular events.”

“These salt substitutes can be another tool in our toolkit.”

“We also have many trials looking at just salt reductions without swapping for potassium salts and seeing blood pressure come down. So sodium clearly seems to play a role as well.”

“They both seem to matter, or maybe it's this ratio between the two.”

“Some people are more salt sensitive than others. Some people can consume more salt and still have great blood pressures, and other people need to be stricter.”

“You can play with your diet, you can play with these salt substitutes if you choose to do so, and you can see exactly what effect this has on your blood pressure.”

“Another trial... also used salt substitutes, potassium salts, and also didn't see adverse outcomes linked to hyperkalemia.”

“Vitamin D helps us absorb calcium in our intestine, but it's also important for our muscles, nerve function, and immune system.”

“Most people need about 600 international units, a bit more for the elderly (800 IU), and 400 IU for infants under one year old.”

“Symptoms of insufficient vitamin D intake include fatigue, bone pain, muscle weakness, muscle aches or cramps, and also mood changes.”

“D3 seems more potent; it raises blood levels more than D2 and might have more biological activity.”

“For children up to 18, vitamin D supplementation improves bone health, reduces the risk of rickets, and seems to reduce respiratory infections.”

“For anyone over 75, vitamin D supplementation can reduce mortality and reduce the risk of bone fractures.”

“High-risk pre-diabetics have indication for vitamin D because it's been shown to reduce the risk of progressing to full-blown diabetes.”

“If you're pregnant, you have automatic indication for vitamin D to help prevent issues like preeclampsia, low birth weight, and intrauterine death.”

“Often in that stage, moms are taking a multivitamin that usually includes vitamin D anyway.”

“Trial data suggests that vitamin D supplementation may reduce the risk of dying from cancer, though not necessarily the risk of getting it.”

“Excess vitamin D is toxic and can lead to hypercalcemia, causing nausea, vomiting, kidney stones, and in extreme cases, kidney failure or death.”

“The tolerable upper intake value is 4,000 international units a day for adults from all sources combined.”

“There is even evidence that very high doses might be worse for bone density, maybe even for fractures.”

“I got some vitamin D drops a while back and it's good for a year for one person and it cost like five euros.”

“Personally, I would just go with a supplement that contains D3. I haven't seen any downsides of D3 supplements.”

“One trial compared the gummies to the tablets and they find a little better bioavailability of the gummies.”

“Another form of vitamin D out there where the vitamin D is hydroxylated and they call it calcifediol; it's more potent and better absorbed.”

“The evidence points to lower dose daily supplementation being better than large doses taken sporadically once a week or month.”

“In randomized trials for inflammatory bowel disease, vitamin D supplementation reduces relapse and reduces episodes.”

“Calcium supplements make sense for specific situations, like if you're at risk of osteoporosis or can't get enough from food.”

“In post-menopausal women with osteoporosis, K2 probably helps increase bone density, though the fracture data is mixed.”

“We don't have a lot of compelling outcome data for magnesium regarding bone fractures, heart attacks, or cardiovascular outcomes.”

“We see a small increase in kidney stones with combined vitamin D and calcium supplements, but not with vitamin D alone.”

“Vitamin D can interact with some prescription meds: statins, steroids, and diuretics are some examples.”

“Dark chocolate though, can reduce blood pressure by about four points. That's because cocoa, that dark chocolate is made from, is rich in polyphenols. These compounds have antioxidant function and can help dilate blood vessels and lower blood pressure.”

“A meta-analysis published just last year found that in people with high blood pressure, beetroot juice lowered systolic blood pressure, that higher value, by about five points.”

“AGE, that other supplement I mentioned, aged garlic extract, also works for blood pressure. AGE actually does not contain much allicin, but it contains other sulfur compounds that also help lower blood pressure.”

“Garlic. When you crush garlic, it forms these sulfur compounds like allicin, a molecule that gets formed in freshly crushed garlic that helps dilate your blood vessels and reduce blood pressure.”

“In people with hypertension, it's even more effective. It reduced systolic blood pressure, the higher value, by 8 to 9 points. That's in the ballpark of some blood pressure meds.”

“Some of these scientific trials used garlic powder and some used a specific supplement called aged garlic extract, AGE. Most brands sell either one of these, the powder or the AGE, in a capsule or in a little gel.”

“If you don't want to do it that way, if you want to do it with actual freshly crushed garlic, you can.”

“Just bear in mind that the allicin in the garlic forms after you crush the garlic and then let it rest for a few minutes, or about 10 minutes, for those compounds to form.”

“This is because the allicin is produced from other compounds in garlic by an enzyme. And this enzyme is destroyed by heat. So if we cook the garlic right after crushing, it destroys that enzyme, so allicin can't get produced.”

“So this is why to maximize the allicin, you want to let that garlic rest for 10 minutes or so after you crush it before you cook it.”

“Garlic powder that is used to cook, the regular garlic powder in stores, that's usually heat-treated, so it's very low in allicin. It's not a great option to lower blood pressure.”

“On the other hand, the garlic powder supplements that are made for this type of benefit, they're prepared in a way that preserves the allicin.”

“Garlic and garlic supplements are usually pretty safe, but if you're on prescription meds, blood thinners for example, check with your doctor before starting a garlic supplement, especially if you're going to go high dose.”

“These polyphenols help the production of something called nitric oxide, which is a molecule that helps dilate your blood vessels and reduce blood pressure.”

“In general, the darker the chocolate, the better. Try to shoot for at least 70% cocoa.”

“Beetroot is a good source of nitrates, which can help dilate blood vessels as well.”

“They recommended caution with their results. They say more trials are needed for beetroot juice.”

“They observed that trials giving people less nitrate level in the beetroot juice actually saw the largest reduction in blood pressure, which is kind of puzzling.”

“Beetroot juice amounting to 200 milligrams of nitrates gave an almost 10-point reduction in blood pressure.”

“I would be a little cautious again with this because the number of trials wasn't huge. So this might not pan out, but it's an interesting observation.”

“It suggests that you don't need to crank it up. A glass or two a day is probably enough.”

“A meta-analysis found that garlic reduces the higher value in your blood pressure reading, what we call the systolic blood pressure, by about five points, and your diastolic, the lower value, by about two and a half points.”

“A lot of you guys asked about creatine and hair loss. Does creatine supplementation cause hair to fall out?”

“Scientifically, do we have any compelling evidence that creatine causes hair loss, yes or no?”

“They gave them either creatine supplements or a placebo.”

“The regime was 25 grams a day for the first week, so that's called a loading phase, and then another two weeks of 5 grams a day. So that's called the maintenance phase.”

“Dihydrotestosterone, which is a byproduct of testosterone, can get converted into this dihydrotestosterone or DHT for short, and that was elevated by 56% after the first week of creatine loading, the high dose.”

“...0.98 specifically in the creatine group.”

“No other trial has shown this elevation of DHT with a creatine supplement.”

“I think that trial from 2009 is not a strong argument that creatine causes hair loss.”

“A group of authors published a paper going over a lot of frequently asked questions on creatine and one thing they touched on was exactly this question of creatine and hair loss.”

“They basically conclude that there's no convincing evidence for that link.”

“We see the number go up in the creatine group.”

“Current evidence does not indicate that creatine raises the total or free testosterone levels or DHT or causes hair loss or baldness.”

“Giving people creatine supplements and actually looking at hair and measuring hair parameters.”

“They basically split the participants randomly into two groups and gave a creatine supplement to one group and a placebo to the other.”

“They gave these participants 5 grams of creatine a day throughout, for the whole three months.”

“They got a lot more, they got 25 grams of creatine for that week and then the rest of the trial they got 5 grams a day.”

“Maybe if you go to a higher dose, maybe that causes problems.”

“Doesn't show an effect of creatine supplementation on hair loss, at least with 5 grams a day for three months.”

“What happens with a higher dose or with a longer exposure, this trial can't address that.”

“What about the effect of creatine supplementation on muscle mass, fat mass, strength, and is it safe for the kidneys?”

“So it's better to stay at lower doses if you can.”

“Oats and barley, and psyllium husk, which is a concentrated form of fiber, is another good option.”

“Another tool to help you lower ApoB is fiber. But not just any fiber. Viscous fiber is particularly powerful.”

“Viscous fiber is the type of fiber that feeds your microbiome, your gut bugs. They chomp up that viscous fiber and they transform it into short-chain fatty acids like butyrate or propionate or acetate. And those can then be absorbed by our intestine and they can have a profound metabolic impact including optimizing lipids and lipoproteins.”

“Let's talk about a supplement, omega-3 supplements have been shown to reduce ApoB.”

“Omega-3s mainly work by reducing the production of very large ApoB particles, what we call VLDLs.”

“One issue with omega-3 supplements is that at very high dose, like several grams a day, they raise risk of arrhythmias, like atrial fibrillation.”

“One randomized trial saw a 20% reduction in ApoB with 1.2 grams a day of omega-3s.”

“So, you may not need very high doses. I would start low, around 1 gram a day or even less, and see if that gives you that nudge you want.”

“And one last supplement, berberine also has some interesting, very promising evidence behind it.”

“...500 milligrams a day taken twice, so 1 gram total, has been shown to lower ApoB by 10 to 15%.”

“Methylene blue can act as a smart drug, improving your mind, memory, and learning. In lab animals like rats or mice, it seems to be able to boost memory.”

“Participants were given 260 milligrams of methylene blue that they took over a span of 24 hours following the treatment.”

“The methylene blue dose was 280 milligrams of an oral tablet.”

“Methylene blue was strengthening their emotional memory of the experience. If the experience of the sessions was good, they do better on methylene blue, but if the experience was bad, then methylene blue is worse than placebo.”

“In the short-term memory test, performance went from about 80% accuracy up to 87% after taking methylene blue.”

“The most common side effects are urinary and gastrointestinal, such as peeing a lot, a sensation of burning when peeing, nausea, or diarrhea. Most of these were mild and transient.”

“For people who are on serotonergic medication like Prozac or SSRIs, you don't want to combine methylene blue with that. They can interact and cause serotonin syndrome, which can be fatal.”

“Other side effects that are more serious but less common include headaches, confusion, vomiting, chest pain, trouble breathing, high blood pressure, and destruction of red blood cells. These are more common at high doses.”

“People who have glucose-6-phosphate dehydrogenase deficiency do not do well at all on methylene blue and can have devastating symptoms.”

“If you decide to try methylene blue, consider pharmaceutical-grade, purified methylene blue, as it is a lot safer contaminant-wise.”

“Personally, I don't take methylene blue. The evidence that I've seen so far isn't compelling enough to justify it.”

“EPA and DHA are anti-inflammatory because in our body they get converted to other molecules like protectins and resolvins that help shut down inflammation. These healthy omega-3s are also great to reduce triglycerides and can help bring down blood pressure.”

“Soluble fiber is the type of fiber that feeds our microbiome and supports our gut health. Steel cut oats or barley are great sources of this fiber.”

“Cocoa is very high in antioxidants called flavanols. A meta-analysis of randomized trials found that cocoa reduces LDL cholesterol, fasting glucose, and blood pressure.”

“In a double-blind randomized controlled trial, people given a cocoa extract had a lower risk of dying of cardiovascular causes than people given a placebo.”

“You want these products to not be Dutch processed. Sometimes they process cocoa with alkali to make it less bitter, but that destroys a lot of these flavanols, beating the purpose of eating dark chocolate.”

“Kefir is a drink made of fermented milk and it's very high in probiotics. It introduces healthy bacteria like Bifidobacterium into your gut, leading to the production of short chain fatty acids that can have profound metabolic effects.”

“Garlic contains a compound called allicin that helps tone down cholesterol production and platelet aggregation, and it also improves endothelial function. It can lower blood pressure, LDL, fasting blood glucose, and inflammation.”

“Allicin gets produced in the garlic after you crush it, but the enzyme that makes it gets destroyed by heat. You want to crush the garlic and let it rest for about 10 minutes before cooking to maximize the benefit.”

“Coffee drinkers consistently have lower risks of heart disease and stroke. Filtered or instant coffee generally looks positive for heart health.”

“Coffee contains compounds called diterpenes that can raise your cholesterol. Be careful with unfiltered coffee and French press.”

“Do the non-dairy sources of calcium have that link to prostate cancer or not?”

“This protective link between dairy and colorectal cancer might be due to the calcium content of dairy.”

“There's some evidence that calcium may play an anti-tumor role, suppressing cell proliferation for example.”

“We don't see that link to higher risk of prostate cancer with non-dairy sources of calcium.”

“Most studies until recently didn't find this protective link between non-dairy sources of calcium and a lower risk of colorectal cancer, unlike the link with dairy.”

“The calcium from non-dairy sources, like from greens for example, often comes together with other compounds like oxalates or phytates that can inhibit the absorption of calcium.”

“You can get around that by choosing low-oxalate greens.”

“By favoring non-dairy calcium, maybe you can get that protective link of lower colorectal cancer without that possible link to higher prostate cancer, but we just don't know for sure.”

“If you choose to not consume dairy, make sure you're getting enough calcium from other sources and try to include some low-oxalate sources of calcium as well.”

“The question is, why don't we just get calcium from a non-dairy source then?”

“A new study suggested omega-3 supplements like fish oil increase the risk of a heart disease called atrial fibrillation.”

“Higher doses, over one gram a day of omega-3s, raised the risk of atrial fibrillation by 49%, while one gram a day or under raised it less, by 12%.”

“A high dose of omega-3s, almost four grams a day, reduced the risk of cardiovascular outcomes, things like heart attacks and strokes, and it also reduced the number of cardiovascular deaths total.”

“What's usually recommended is purified EPA, just EPA, not the mix of EPA/DHA, because in most trials that we have for these high-risk populations, the EPA alone looks a little better.”

“Risk of heart attacks, myocardial infarctions, was significantly lower in the population receiving the omega-3 supplement.”

“People who ate a lower amount, under one and a half servings of fish average a week, they benefited from the omega-3 supplements. But people who ate more fish, one and a half servings or more, they saw no significant benefit of the supplement.”

“I would especially mind this source of long-chain omega-3s in the context of pregnant women and small children because of brain development.”

“We do know that algae oil is absorbed and it raises the levels of DHA in the plasma just as well as getting it from fatty fish.”

“I'll sometimes take an omega-3 supplement from algae. I'm not religious about it; sometimes I forget because the evidence is not super strong.”

“Creatine helps you build muscle and lose fat. A systematic review and meta-analysis of randomized trials found that creatine supplementation increased fat-free mass by an average of 0.8 kilograms while reducing body fat percentage by roughly 0.28%.”

“Creatine also helps you increase your strength, and this is seen even in older adults and even in people who have muscle conditions like muscle dystrophies.”

“If you are vegetarian or vegan, you may benefit even more from creatine because your diet naturally contains less of it, as it is richest in animal products like meat or seafood.”

“Creatine also helps you perform and recover faster. It can activate special cells in muscle tissue that help heal micro-tears and accelerate your recovery.”

“Some evidence indicates that creatine can help improve your short-term memory, your reasoning, attention, and information processing speed. This effect is seen more often in older individuals.”

“Creatine may also help control your blood sugar. A randomized trial found that diabetics receiving creatine supplementation lowered their glycated hemoglobin (HbA1c) and their blood sugar levels after a meal.”

“One of the main concerns with creatine supplementation is kidney safety. When we take creatine, some of it gets converted to creatinine, so the levels of creatinine are artificially raised in the blood, and that can look like a kidney issue.”

“Multiple studies varying in duration from five days all the way to five years, and varying in dose from 5 to 30 grams a day, have shown no measurable effect on indices of kidney function like glomerular filtration rate (GFR) in healthy individuals.”

“In my case, we have a kidney disease that runs in my family, polycystic kidney disease (PKD). We have no data on the safety of creatine supplementation in individuals who have some kidney disease, so I've personally never taken it.”