Michael Klaper, MD

I'm just fine. Laurie, it's great to be with you and your viewers.

Laurie Marbas, MD, MBA

Thank you. Today, we really wanted to hone in on a topic that most of us understand that salt can cause an issue. But even still, I get some pushback sometimes from people who are hypertensive and still should be aware of the risks. I just wanted to clarify some of the processes with you, if you wouldn't mind. In particular, when you think about the salt and hypertension link. How does excessive salt intake contribute to the development of hypertension?

Michael Klaper, MD

That's a very important question. The answer can be a bit convoluted. Since we have time to speak at the summit, Laurie, you take a big, long windup as a former ballplayer here, and so, first of all, sodium, it's an amazing atom, is one of the elements that make up the universe and that makes up the core of the earth. We have a very primordial relationship with sodium. Of course, its sister, atom chloride, makes up the mildew that is the liquid aspect of our cells. All our chemistry takes place in a watery medium, but it's not pure water. There's a lot of sodium in there, as I said; it's a primordial relationship we have because where did this sodium come from? Well, if you believe in evolution, life began in the sea when we developed into multi-cell organisms and eventually made that epic trek onto land. We took the ocean with us, and it's in the form of our blood circulation and in the intracellular liquid that's in all our cells. It's a salty solution that we live in and that we depend upon. We've got a delicate relationship with it because of some of the remarkable properties it has as a solution to electricity. A solution of sodium chloride happens to be able to convey the electrical current. That's wonderful because we are electrical creatures; our nerves of fire revolve around electrical impulses, and our muscles rely on electrical impulses. It's this sodium that's in our cells on either side of our cell membrane that allows this electrical phenomenon to happen. We've got a delicate relationship with sodium light, like Goldilocks. You can't have it. Who couldn't have the soup too hot or too cold? We can't have too much sodium in our cells. We can't have the sodium because it can't be too concentrated. We would go from the inside if that happened, but it can't be too low either. We would have too much water enter our cells, and we would cease to function. We need to keep the sodium balance in our body and the blood in our cells within a fairly narrow range, similar to the salinity of seawater, and there is no coincidence about that. Over the eons, our body, what became our body, namely the organ known as kidneys, that all organs have, has become very adept at regulating how much sodium is in our blood. It's the kidney's job, largely to determine how much sodium to hold on to in our bloodstream and how much to let go of in the urine. So healthy kidneys are safeguards against the right amount of sodium in our bloodstream. They do a pretty good job of it because sodium is out in the wild in our ancient foraging days, a million years ago, on the Africans who built their meals, we spent most of our days foraging for calories, digging up roots and tubers, energy, edible grasses, berries, etc., and occasional carcasses rotting in the sun, I'm sure. But sodium was a fairly rare commodity. Not many plants have that much sodium in them. and so we naturally ate a low-sodium diet, and their kidneys had no problem excreting these moderate amounts of sodium in there. You're probably aware that high blood pressure wasn't an issue for our ancient Paleolithic ancestors but welcome to the 21st century we now use salt profligate for food manufacturing here. Does that explain how seductive salty foods can be? And so now most processed food, if you read the label, has some salt in it and sodium chloride in it. Whether it's the chips or the snack foods, it's obvious the salty French fries at the fast food restaurant. But cheese—you can't make cheese without salt—exalts pretty bland stuff. The huge amounts of dairy products and these five cheeses go as the salt load, and the restaurant meals are the spaghetti sauce in the Italian restaurant and the soy sauce in the Asian restaurant. Tasty but in the meantime, it adds to the level of salt that's coming in here. Now, what do your kidneys do with you after a meal? Sorry, your blood is going up. Not a very good thing as far as your kidneys go. Why? Because again, the kidney's job is to keep the salt concentration from getting too high. You don't want to take all your cells from the inside. By then, the salt would draw water out of the cells, and our cells would shrivel while the sodium pulled water to them wherever they were, and you would get intracellular dehydration if the salt concentration gets too high, the kidneys sense that the salt concentration is going up after a bag of extra-large fries and two slices of pepperoni pizza. There's a big salt load in the bloodstream, what did the kidneys do? The quickest way to lower the salt concentration is to dilute it out. How do the kidneys do that? They retain water. A message comes from the brain. We also sense too much salt in the kidneys. Know that is the water you are going to excrete in the urine. Hold on to it. We need to dilute out all this salt in the bloodstream with messenger molecules called the anti-diuretic hormone or ADH. But it makes us retain water, and it works and lowers the salt concentration. We get to eat another pretzel. But there's a price. Normally, your heart's pumping around about eight pints of blood. Now you're holding on to water that you would have excreted. Now that you're here, your heart's got to pump around nine pints of blood. then the blood volume goes up when you retain all that water. We'll ask any plumber what any extra volume does to the pressure in the pipes. In any system there, you have more fluid, and the pressure's going to go up. So this is the change. There's a long answer to your question: How does salt raise blood pressure? There are several mechanisms by which, as the soil's accreditation goes up, the kidneys retain water to dilute it out the extra volume is going to raise the sodium level, which is going to raise the blood pressure. But there's another mechanism involving the level of muscle tone in the arteries. We'll probably talk about those. But in general, salt makes you retain fluid and raises blood pressure.

Laurie Marbas, MD, MBA

The pressure when you talk about pipes and ask a plumber when we moved into this home, we had to repipe it. It's a 50-year-old home because the pressure from outside was coming in at such a high volume and at such a high rate that it was destroying the pipes and the house, causing little leaks. It's a very clear demonstration of how much too much pressure can be damaging. The next question I'd have for you is, what is salt sensitivity in the context of hypertension? How can one determine if they are salt-sensitive?

Michael Klaper, MD

We're talking about blood pressure, and you don't want to walk around with high pressure in your system. Why? Because after a while, it's hard on the pump. It's hard on the heart, and the heart starts to thicken, then eventually fails. How to sustain high blood pressure is hard on the heart. You're having congestive heart failure, but it's hard on the kidneys as well. That high pressure is slamming into those delicate filter membranes. your kidneys; a heartbeat after a heartbeat eventually damages the kidneys and damages the eyes. You start getting hemorrhages in the eye. The system is not meant to run up to higher pressure, like the pipes in Dr. Marbas’ house. If you exceed the pressure, you damage the system. This is why we're concerned about it. Your question again?

Laurie Marbas, MD, MBA

Salt sensitivity. Some people are more sensitive to salt. Then we have like a normal sensitive individual who may or may not be able to take salt in and not see but I'm not sure if that's so true. But anyway, you tell me.

Michael Klaper, MD

Those of us who do it out of ours in that, and is that going to be any great surprise given any biological response in a group of human beings, including the human population? You're going to get, as the statisticians tell us, this glorious bell-shaped curve, and most people are going to be in the middle. Most people react with X amount of elevation of blood pressure to a salt load, but some folks will react not at all, for they're there for any number of reasons. Their kidney function, the tremendous elasticity of their arteries, or maybe their absorption, whatever it is. Some people are at the tail of the bell-shaped curve out there and don't react much at all. But there are, of course; their opposite number is that there's a bunch of people who, even with just moderate or small amounts of sodium, get a very exaggerated response. They are, first of all, to milk salty water under pressure of 220 over 110 for hours. This is not a good idea, or they're just constantly walking around with pressures of 65 or 95, day after day after day, and again over time, this builds up and causes damage. Are you a hyper-responder or not? The only way to find out, of course, is to get around to the subject of accurate blood pressure measurement. Of all the things we do in medicine, we're measuring blood pressure. Blood pressure is one of the more inexact sciences. What is done is that a cuff is placed around a major artery, usually, the peripheral artery in the upper arm, and a stethoscope is placed on that artery as it emerges from a blood pressure cuff because it's inflated to a higher pressure than the pressure in that artery coming down the arm. then the pressure is slowly released, and the person measuring pressure is listening for the first time in years they have heard that blood surge through under that cuff. At that point, the pressure, by definition, in the arteries was equal to whatever it was reading on the cuff there. That's the systolic pressure. That's the highest pressure that the heart is mustering to make the blood move through the system. This is how blood pressure is measured. You then keep listening until the sound disappears. That's the second number as the diastolic pressure, and this range ideally should be. The first number should be no higher than 120, or 130 in that area. That's the actual number when the arteries relax between beats, you want their pressure to drop well below 90 to 80 preferably 70 or lower. In that split second, the arteries get relaxed. That's when, and what you're looking at now, are the peaks in the trough of the pressure wave that the arteries have to deal with as the heart is beating. You don't want them too high or too low for a reason. Dr. Marbas’ pipes there. The consistently high sustain pressures—are certainly going to set you up for damage to the arteries. As far as measuring it properly, this is distorted. We are all told that when students are told to go to medical school before they check anybody's blood pressure, be sure they've been sitting in a chair quietly for five minutes. Let their heart rate come down. Let those arteries relax and get a baseline. But they're so often that what happened, everybody's in a hurry in a doctor's office, a nurse or should sit you down further cuff on there are more 150 over 90 until you have high blood pressure and all blood pressures go off just with physical activity, just walking across the room, sitting in a doctor's office, generating adrenaline is going to raise your blood pressure. The blood pressure is notoriously inaccurate in the doctor's office. The best are done at home with your blood pressure cuff again after you've been sitting quietly, either in bed or a chair for five minutes. Think yourself out on a nice summer day in a pasture, the blue skies, and butterflies for five minutes before you hit that button there to let their pressure come down, and you'll get a fairly decent reading. Do readings are different often in the morning, then in the late afternoon after a full day of activity, you might notice the circle pressure's higher or lower. Note it; just write them down. But these are the numbers that your doctor is interested in. These are the more valid numbers for you because, as you read through the plant-based diet, those arteries relax and the pressure comes down. If you're on blood pressure medication, maybe it's time to start decreasing them or stopping them, and you'll know that pressure because this is a go-to. If you're standing up, you get lightheaded, and your pressure is 70 over 40. Pick up the phone call your doctor's office and say, I'm getting lightheaded when I'm standing up. Here's the last of your numbers, do you think I might want to reduce my medication or maybe stop them? But this is how the process unfolds. important. Those accurate numbers are important to give to your doctor there. That's how to get the best numbers.

Laurie Marbas, MD, MBA

They're perfect. No, I agree. 100%. It's so important that they're monitoring at home so carefully and giving very strict guidelines because, not only do they do that, but if someone else is eating the food that they're preparing, sometimes I call it positive collateral damage. When people are eating these healthy foods, unbeknownst to them, they're also going to get better and need monitoring of their medication. It's important that the people around you, too, are consuming these healthy foods. Which leads me to my next question. What are some of the recommendations for effectively reducing salt intake? If someone is cooking, going out, or traveling, what are your suggestions for people who are in different circumstances?

Michael Klaper, MD

As a recovering saltaholic myself, I've become very interested in this issue, and I'm making an effort to entertain my tongue with non-salty flavorings. I love what umami flavorings they are. but there's too much salt. What should I do? I've become a big fan of squeezing lemon juice on my greens and places where I wouldn't think of it. I worked on baked potatoes, and I squeezed it there. I see where lemon juice can be entertaining. There's a whole world of balsamic vinegar. We've got quite a collection in our pantry, and they come in all flavors, shapes, and sizes there. Try an assortment of those that help. There are salt substitutes that, instead of sodium chloride, are potassium chloride, and they work. Some people don't like the aftertaste, but others find it tasty. You might want to check out some salt substitutes with potassium chloride, but you can mix them up if you get on the internet and put a homemade salt substitute recipe, though there are dozens of them using all these wonderful herbs, black peppers, oregano, thyme, and all these things. You put them in waves or coffee grinders, and it turns into a lovely powder to sprinkle on your veggies there. Look up some of the recipes for homemade salt substitutes. Then, finally, I'm a big fan. I have no stock in your company. I wish I did, but there's a lot. One of my favorites is called Benson's Table Tasty. It's nutritional yeast with some dry herbs, but it tastes salty, and it has very little sodium there. I'm a big fan of Benson's. No, I don’t make anybody go through your sales of their cover product. These are things to do, and you make an effort. If you hold restaurant eating to a minimum, if you have to do restaurant food, usually produce healthy, do the best you can, and enjoy the meal, then have us have an extra salad the next day.

Laurie Marbas, MD, MBA

Which got me to the salt substitute. When you mentioned potassium chloride, how was that helpful? How is the potassium-sodium balance helpful? For example, soy miso, even though it has some sodium but has more potassium, might have potential. Substitute in small amounts. I don't know what you would suggest.

Michael Klaper, MD

There is so much in there. Excellent question. This primordial pairing of the sodium chloride that makes up table salt makes up the milieu of ourselves and the dissolved salts. Well, there's another atom out in the wings here called potassium that has a similar relationship with chloride. Potassium chloride is a very useful atom in our circulatory system. Our muscles depend on normal potassium. All the relaxation of our artery walls depends on potassium, and one of the nice things about a plant-based diet is that most plants are rich in potassium, but a little extra potassium is often beneficial. As far as lowering blood pressure, it does have the property of relaxing the artery walls. so it also makes for an interesting substitute instead of sodium chloride and classic cables. They pull out the sodium and put in the chloride of the potassium atom. It's potassium chloride, and it tastes fairly salty and gives you a little bit of potassium. Also, again, when substituted for the sodium, you might have been eating your popcorn or whatever it is—regular salt. Some potassium chloride is a very useful type of sodium substitute. again, may have benefits in lowering your blood pressure a bit. But all of these are used in tiny amounts here, and it becomes noticeable how little sodium you need to create a salty sensation. Dr. Marbas mentioned soy miso. I'm a big fan of fermented soybeans; it's a paste that you can mix up into gravies, soups, and sauces, and I love the taste, so classic miso is fairly rich in sodium. They've now been backing down, inching down the sodium content of many of today's modern miso. Now that some of them even have our potassium-based miso, I welcome that. Apparently, according to Dr. Greger, miso in general, there's something else in the soy paste that seems to prevent big rises in blood pressure, despite a bit of a sodium content there. But again, a tablespoon of miso once a week in a soup broth is probably not going to cause a great risk for the cardiovascular system. But if you can get the lower-sodium version of it all, the better.

Laurie Marbas, MD, MBA

Because a lot of people switch over to these fancy sea salts, and then they're still at high risk of high sodium as well. Correct.?

Michael Klaper, MD

Salt is salt, even if it comes from the crystal caves in the Himalayas, it’s still salt.

Laurie Marbas, MD, MBA

Salt is salt at the end of the day. This is just the same. When we speak to iodine because iodine is an important micronutrient and many in the developed world eat table salt that is iodized, which helps with thyroid function. any recommendations to go off a little bit of it? But we'll come back to the salt here in a minute. But for iodine consumption and making sure people are getting what they need.

Michael Klaper, MD

Dr. Marba that is a fact of physiology in medical history, and people who don't have enough iodine in their diet develop goiter in their thyroid gland. The thyroid is working overtime to produce thyroid hormone without enough iodine, and it has a very dramatic appearance for these folks. So you want to give your thyroid gland enough iodide? No question. The ocean water is full of iodine, so the fish eaters get plenty of iodine. But we are friends with the fish, and we'll let them off the hook there. So where does the plant-eater get iodine? It's a soil element, and an organic farmer should be an ideal organic farmer, they enrich their soils with multi-users, etc. It should be plowing back seaweed into the soils there and keeping their soils iodine-rich. There are other ways to get iodine into the soil, but it should be coming from supposedly root vegetables that take up soil minerals. Carrots, onions, turnips, and beets should be good sources of iodine and from healthy soils. But it might not be just commercial vegetables that grow in iodine-poor soil. You may need to look for other sources. So, where else can you look? One place that's mentioned is iodized salt. People were eating back in the 1920s and '30s. They were eating so little iodine-containing foods that people were getting goiter. They started adding iodine to table salt, and it did take care of the goiter problem. and iodized salt is still around, and it would play a useful role in the life of a vegan looking for an idea and source. We'll come back to that as far as how to use iodine salt. There are other iodine sources, and there are organic sea vegetables you can get. Wakame is green vegetables in Japanese restaurants. The salad is there, and I gather that your super salad a few times a week will give you the iodine you need. Wakame is another sea vegetable. ever may be no issue as you can get these and you still come and throw them into a supercell a few times a week so you can get iodine that way if you're taking a vegan multivitamin. Many of us want to ensure we get more zinc and vitamin D. Learn the label. Most of my 150 micrograms of iodine. That's a good place to get it as well. Finally, in those other sources, the C vegetables in the multivitamin mentioned, What about iodized salt? I'm all for it because it comes down to the issue of table salt or salt at the table. I heard this today in this low-salt world, and it's not true. The reason people say, Oh, we got rid of our slow triggers, got real, never salt or food. That's the one place you've got control over the salt intake at the Italian restaurant. There's nothing you can do about it; it's already in the spaghetti sauce, but at the table, you can decide how much salt you should be cooking with it. You can add so much salt to boiling water that you're going to taste it. But salt, if you're going to use it, should be at the table because very little salt lands on the surface of the veggies. When you bite into the corn or potato, you get a big, salty head on your tongue for very little actual sodium. Little salt crystals deliver the salty taste without a teaspoon of salt being involved. I don't have a problem with the salt at the table if it's done in proper amounts. Like the toxicologist told us, the dose makes the poison, and we're talking about a pinch. You'll get your salt on your veggies. That's about an eighth of a teaspoon, or a little less. And a pinch of salt on your veggies, breakfast, lunch, and dinner. That is 3/8 of a teaspoon. The general recommendation is about 250 milligrams of sodium. It's less than that. But, that's as much as you want to use because all you would need to use, and that would give you about 50 micrograms of iodine, depending on the actual salt. If you're going to use a pinch of salt, make it iodized. You can get iodized sea salt as well. If you're a big sea salt, you can get it tonight. Yes, if you're going to be using salt, hold it to a pinch and let it be iodized. Unless you've got runaway high blood pressure, if you're on three medications for blood pressure and it's still too thin over what to do, don't be putting a pinch of salt in your food. But if you get it, blood pressure isn't an issue for you. Hold it in a pinch.

Laurie Marbas, MD, MBA

Perfect. That makes complete sense. I had one of my newer patients this past week on five overshrinks and still uncontrolled. My heart is done. She's new to the plant-based world, and I'm excited to see where she might go. But it was like she didn't even understand the medications or what they were for. She's like, Well, the cardiologist prescribed them. Well, this is why, and so it breaks my heart. But anyway, I do want to say thank you for joining us today, everyone, and I hope you found this conversation insightful and engaging, as Dr. Klaper always is. If you're a summit purchaser, stay right here, because we're even about to dig a little bit deeper into the salt conversation. If you're not, click on the button below or the site and get access to the rest of the conversation. Now, if you're watching this, thank you for being a valuable member of our community. let's continue. Just a few more questions, Dr. Klaper, and I appreciate you staying with us and answering a few more questions. When we speak about the number of salt people should be consuming and educating the public, what are some of the effective ways we can educate the general public, our neighbors, or our colleagues about the risk of high salt intake and its relation to hypertension? Where should we begin? Or maybe, speak to your efforts to help educate young medical students about lifestyle medicine in a plant-based diet, especially.

Michael Klaper, MD

How do we educate society to change this course? I'm turning an ocean liner here because, again, the fast food industry has to have been artistic in its ability to seduce the public's taste. I saw foods, and again, when your body is there, buffalo takes the salt that's loaded with it into the cheese, the thick cheese pizza. You don't taste the salt, but we were coming to accept it as normal. so it's quite a habit to break. Of course, this is tied into the bigger issue. The truth is humanity and certainly the American public need to, as individuals and as a society, make a big evolution of our diet from plant-based foods to a plant-based food stream for every region you can imagine. It would clean our arteries and our guts and reduce our chronic disease burden. But we'd need so much less land to grow our food that the forest would come back. As the trees grow, they take carbon dioxide out of the air and turn it into solids. Would it be reversed? Global warming is the only smoke, the only tool. We have the most powerful tool we have to reverse global warming. The lights are flashing. Humans want to survive as individuals, and you want to survive as a species. Evolve your diet, your plant-based ones. The era of animal eating is over; that's the message that humanity needs to hear. That's what many of us in the plant-based world are trying to convey. I'm trying to get under the guise of the young medical students: you want to heal your patients, or you just want to treat their chronic disease, or you want to heal your patients, get them on a plant-based diet, and you'll reverse the disease you're spending all these hours treating here. I'm telling them, for the sake of becoming better, more powerful physicians who can heal disease, to educate themselves and adopt a plant-based diet. But I'm also doing it because I know it's a key passage that our noble profession has to go through. We, the medical professors, are the major bottleneck preventing this change to a plant-based diet. In our society, doctors don't mention nutrition. We don't talk about it. We don't know anything about it or have learned anything about it. Nothing gets said at the visit when it's one—the treatment that could save our patients and help save their lives. They're freeing themselves from these diseases we're going to get, which would make medicine fun again to see these people get healthy, or they would save their medical practices. But we will silence the conspiracy of silence. No one says anything. The patients remain obese and sick, and the doctors are very frustrated. our society continues down towards bankruptcy from medical debt, when none of this has to be changed to a plant-based diet is essential and it could be done. What if every doctor at every visit at the end of his, by the way, Joe, Mary has a plant-based diet, or do I change to a plant-based diet? Six months ago, man, I felt great. How's your diet going? Do you want to see Mr. Smith, a plant-based dietitian, down the hall to discuss your diet? I'll be glad to arrange it for you. What if every doctor said that it would change the course of medicine? It would change the course of our society. You're asking: How do we get people to eat less salt dried together, be less animals, and be less left to move to a plant-based diet? The two answers converge. You're sorry to go off on this tangent, but you know I'm facing the same thing on a larger scale here, as we both are. What would it take if it were to educate the public? I'll talk to read books like. That Food is Climate by Glen Merzer. A little book, 60 pages. You can read it in 2 hours, and it'll educate you on the issue. I read a book called Comfortably Unaware by Richard Oppenlander, who makes it very clear that adopting a plant-based diet is our only hope and our most powerful tool. Educate yourself, then make your change. But for a change in your diet, set a good example for the people around you. But then elect people who will break up the logjam in Congress through our young progressive legislator candidates. The farm bill is coming up. We don't want to give hundreds of billions of dollars to animal industries that just keep the pollution going. Let's elect lawmakers to change the subsidies. Eliminate subsidies or help the broccoli farmers transition to some other use of their land. You don't have to run cattle land, grow broccoli, or grow fruit trees. Help the government pay them to let the forest come back to you and help these people transition. It's all doable. But you're asking, what would it take? Education, social transformation, and legislation, and then do it and then get their huge marketing machine geared up. What if you had sports celebrities and movie stars? I went plant-based six months ago with my dog, and you know what? With all these glamorous movie stars, TV commercials, and billboards, you could change the design. It's doable. All this is doable. How can we get people to eat less salt? You could do well; you could do well; the salt interest wouldn't be happy, but you could start taking out billboards and TV commercials again, and he'd tell the doctors. There's been a campaign to educate doctors about the risks of high salt. But what if every doctor at every visit asks, How's your salt intake? Here's the list of low-salt vegetables that you ought to be eating, etc.; then again, in public campaigns, it could be done. but buyer beware, caveat emptor, buyer beware. You should beware. There's hidden sodium in processed foods. If it's in a package or box, it's probably got salt in it. The things you can identify, like growing in the garden, there's a tomato, there's a cucumber. They probably don't have a lot of salt. Whole foods are always going to be an island of safety. If you're wondering if the salt intake is an issue here, keep the food on your plate, too to recognizable vegetables and fruits that you can call by name, and you'll probably be okay.

Laurie Marbas, MD, MBA

I always liked it. I can't recall who came up with it, but the saying is that if you can read the ingredients on a can and your grandmother can recognize the ingredients, you're probably right. But if not, we'll put it back.

Michael Klaper, MD

You do another guess. I agree. That's a good one.

Laurie Marbas, MD, MBA

If you need a chemistry Ph.D. to decipher exactly what's going on. I love to share further the work that you're doing with medical students. Can you tell us a little bit about it and how maybe people can get involved if they're interested?

Michael Klaper, MD

Sure. The sad truth is that they are screaming for us from every angle of medicine. But the powers that be just don't want to listen to it if the vast majority of patients that we see in the hospitals, in the clinics, and in private practice offices are not there due to some weird and wonderful infectious disease. The majority of them are sitting in front of us overweight, hypertensive, diabetic, and inflamed from what they're eating from the standard Western diet; they're pouring through their bloodstream every 4 hours: bacon and eggs for breakfast, a cheeseburger for lunch, and a fried chicken for dinner and the ice cream for dessert—that's the toxic food stream that's causing all this inflammation and organ dysfunction. And you get these folks on a whole-food plant-based diet, they get leaner and healthier. The diseases are lessened, the inflammation subsides, and their joints start working. It's magical. Every doctor needs to know about this, especially every young doctor, who needs to understand the power of plant-based nutrition. I realize that there's an acupuncture point in the system there. If I can reach the medical students before pharmaco sclerosis sets into their brains and they think that drugs and surgery are the only treatment for these illnesses, it's the food change that. I know change will change the patient's life, and I think this is such an important, career-changing message. Somebody should be telling the medical students that somebody should tell the manager. A little voice on my shoulders is about you doc. I realized that the best use of my talents at this point in my career is to go to the medical students and say, "Listen, these diseases like high blood pressure and diabetes, whose etiology is unknown. It's the food, generally. There are other lifestyle issues, but it's largely the food. So I give them the lecture I wish someone had given me 50 years ago, called What I Wish I Learned in Medical School about Nutrition. It's on my website. To give this message to them and tear down the curtain of etiology unknown, and empower them to give you the resources to educate themselves about how to become more aware of plant-based nutrition once they get out of our medical school into practice, where they can practice medicine like they know it should be practiced, so I've been reaching the students with this message. We've established a nonprofit initiative called Moving Medicine Forward that helps me deliver this better. This message is to medical students across the country. If people would like to learn more about what we're doing and probably support us, it takes money to run websites, buy plane tickets, etc. I go to movingmedforward.com as a reward for sitting through my discourse, so I will look forward to Dr. Marbas my four-page handout. My Healthy Living, Healthy Body Plan handout that I give to all my new patients about what to eat and how to live a healthy, it is there. So just, Dr. Marbas will make that available to you. Check out Moving Medicine Forward, and you'll understand what we're doing, and we could sure use your help. Thanks for letting me talk about it.

Laurie Marbas, MD, MBA

That's fabulous. I love that you're still passionate after all these years. A lot of people would rather go and sit on the beach and relax, but you're still making changes and still pushing forward. We all must do it in all aspects of our careers. We appreciate you. Thank you.

Michael Klaper, MD

Thank you. It's the least I can do for this profession. You've been so wonderful to me it’s the least I can do to our sacred calling here. Thanks for letting me get the word out.

Laurie Marbas, MD, MBA

We appreciate it. Thanks, everyone, for listening, and we'll see you in the next conversation.

Michael Klaper, MD

Bye-bye.

Salt’s Impact: What Your BP Needs

Laurie Marbas, MD, MBA

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Laurie Marbas, MD, MBA