More SALT Controversy - Nestle

It’s salt war time again: new research, arguments over public health recommendations, and issues of conflicts of interest

Here are the burning questions about sodium (which is 40% of salt) intake:
(a) Does too much dietary sodium cause high blood pressure?   Answer: an unambiguous yes (although not necessarily in everyone).
(b) Are public health recommendations to reduce salt intake warranted?  I think so, but others disagree.
(c) If so, to what level?  Although virtually all committees reviewing the evidence on salt and hypertension view public health recommendations as warranted, and advise an upper limit of about 2 grams of sodium (5 grams of salt, a bit more than a teaspoon (see table from the Wall Street Journal), these too are under debate.

These recommendations are strongly opposed by The Salt Institute, the trade association for the salt industry, its industry supporters, and some groups of investigators.
Now the New England Journal of Medicine weighs in with three new studies, an editorial, and a cartoon video.  The papers:

• Association of Urinary Sodium and Potassium Excretion with Blood Pressure: A. Mente and Others | N Engl J Med 2014;371:601-611
• Urinary Sodium and Potassium Excretion, Mortality, and Cardiovascular Events: M. O’Donnell and Others | N Engl J Med 2014;371:612-623
• Global Sodium Consumption and Death from Cardiovascular Causes: D. Mozaffarian and Others | N Engl J Med 2014;371:624-634

Start with the video,  narrated by the editor, Dr. Jeffrey Drazen (click on video link on the right side).  It gives an excellent summary of the three papers.  Despite their methodological differences, all confirm (a).  They disagree on (c) and, therefore, (b).

Are public health recommendations warranted?
But note Dr. Drazen’s suggestion: “throw away the salt shaker.”
He is in favor of reducing salt intake.  But the salt shaker is not where most dietary salt comes from.  At least 75% of salt in American diets comes from restaurant and processed foods.   As Dr. Yoni Freedhoff explains:

If you’d like to reduce the sodium in your diet, rather than keep a running tally of how much you’re actually consuming, why not try instead to determine what percentage of your diet comes from restaurants and boxes? Sure, there’s data to suggest you might simply find other ways to add salt to your diet. But visit restaurants and consume processed foods less frequently, and I’d be willing to wager that you’ll be far more likely to see health benefits than were you to simply fill your grocery cart with low-sodium versions of highly processed foods.

Individuals cannot cut down on salt on their own.  That’s one reason why public health policies are needed—to get restaurants and processed food manufacturers to reduce salt content.
Two of the papers say that the only people who need to cut down on salt are those with hypertension and older people (one of the studies says that means people over age 55).

• How many Americans have hypertension?  67 million (1 out of every 3 adults) according to the CDC.
• How many Americans are over age 55?  More than 80 million, and rising.

You can’t expect 70 or 80 million people to reduce salt intake on their own.  Hence: public health recommendations.

Conflict of interest alert
Some of the investigators report receiving grants or fees from companies that make anti-hypertensive drugs but the editorial accompanying the papers is of special concern.   Written by Dr. Suzanne Oparil, it says about one of the studies:

These provocative findings beg for a randomized, controlled outcome trial to compare reduced sodium intake with usual diet. In the absence of such a trial, the results argue against reduction of dietary sodium as an isolated public health recommendation.

These conclusions sent me right to her conflict-of-interest disclosure statement.  Although Dr. Oparil reports receiving grants or fees from companies making anti-hypertensive drugs—-and, even more remarkable, from The Salt Institute—she states that she has no conflicts of interest.
I think she does.

Implications
Her editorial is especially unfortunate because it influences the way reporters write about the studies.
The Associated Press account, for example, begins:

A large international study questions the conventional wisdom that most people should cut back on salt, suggesting that the amount most folks consume is OK for heart health — and too little may be as bad as too much. The findings came under immediate attack by other scientists.

As well they should.  Blood pressure rises with age and huge swaths of the population would be healthier eating less salt.   The AP reporter quoted me saying so:

“People don’t eat salt, they eat food,” she said. “Lots of people have high blood pressure and lots of people are getting older,” making salt a growing concern, she said. “That’s the context in which this is taking place.”

The three studies are complicated to interpret because of differences in methods and discrepancies in outcomes.  They agree that if you already have hypertension or are “elderly,” or eat a lot of salt, you should cut down.

This seems like a good idea for just about anyone.   People don’t eat salt; they eat foods containing salt, and foods high in salt tend to be high in other things best consumed in small amounts.
The studies also talk about the protective effects of potassium, best obtained from vegetables.
Eat a lot of vegetables and not too much junk food, and you don’t have to worry about any of this.
=========================================================
Read the complete article here.

Salt intake What of Nuns? - Kendrick

Salt intake – What of Nuns?

 

Excess salt intake is one of the great issues in preventative medicine. Last year I watched a bus go by, with an advert for reducing salt plastered all over the side. Some restaurants have taken salt cellars off their tables, to protect customers. Many foodstuffs now have their salt content clearly labeled, with high salt content given a red sticker.

Given all of this you would think, would you not, that the case for excess salt consumption causing cardiovascular disease had been made beyond even the slightest possibility of doubt. One of the arguments in support of the dangers of salt consumption (the one that I am looking at in this article), comes from the native peoples living in the Amazon

The Amazon is an extremely low salt environment, and the average salt consumption of those living there is at very low. Several studies have found that the tribes people living in the Amazon have very low blood pressure which does not increase with age. They also have very little in the way heart disease and strokes.

‘Primitive societies who ingest little or no salt have no hypertension¹’

Proof, the anti-salt lobby cry, that it is excess salt intake that causes our blood pressure to rise dangerously.

Or is it? When presented with ‘proof’ like this I tend to look for contradiction, rather than confirmation. Are there, I wondered, other populations that fail to demonstrate a rise in blood pressure with age, that do not have a low salt consumption. My attention was drawn to nuns, living in Italy.

‘The powerful effect of psychosocial and acculturating influences on population blood pressure trends seems to be confirmed, through longitudinal observations, in the nuns in a secluded order. After initial observations had been made on culture, body form, blood pressure, diet, and other variables in 144 nuns and 138 lay women, included as a control group, a 30-year follow-up study was undertaken. Most striking were opposite trends noted between the two groups in blood pressure trend. During the follow-up period, blood pressure remained remarkably stable among the nuns. None showed an increase in diastolic blood pressure over 90 mm Hg.’

So, nuns do not develop high blood pressure as they age. What happened to the control women in this study?

‘By contrast, the control women showed the expected increase in blood pressure with age. This resulted in a gradually greater difference (delta>30/15 mm Hg) in systolic and diastolic blood pressure between the two groups, which was statistically significant.’

No difference in diet or salt consumption, yet one population developed the ‘normal’ Western rate of hypertension whilst the other did not. What did the authors of this thirty yearlong study think was the reason for this finding?

‘In conclusion, it seems reasonable to attribute much of the difference in blood pressure and cardiovascular events, to the different burden in psychosocial factor and to the preserved peaceful lifestyle of the nuns².’

Now I do not know for sure if those living in the Brazilian rain forests have managed to preserve a traditional peaceful lifestyle – but it seems a reasonable assumption to make.

However, the main point I am trying to make here is that you do not need a low salt diet in order to prevent hypertension. You can find populations with a normal salt diet who do not develop hypertension either.

What factor, or factors, appears to link these two populations? The factor appears to be living a preserved peaceful lifestyle. This would suggest that stress is the cause of hypertension and cardiovascular disease, and not salt. Whilst association cannot prove causation, a lack of association disproves it.

1: Freis ED. The role of salt in hypertension. Blood Pressure 1992; 1: 196-200.
2: Timio M, et al: ‘Blood pressure in nuns in a secluded order: A 30-year follow-up.’ Miner Electrolyte Metab. 1999 Jan-Apr;25(1-2):73-9

JAMA on salt HERE.
=============================================================================================================
Read the complete article here.
Another article here.

Salt guidelines raised ... as Canadian experts cite existing targets as ‘not feasible’

More data in the Salt Wars - Aug 14, 2014; http://www.medpagetoday.com/Cardiology/Hypertension/47203

An article by Marion Nestle - http://www.foodpolitics.com/2014/08/its-salt-arguments-again-new-research-arguments-over-public-health-recommendations-and-issues-of-conflicts-of-interest/

Is salt really so bad for you? - Fenster

Is salt really so bad for you?

Decades of science show NO conclusive evidence that cutting back on dietary sodium reduces cardiovascular morbidity

By Michael S. Fenster                     
                        

Enlarge

(Credit: This piece originally appeared on Pacific Standard.

 

No salt, low salt, salt free, heart-healthy salt substitution–any added salt will hurt your constitution. It reads like some bizarre, Seussian tale. Excepting that we’ve heard it not from the good Dr. Geisel but from the medical community and public health advocates everywhere. We watch as celebrity chefs take the salt elimination cooking challenge to prepare an “improved healthy” cuisine. Self-anointed “experts” cadge, coax, and cajole us to decrease our salt, or, more specifically, sodium intake. If that doesn’t work then the specter of heart attacks and strokes is unleashed upon us, along with a dash of fire and brimstone for good measure. It is, after all, clearly in our best personal and the greater public interest.
The hypothesis is sound and the supporting data is impeccable, right?

The theory goes as follows: Salt acts to make us retain fluid. When we retain more fluid it increases our blood pressure (albeit temporarily). Increased blood pressure is hypertension. Hypertension is a risk factor for cardiovascular disease like heart attacks and stroke. Heart attacks and strokes are bad. Therefore, hypertension is bad. Thus, sodium must be bad; A causes B which causes C, therefore A causes C. Get rid of A and you get rid of C—simple basic arithmetic, no? Reduce sodium intake and you will reduce blood pressure and thus reduce the incidence of stroke and heart attack. Reducing sodium intake is good—simple, effective, and undeniably the prevailing conventional wisdom these days.

Except… one thing is missing.

The conclusive data—or any data-that definitively shows that cutting back on dietary sodium reduces mortality or significantly reduces cardiovascular morbidity. For over half a century, starting in the 1960s, there has been a vehement and salty exchange just out of public earshot involving respected scientists on both sides of this line. But with the advent of an aggressive public policy to reduce dietary sodium intake for presumed public health benefit and studies emerging suggesting negative consequences of a low-sodium diet, the clamor of dissension is heating up.
=====================================================================
JAMA on salt HERE.
Read the complete article here.

Here is an article from The Kennebec Journal on the division regarding the salt controversy. Here are a couple of quotes:

"Four months after an Institute of Medicine report said reducing salt to the lowest recommended level doesn't improve health and may harm it, the U.S. Centers for Disease Control and Prevention said they disagree. In an article published Monday in the American Journal of Hypertension, the CDC and New York City health officials said getting Americans to eat less salt remains a key objective with the potential to save thousands of lives."

and

"Lowering sodium to the extent required to lower blood pressure has a variety of other effects," including some that boost heart attacks, strokes and death, he said. "It's just not that simple. The message from the evidence is we don't know."

Here is another article from Food Politics by Marion Nestle.
Another article on salt here.

More data in the Salt Wars - Aug 14, 2014; http://www.medpagetoday.com/Cardiology/Hypertension/47203

An article by Marion Nestle - http://www.foodpolitics.com/2014/08/its-salt-arguments-again-new-research-arguments-over-public-health-recommendations-and-issues-of-conflicts-of-interest/
 

Why salt doesn’t deserve its bad rap - Wartman

Why salt doesn’t deserve its bad rap
      

By Kristin Wartman

 

For something that’s so often mixed with anti-caking agents, salt takes a lot of lumps in the American imagination. Like fat, people tend to think of it as an unnecessary additive — something to be avoided by seeking out processed foods that are “free” of it. But also like fat, salt is an essential component of the human diet — one that has been transformed into unhealthy forms by the food industry.

Historically, though, salt was prized. Its reputation can be found in phrases like, “Worth one’s salt,” meaning, “Worth one’s pay,” since people were often paid in salt and the word itself is derived from the Latin salarium, or salary.

Those days are long over. Doctors and dietitians, along with the USDA dietary guidelines, recommend eating a diet low in sodium to prevent high blood pressure, risk of cardiovascular disease, and stroke; and doctors have been putting their patients on low-salt diets since the 1970s. But a new study, published in the May 4 issue of The Journal of the American Medical Association (JAMA), found that low-salt diets actually increase the risk of death from heart attack and stroke — and in fact don’t prevent high blood pressure.

The study’s findings inspired much criticism and controversy — as research that challenges conventional dietary wisdom often does. When The New York Times briefly reported on it, even the title conveyed the controversy: “Low-Salt Diet Ineffective, Study Finds. Disagreement Abounds.” The Times reports that the Centers for Disease Control and Prevention “felt so strongly that the study was flawed that they criticized it in an interview, something they normally do not do.” According to the Times, Peter Briss, a medical director at the Centers, said that the study was small, that its subjects were young, and that they had few cardiovascular events — making it hard to draw conclusions.

But most of all, Briss and others criticized the study because it challenges dietary dogma on sodium intake. These experts claim that a body of evidence establishes sodium consumption as a serious driver of cardiovascular disease. But if you take a careful look at the evidence, you’ll see that the case against sodium crumbles under the weight of its contradictions. Gary Taubes wrote about the controversy on the benefits of salt reduction more than 10 years ago in a piece for Science called “The (Political) Science of Salt.” He portrayed a clash between the desire for immediate and simple answers and the requirements of good science. “This is the conflict that fuels many of today’s public health controversies,” Taubes asserted.

The JAMA study published early this month is not the first to find that a low-salt diet may be detrimental. In 2006, data from the NHANES II study showed that death from heart disease and all causes rose with lower salt consumption. Published in the American Journal of Medicine, the report found:

Lower sodium has been associated with stimulation of the sympathetic nervous system, that, in turn, has been associated with adverse [cardiovascular disease] and mortality outcomes. Sodium restriction may also influence insulin resistance.

The insulin resistance association is compelling since so many Americans are exhibiting signs of insulin resistance, the precursor to diabetes. Michael Alderman, a blood-pressure researcher at Albert Einstein College of Medicine and editor of the American Journal of Hypertension, said in an email, “The problem with reducing sodium enough to change blood pressure [is that it] has other effects — including increasing insulin resistance, increasing sympathetic nerve activity, and activating the renin-angiotensin system and increasing aldosterone secretion. All bad things for the cardiovascular system.”

There are those who will argue that any study claiming that sodium is not as harmful as previously believed are connected to the salt lobby, but this is untrue. The most recent JAMA study has no such connection and many real-food advocates, myself included, believe that salt is an essential part of a healthy diet. Alderman was once an unpaid consultant for the Salt Institute but no longer is, according to the Times article.

There is also a strange psychological component to this debate as is often seen in the nutrition world: When a message has been hammered in and repeated millions of times over the course of decades, whether or not that message is actually true becomes irrelevant — and the people invested in presenting that message, whether for monetary gain or not, are especially resistant to any evidence that might be contrary. When asked about this phenomenon and the standard recommendations on salt, Alderman said, “They are based upon the hope that the blood pressure effect of lowering sodium would translate into a benefit in health. Opposition to these findings — which only adds to a substantial body of similar information — is that these folks have long held the faith that lowering sodium was a good idea. They have opposed randomized trials with the bogus argument that a randomized controlled trial would be too tough and expensive. Not so. They choose faith over science, but it’s not a theological issue.”

Witness the low-fat campaign that has raged on for decades despite research that now shows the low-fat campaign was actually based on little scientific evidence. When it comes to the fat debate, the crucial issue is determining which fats are healthy and which fats are not: Real, whole-food sources of fats, like butter and eggs, are healthy while industrially produced sources of fats, like partially hydrogenated oils or trans-fats, are not. Real fats and industrial fats cannot be lumped into the same category, and when they are, as is often the case in scientific research, the results are muddled. This was the case with studies on coconut oil, which used partially hydrogenated versions to determine that coconut oil was unhealthy, tarnishing it with a reputation as one of the worst fats. Meanwhile, recent research using unprocessed coconut oil shows that it is actually a healthy fat with a host of health benefits.

As for salt, the same logic can be applied. There are no studies based on a diet that draws its sodium from unrefined salt and from foods containing naturally occurring salt (like zucchini, celery, seaweed, oysters, shrimp, beets, spinach, fish, olives, eggs, red meat, and garbanzo beans). Clearer answers would surely emerge with a study like this.

The differences between refined and unrefined salt are significant. (Make sure you use unrefined sea salt, as other sea salts can be just as processed as ordinary table salt.) Unrefined sea salt contains about 82 percent sodium chloride and the rest is comprised of essential minerals including magnesium and calcium; and trace elements, like iodine, potassium, and selenium. Not coincidentally, they help with maintaining fluid balance and replenishing electrolytes.

Refined, processed salt is actually an industrial leftover, according to Nina Planck’s book Real Food. Planck describes how the chemical industry removes the valuable trace elements found in salt and heats it 1,200 degrees F. What’s left is 100 percent sodium chloride, plus industrial additives including aluminum, anticaking agents, and dextrose, which stains the salt purple. To gain its pure-white sheen, the salt is then bleached. Thus refined salt is hardly a whole food; and consuming a jolt of sodium chloride upsets fluid balance and dehydrates cells, to say nothing of the harm the various additives and bleach residues may cause.

But what’s fascinating about this most recent study is that even in monitoring those on a largely industrial foods diet, consuming what’s considered high levels of salt, the results indicate that even this is better than a low-sodium diet.

Why might this be? Sodium is one of the two major electrolytes our bodies need to function properly, and like any other element, nutrient, vitamin, or mineral we put into our bodies, it does not exist or function in isolation. Sodium is important for maintaining blood volume, it works in concert with potassium, which is needed for vasodilatation or constriction, and it also interacts with calcium, which is needed for vascular smooth muscle tone. Sodium exists in all of the fluids in our body and is essential to water balance regulation, nerve stimulation, and proper function of the adrenal glands. It is also crucial to maintaining mental acuity — sodium is required to activate glial cells in the brain — these cells make up 90 percent of the brain and are what makes us think faster and make connections. This is part of the reason sodium deficiency (sunstroke, heat exhaustion) leads to confusion and lethargy as the human brain is extremely sensitive to changing sodium levels in the body.

Like fat, salt was prized by traditional cultures. Those groups that were landlocked often burned sodium-rich marsh grasses and added the ash to their foods to acquire healthy amounts of salt and they traded with peoples living near the ocean for fish and salt. The tendency of scientific studies to isolate parts of our foods and determine whether or not they are good or bad obfuscates a clear picture of the larger processes involved in eating and metabolizing in the human body. It also complicates something that shouldn’t be complicated: eating real, whole foods as they exist in nature. Isolating and demonizing certain aspects of real, whole foods — like fat and salt — only confuses the public.

Kristin Wartman is a food writer living in Brooklyn. She is a Certified Nutrition Educator and holds a Master's degree in Literature from UC Santa Cruz. She focuses on the intersections of food, health, politics, and culture.

=================================================================
Read the complete article here.

JAMA on salt here.

Another article from Food Politics by Marion Nestle found here.
.
and
.
Salt guidelines raised ... as Canadian experts cite existing targets as ‘not feasible’

Low Salt Diet Found to Increase Mortality - Dach

Low Salt Diet Found to Increase Mortality
Part 1
by Jeffrey Dach MD

Low Salt Diet Found to Increase Mortality The Low Salt Diet Revisited

A recent Lancet study on the effect of a low salt diet made headlines, finding that a low salt diet increases mortality for patients with congestive heart failure.(1-6) The study concluded there was not enough evidence to advise a low-salt diet for the rest of us. They doubted a low salt diet would benefit the population.(6) In this article we will re-examine the low salt diet, clear away the confusion, and make recommendations about salt intake, hypertension, and health.


Health Benefits of Salt

We know from many years of published studies that increasing salt intake increases blood volume and also blood pressure. Salt is essential for maintaining blood volume, blood pressure, and overall health. The salt content of blood is similar to ocean water. Both have sodium chloride, also known as salt.

Importance of Salt

One example of the importance of salt is the common practice of starting an intravenous solution of salt and water as the first line treatment for the trauma patient upon arrival to the hospital Emergency Room.

Low Salt Diet to Reduce Blood Pressure

One of the central dogmas of mainstream medicine is the “low salt diet” as a treatment for reducing blood pressure in the hypertensive patient. Indeed, popular wisdom says that the “low salt diet” is also healthy for the rest of us “normal” people who don’t have hypertension.(25) Along with the rest of my medical school class, I was indoctrinated to believe this. Is this really true? Many studies have looked at this question. They show the “low salt diet” will in fact reduce blood pressure slightly. However, this effect is minimal, and is counteracted by compensatory mechanisms that release harmful substances into the bloodstream, hormones and chemical mediators that counteract the “low salt diet”. The released chemical mediators include insulin, epinephrine, norepinephrine, renin, aldosterone, etc. These are harmful and damaging to the vascular system. (7-11)

Low Salt Diet Increases Cardiovascular Mortality

In addition, a number of studies have found that a “low salt diet” increases cardiovascular mortality. (5) A study published in the 1995 Hypertension found 4.3 times greater mortality in hypertensive men on a low salt diet.(12) They also found higher plasma renin in these men, a hormone produced by the body which causes salt and water retention by the kidney to compensate for the low salt diet.(12-15)

A 2011 JAMA provides the reasons for this increased mortality and says … (16)

The underlying mechanisms explaining the inverse association between cardiovascular mortality and 24-hour urinary sodium excretion might be that a salt intake low enough to decrease blood pressure also increases sympathetic nerve activity, decreases insulin sensitivity, activates the renin-angiotensin system, and stimulates aldosterone secretion. (16)

A 1998 JAMA report found that a low salt diet increased plasma renin 3.6-fold and aldosterone by 3.2-fold, increases that were proportional to the degree of sodium restriction. (17) The authors also reported the “low salt diet” increased other harmful substances such as noradrenaline, cholesterol, and low-density lipoprotein cholesterol (LDL). (17) A 1999 report in American Journal of Hypertension found that “moderate salt restriction aggravates both systemic and vascular insulin resistance.” (18)
==========================================================
Read the complete article here.


Low Salt Diet Part Two

In Part One, we discussed the low salt diet, and studies which show an increased mortality from a salt restricted diet. You may have been wondering about this if you saw a recent article in the New York Times by Jane Brody extolling the virtues of a low salt diet.(1) Jan Brody quotes a computer simulation model that predicted 500,000 lives saved by eliminating dietary salt in a program similar to Finland which was described in a New England Journal article.(2,3)

Gary Schwitzer does a good job on their blogs explaining where the Jane Brody article goes wrong.(4,5).

Research by Jan A. Staessen, MD, PhD, of the University of Leuven in Belgium and colleagues, raises questions regarding whether population-wide sodium restriction will actually lower cardiovascular risks. (5,6) In actually clinical studies where 24 hr sodium excretion is measured in 3681 participants and followed over 8 years, this is what they found:

In this population-based cohort, systolic blood pressure, but not diastolic pressure, changes over time aligned with change in sodium excretion, but this association did not translate into a higher risk of hypertension or CVD complications. Lower sodium excretion was associated with higher CVD mortality.(5,6)

 

This type of data seems to suggest that salt restriction has been over-hyped as an intervention, and although will help to slightly reduce blood pressure, does not reduce mortality or complications of cardiovascular disease.

I would agree with Jane Brody that hypertension, heart disease and other health problems are a direct result of diets containing large amounts of processed salt (NaCl), Trans Fats, Sugars, MSG, Aspartame, GMO corn and GMO Soy, and added wheat fillers. To focus attention on the salt content alone, while ignoring the other harmful additives may be not be a valid exercise.

The “low salt diet” for reducing blood pressure in the hypertensive patient is a central dogma of mainstream medicine. Indeed, popular wisdom says that the “low salt diet” is also healthy for the rest of us “normal” people who don’t have hypertension. Along with the rest of my medical school class, I was indoctrinated to believe this. Is this really true? Many studies have looked at this question. They show the “low salt diet” will in fact reduce blood pressure slightly. However, this effect is minimal, and is counteracted by compensatory mechanisms that release harmful substances into the bloodstream, that counteract the “low salt diet”. The released chemical mediators include insulin, epinephrine, norepinephrine, renin, aldosterone, etc. These are harmful and damaging to the vascular system.

In addition, a number of studies have found that a “low salt diet” increases cardiovascular mortality. A study published in the 1995 Hypertension found 4 times greater mortality in hypertensive men on a low salt diet.
=================================================================
Read the complete article here.

This new link added April 30, 2013: WebMD offers dangerous junk science-based dietary salt advice… This article states that "… even though one of its cited “experts” tacitly admits there is no established cause-and-effect relationship between typical/normal/current salt intake and adverse health effects."

Another article from Food Politics by Marion Nestle found here and

here: http://news.nationalpost.com/2013/09/22/little-evidence-sharp-reductions-in-salt-consumption-will-improve-health-heart-researcher-says/

More data in the Salt Wars - Aug 14, 2014; http://www.medpagetoday.com/Cardiology/Hypertension/47203

An article by Marion Nestle - http://www.foodpolitics.com/2014/08/its-salt-arguments-again-new-research-arguments-over-public-health-recommendations-and-issues-of-conflicts-of-interest/

http://www.zoeharcombe.com/2013/03/salt-awareness-week-10-things-to-be-aware-of/

Salt Awareness Week – 10 things to be aware of

Written by Zoë on March 11, 2013
  

March 11-17 2013 is “Salt Awareness Week” in the UK – what exactly might we like to be aware of?
Let’s get some definitions out of the way first. Salt can be unrefined or refined. Unrefined salt is also known as sea salt. Unrefined (sea) salt comes with many valuable minerals and natural elements. Refined salt is also known as table salt. This is made up of sodium and chloride. There are approximately 2.4g of sodium in 6g salt. This means that approximately 40% of salt is sodium. You’ll see sodium on food labels, rather than salt.

Here are 10 things that you may find interesting about salt…

1) Like every other government target, the salt dictat has no evidence base

The NHS wants us to eat “no more than 6g salt per day.” (Ref 1) (which equates to 2,400mg sodium). Why? I have no idea and nor does the NHS. Why not 7? Why not 5? Why have a target at all? Goodness only knows. Just like 5-a-day, 14/21 alcohol units, 20-30g saturated fat, 18g fibre – none of these precise targets has precise evidence.

The NHS web site is supposed to provide evidence for government policy. Here is “Salt – the facts” which opens with “Many of us in the UK eat too much salt. Too much salt can raise your blood pressure, which puts you at increased risk of health problems such as heart disease and stroke” and then it goes on to tell you how to cut your salt intake. I don’t know about you but I found those ‘facts’ quite underwhelming.

2) We need to consume salt (and potassium) or we die

We die without salt. It’s as simple as that. Unlike cholesterol, which is also utterly life vital, our body doesn’t make salt. The term “essential nutrient” in nutrition mean that it is essential that we consume the nutrient. Salt is thus an essential nutrient. Fortunately it is in the majority of real foods, including water, and so ingestion of this vital mineral is not difficult.

Potassium is another essential dietary mineral. The potassium/sodium balance, is absolutely critical to the overall functioning of every cell in the human body. If salt levels fall too low, a condition called Hyponatremia can develop, which can be fatal. (Ref 2)

3) Salt has nothing to do with obesity

The inclusion of salt in the Academy of Royal Colleges obesity report (Ref 3) was quite bizarre because salt has nothing directly to do with obesity. It has no calories, no macronutrients (no fat, no protein, no carbohydrate) and therefore cannot directly impact obesity.

There may be an indirect argument that salt could encourage people to eat things. However, I would argue that people may desire doughnuts or biscuits (combinations of flour, sugar and salt), but that they would be unlikely to crave, say, anchovies, unless salt deficient for some reason. I would then expect a salt-deprived person to stop consuming anchovies once any salt deficiency were corrected and not to binge on them. The ‘but for’ test therefore points to the refined carbohydrates, containing salt, being substances of desire and not salt per se.

4) CASH has it in for salt

A charity called Consensus Action on Salt and Health (CASH) exists purely to campaign against salt. As the web site says: “CASH was set up in 1996 as a response to the refusal of the Chief Medical Officer (CMO) to endorse the COMA recommendations to reduce salt intake.” (COMA stands for Committee On Medical Aspects of Food Policy).

The COMA report merely says (and I quote) “The panel recommends that the dietary intake of common salt should not be increased further and that consideration should be given to ways and means of decreasing it.”

The worst thing that the COMA report could say about salt was: “High salt intakes have frequently been linked with the prevalence of high blood pressure in communities but a mechanism whereby salt could lead to the development of essential hypertension has not been established.”

Hang on a second – so there are alleged “frequent links”, for which no evidence is presented and we don’t even know how salt could impact hypertension (high blood pressure)… (I’ll answer this for them in a minute – we’ve known how since Carl Von Voit’s work in 1860).

The COMA report continues “Cross-cultural studies show a statistical association between estimates of salt intake and the average blood pressure of a community but detailed investigations within a single community frequently fail to demonstrate such a relationship.” And CASH was set up because the CMO failed to take action against salt?!

5) ‘High’ blood pressure is in fact normal

If you look at figures 1 and 2 in this highly referenced article, the actual population normal/average blood pressure is 140/86. The European Society of Hypertension and the World Health Organisation both define blood pressure of 140/90 as the baseline for high blood pressure. So normal has been redefined as high. This enables drug companies to medicate many more people.

6) Salt can increase blood pressure, but so what?

There is a very simple mechanism by which salt can increase blood pressure (of which the COMA report didn’t seem to be aware). Salt provides sodium. The normal concentration of sodium in blood plasma is 136-145mM (mmol/Litre). One of the easiest ways for the body to maintain the concentration of sodium is to increase fluid levels if sodium rises. If we consume salty food, we want to drink more (that’s why bars put free bowls of peanuts on the counter) so step 1 is for the increased intake of sodium to lead to an increase in fluid intake. Step 2 means that the additional fluid is more likely to be retained because the body is back in sodium concentration equilibrium, albeit with more sodium and more water.

Water retention in the human body can raise blood pressure. However, there are three points to make here:

i) Raised blood pressure is a symptom. It’s not a problem per se. What the salt antagonists fail to provide is any evidence for a substantial and/or sustained increase in blood pressure as a direct result of any defined level of salt consumption.
ii) Salt opponents also fail to provide any direct causation between salt consumption and end point disease (e.g. heart disease) regardless of whether or not salt impacts blood pressure.
iii) A completely overlooked point is that any rise in water retention from consuming even a couple of grams of salt is incomparable to the impact of consuming 100g of carbohydrates – which we are encouraged to consume (a few times a day) in illogical parallel with the discouragement of salt intake.

We can store up to 500g of glycogen if we consume carbohydrates that are not used up for energy. We know that each gram of glycogen is accompanied by four grams of water. Hence we can gain 2.5kg (c. 5lb) overnight by consuming carbohydrates above human need. This is way more significant in terms of water retention and blood pressure than any impact of a couple of grams of salt – and yet carb consumption is recommended and salt consumption is demonised. Yet another example of our completely incomprehensible dietary advice.

7) Even if salt impacts blood pressure, and even if this matters, reducing salt intake substantially would have negligible impact

The 1994 COMA report (Ref 4) states: “Its [The review group] recommendation was to reduce salt consumption by an average of 3g/day. It has been estimated that this would reduce average systolic blood pressure by about 3.5mm Hg.” [systolic blood pressure is the first of the two numbers we get].
Gary Taubes noted the same in The Diet Delusion: “cutting our average salt intake in half, for instance, which is difficult to accomplish in the real world – will drop blood pressure by perhaps 4 to 5 mm Hg in hypertensives and 2 mm Hg in the rest of us.”

So, halve your salt intake and your blood pressure may go from 130/X to 127/X?

If you have ever had your blood pressure read frequently (while in hospital or getting ready for an operation or a baby), or if you have one of those blood pressure machines at home, you will know that you hardly ever get the same reading twice in a row. Even within a couple of minutes, your blood pressure can vary by more than a handful of points – more than the amount it could possibly change by if you managed to halve your salt intake.

8) CASH’s evidence on “Salt & Health” is completely lacking

For the seven years after its formation, Consensus Action on Salt & Health was relying upon the 1994 COMA report. Since 2003 they have relied upon a Scientific Advisory Committee on Nutrition (SACN) report, called “Salt and Health”. (Ref 5)

Feel free to read the 134 page document. The summary will give you the key elements. The summary opens by saying: “Increased blood pressure, or hypertension, is the most common outcome that has been associated with high levels of salt intake. Hypertension is a major risk factor in the development of cardiovascular disease. The relative risk of cardiovascular disease increases as blood pressure rises even within what is considered the normal range of blood pressure, indicating that large numbers of people are at risk.”

i.e. the most common (the only?) outcome that salt intake has been associated with is increased blood pressure. If there were any direct association between salt intake and any actual disease, it would have been claimed.

Increased blood pressure in turn is then claimed to be a “major risk factor in the development of cardiovascular disease.” I disagree. High blood pressure (BP) (even when properly defined as actual high BP and not normal BP i.e. 140/86) is a symptom, not a cause. This makes blood pressure a condition observed at the same time as heart disease and not a risk factor. (It is far more likely the opposite direction of causation – heart disease causes high blood pressure – hence the symptom).
Notwithstanding this – the argument against salt still boils down to – we think salt is associated with blood pressure and we think blood pressure causes heart disease. So, by inference, they want us to think that salt causes heart disease.

The jewel in the crown of the anti-salt lobbyists is “The International Study of Salt & Blood Pressure” (Intersalt Co-operative Research Group, 1988). This study collected data on 24-hour urinary sodium excretion and blood pressure of over 10,000 adults in 52 population samples from 32 countries. Associations (note, not causation) were found between sodium excretion and blood pressure readings – until the four populations with very low salt intakes were removed from the analysis and then any statistical significance disappeared. (That latter point about the statistical significance disappearing was the view of the SACN Salt and Health report to give credit for honesty – it wasn’t my playing with numbers that led to this finding.)

Dr David Brownstein’s book Salt your way to health noted the findings from the Intersalt study as follows: “Although there was a slight relationship between blood pressure and sodium excretion in INTERSALT, a ‘smoking gun’ could not be found. This study showed a mild decrease in blood pressure (3-6mmHg systolic and 0-3mmHg diastolic) when there was a dramatic decrease in salt excretion.”

9) There is no evidence that salt causes heart disease; there is evidence that low salt is associated with heart attacks

A study of approximately 3,000 hypertensive subjects (men with high blood pressure) found that there was a 430% increase in myocardial infarction (heart attack) in the group with the lowest salt intake versus the group with the highest salt intake. (Ref 6) Knowing how vital salt is for human health, this should not be surprising – low-sodium diets have been shown to cause multiple nutrient deficiencies, including nutrients vital for heart health (calcium, magnesium, potassium and B-vitamins). (Ref 7)
The SACN report concluded: “There are insufficient reliable data on long-term effects of salt on cardiovascular disease outcomes to reach clear conclusions.” Quite.

c

p.s. The interesting twist to researching salt is that the motive for attacking this substance has not been as obvious as usual. The motive in the anti-fat movement is clear – it gives the ‘food’ industry the green light to make highly lucrative fake low-fat food. The motive in the anti-cholesterol movement is clear – it gives the drug industry the green light to make drugs worth tens of billions of dollars and ‘food’ companies can make spreads and other ‘cholesterol-lowering’ fake foods.

The common bad relationships between the ‘food’ industry and health campaigners can be found in the salt world. Check out p12 of the April 2012 Action on Salt annual report – the usual suspects from the ‘food’ industry are warmly thanked for their support.

Who gains by demonising salt? The lo-salt company clearly does. The founder of Consensus Action on Salt & Health, Professor Graham MacGregor, has personally done well out of founding the organisation. MacGregor is now chairman of action on salt. MacGregor is also chairman of the Blood Pressure Association. He sits on the board for the World Hypertension League and recently served as President of The British Hypertension Society. MacGregor was awarded 37th place on the Independent on Sunday’s list of people who have made Britain a “much, much better place.” (Ref 9) Salt has given MacGregor’s life purpose – I believe that he believes that salt is a bad thing. I also think that he is wrong.

As a final thought – have you heard of the expressions “salt of the earth” or “worth his/her salt”? We describe someone as the salt of the earth when they are as good and worthy as anyone can be. The word salary comes from the Latin word salarium and has the root sal or salt. In ancient Rome, salary meant the amount of money given to a Roman soldier to buy salt, which was an expensive but essential commodity. This explains the “worth his salt” expression. Our language is telling us the truth, our government is sadly not.


References
1) http://www.nhs.uk/Livewell/Goodfood/Pages/salt.aspx
2) http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001431/
3) http://www.aomrc.org.uk/about-us/news/item/doctors-unite-to-deliver-prescription-for-uk-obesity-epidemic.html
4) http://www.actiononsalt.org.uk/salthealth/Recommendations%20on%20salt/42491.pdf
5) http://www.sacn.gov.uk/pdfs/sacn_salt_final.pdf
6) Alderman “Low urinary sodium is associated with greater risk of myocardial infarction among treated hypertensive men.” Hypertension. 1995
7) Engstrom et al “Nutritional consequences of reducing sodium intake.” Ann. Intern. Med. 1983.
8) http://www.charity-commission.gov.uk/Accounts/Ends18/0001098818_AC_20100430_E_C.PDF
9) http://www.independent.co.uk/news/people/news/the-ios-happy-list-2012–the-100-7661358.html?action=gallery&ino=37
========================================================================================
Read the complete article here.
Another article here.

More data in the Salt Wars - Aug 14, 2014; http://www.medpagetoday.com/Cardiology/Hypertension/47203

An article by Marion Nestle - http://www.foodpolitics.com/2014/08/its-salt-arguments-again-new-research-arguments-over-public-health-recommendations-and-issues-of-conflicts-of-interest/

Scant Evidence That Salt Raises BP - Kaiser

Scant Evidence That Salt Raises BP, Review Finds

By Chris Kaiser, Cardiology Editor, MedPage Today  Published: December 04, 2012

 

The evidence for health benefits associated with salt reduction is controversial and the "concealment of scientific uncertainty" is a mistake, researchers suggested.

Controversy about what effect too much sodium intake has on the body goes back to the early part of the 20th century, according to Ronald Bayer, PhD, and colleagues from Columbia University Mailman School of Public Health in New York City.

But in the last few years, the discourse has reached a fever pitch, they wrote online in Health Affairs.

In 2011, for example, the Journal of the American Medical Association published a study by Stolarz-Skrzypek et al. that found only a weak correlation between salt and blood pressure. An editorial in the Lancet lambasted the JAMA study as "disappointingly weak" and "likely to confuse public perceptions of the importance of salt as a risk factor for high blood pressure, heart disease, and stroke."

Also in 2011, the Cochrane Review published two studies finding little or no relationship with all-cause mortality and salt reduction. The Lancet criticized both the Cochrane Library and the authors, saying, "They have seriously misled the press and thereby the public."

One of those reviews had concluded that "after more than 150 randomized controlled trials and 13 population studies without an obvious signal in favor of sodium reduction, another position could be to accept that such a signal may not exist."

Bayer and colleagues cited several studies that could not find a link between salt intake and elevated blood pressure, including a 1967 study of the Framingham cohort, and Japanese and Scottish reports in the 1980s totalling 15,000 people that concluded the association between sodium and blood pressure is "extremely weak."

The researchers noted that most of the evidence pointed to the weakest of correlations between salt and blood pressure. Yet, the cause to reduce salt was taken up by government agencies with special speed.

They cited a 2010 Institute of Medicine report called "Strategies to Reduce Sodium Intake in the United States." In the report, the IOM claimed that the "harmful relationship of salt with hypertension has been known for 40 years," which Bayer and colleagues argue is debatable -- based on the evidence.

"The [IOM] report was welcomed by the incoming president of the the American Society of Hypertension," the investigators wrote, "who warned that the 'outcomes mafia' might challenge the justification for a regulatory approach."

In 2011, the FDA also called for data and recommendations "that would help it shape regulatory policy on salt in food."

"All the while, skeptics still were asking for the evidence," Bayer and colleagues wrote.
More than 20 years prior to the IOM report, C. Everett Koop, MD, the U.S. Surgeon General, issued a report noting that government agencies were "very quick to embrace the importance of salt reduction in the 1970s and 1980s, which stood in stark contrast for the snail's pace of recommendations related to reducing blood cholesterol levels."

The authors cited many more studies finding little association between salt and blood pressure that did not eliminate the stigma attached to the mineral.

Advocates for salt reduction questioned the science behind studies that didn't conform to their opinion, and proponents partially blamed the food industry because it was in their best interest to muddy the waters and keep the debate going.

One of the interesting things about this debate, Bayer and colleagues pointed out, was that you could find respected academics on both sides.

"At the most fundamental level, we believe that it is essential to recognize the role that judgment and values must play in evidence-informed policy making," the authors concluded.

"Science must remain open, skeptical, and concerned about unmeasured confounding and selection bias in studies that accompany even the best efforts to articulate the evidence for new interventions," they added.

The investigators said that one of the reviewers of this paper had asked, "In the end, does the harm of exaggerating certainty do more harm than good? After all, it would be very hard to make any policy from a position of informed, complicated, contextualized ambivalence."

They concluded that the "concealment of scientific uncertainty is a mistake that serves neither the ends of science nor good policy. Simplistic pictures of translation from evidence to action distort our ability to understand how policy is, in fact, made and how it should be made."
==================================================================
Read the complete article here.

Another article here.

More data in the Salt Wars - Aug 14, 2014; http://www.medpagetoday.com/Cardiology/Hypertension/47203

An article by Marion Nestle - http://www.foodpolitics.com/2014/08/its-salt-arguments-again-new-research-arguments-over-public-health-recommendations-and-issues-of-conflicts-of-interest/

Salt, We Misjudged You

By GARY TAUBES

Published: June 2, 2012   Oakland, Calif.

THE first time I questioned the conventional wisdom on the nature of a healthy diet, I was in my salad days, almost 40 years ago, and the subject was salt. Researchers were claiming that salt supplementation was unnecessary after strenuous exercise, and this advice was being passed on by health reporters. All I knew was that I had played high school football in suburban Maryland, sweating profusely through double sessions in the swamplike 90-degree days of August. Without salt pills, I couldn’t make it through a two-hour practice; I couldn’t walk across the parking lot afterward without cramping.

While sports nutritionists have since come around to recommend that we should indeed replenish salt when we sweat it out in physical activity, the message that we should avoid salt at all other times remains strong. Salt consumption is said to raise blood pressure, cause hypertension and increase the risk of premature death. This is why the Department of Agriculture’s dietary guidelines still consider salt Public Enemy No. 1, coming before fats, sugars and alcohol. It’s why the director of the Centers for Disease Control and Prevention has suggested that reducing salt consumption is as critical to long-term health as quitting cigarettes.

And yet, this eat-less-salt argument has been surprisingly controversial — and difficult to defend. Not because the food industry opposes it, but because the actual evidence to support it has always been so weak.

When I spent the better part of a year researching the state of the salt science back in 1998 — already a quarter century into the eat-less-salt recommendations — journal editors and public health administrators were still remarkably candid in their assessment of how flimsy the evidence was implicating salt as the cause of hypertension.

“You can say without any shadow of a doubt,” as I was told then by Drummond Rennie, an editor for The Journal of the American Medical Association, that the authorities pushing the eat-less-salt message had “made a commitment to salt education that goes way beyond the scientific facts.”

While, back then, the evidence merely failed to demonstrate that salt was harmful, the evidence from studies published over the past two years actually suggests that restricting how much salt we eat can increase our likelihood of dying prematurely. Put simply, the possibility has been raised that if we were to eat as little salt as the U.S.D.A. and the C.D.C. recommend, we’d be harming rather than helping ourselves.

WHY have we been told that salt is so deadly? Well, the advice has always sounded reasonable. It has what nutritionists like to call “biological plausibility.” Eat more salt and your body retains water to maintain a stable concentration of sodium in your blood. This is why eating salty food tends to make us thirsty: we drink more; we retain water. The result can be a temporary increase in blood pressure, which will persist until our kidneys eliminate both salt and water.

The scientific question is whether this temporary phenomenon translates to chronic problems: if we eat too much salt for years, does it raise our blood pressure, cause hypertension, then strokes, and then kill us prematurely? It makes sense, but it’s only a hypothesis. The reason scientists do experiments is to find out if hypotheses are true.

In 1972, when the National Institutes of Health introduced the National High Blood Pressure Education Program to help prevent hypertension, no meaningful experiments had yet been done. The best evidence on the connection between salt and hypertension came from two pieces of research. One was the observation that populations that ate little salt had virtually no hypertension. But those populations didn’t eat a lot of things — sugar, for instance — and any one of those could have been the causal factor. The second was a strain of “salt-sensitive” rats that reliably developed hypertension on a high-salt diet. The catch was that “high salt” to these rats was 60 times more than what the average American consumes.

Still, the program was founded to help prevent hypertension, and prevention programs require preventive measures to recommend. Eating less salt seemed to be the only available option at the time, short of losing weight. Although researchers quietly acknowledged that the data were “inconclusive and contradictory” or “inconsistent and contradictory” — two quotes from the cardiologist Jeremiah Stamler, a leading proponent of the eat-less-salt campaign, in 1967 and 1981 — publicly, the link between salt and blood pressure was upgraded from hypothesis to fact.

In the years since, the N.I.H. has spent enormous sums of money on studies to test the hypothesis, and those studies have singularly failed to make the evidence any more conclusive. Instead, the organizations advocating salt restriction today — the U.S.D.A., the Institute of Medicine, the C.D.C. and the N.I.H. — all essentially rely on the results from a 30-day trial of salt, the 2001 DASH-Sodium study. It suggested that eating significantly less salt would modestly lower blood pressure; it said nothing about whether this would reduce hypertension, prevent heart disease or lengthen life.

While influential, that trial was just one of many. When researchers have looked at all the relevant trials and tried to make sense of them, they’ve continued to support Dr. Stamler’s “inconsistent and contradictory” assessment. Last year, two such “meta-analyses” were published by the Cochrane Collaboration, an international nonprofit organization founded to conduct unbiased reviews of medical evidence. The first of the two reviews concluded that cutting back “the amount of salt eaten reduces blood pressure, but there is insufficient evidence to confirm the predicted reductions in people dying prematurely or suffering cardiovascular disease.” The second concluded that “we do not know if low salt diets improve or worsen health outcomes.”

The idea that eating less salt can worsen health outcomes may sound bizarre, but it also has biological plausibility and is celebrating its 40th anniversary this year, too. A 1972 paper in The New England Journal of Medicine reported that the less salt people ate, the higher their levels of a substance secreted by the kidneys, called renin, which set off a physiological cascade of events that seemed to end with an increased risk of heart disease. In this scenario: eat less salt, secrete more renin, get heart disease, die prematurely.

With nearly everyone focused on the supposed benefits of salt restriction, little research was done to look at the potential dangers. But four years ago, Italian researchers began publishing the results from a series of clinical trials, all of which reported that, among patients with heart failure, reducing salt consumption increased the risk of death.

Those trials have been followed by a slew of studies suggesting that reducing sodium to anything like what government policy refers to as a “safe upper limit” is likely to do more harm than good. These covered some 100,000 people in more than 30 countries and showed that salt consumption is remarkably stable among populations over time. In the United States, for instance, it has remained constant for the last 50 years, despite 40 years of the eat-less-salt message. The average salt intake in these populations — what could be called the normal salt intake — was one and a half teaspoons a day, almost 50 percent above what federal agencies consider a safe upper limit for healthy Americans under 50, and more than double what the policy advises for those who aren’t so young or healthy. This consistency, between populations and over time, suggests that how much salt we eat is determined by physiological demands, not diet choices.

One could still argue that all these people should reduce their salt intake to prevent hypertension, except for the fact that four of these studies — involving Type 1 diabetics, Type 2 diabetics, healthy Europeans and patients with chronic heart failure — reported that the people eating salt at the lower limit of normal were more likely to have heart disease than those eating smack in the middle of the normal range. Effectively what the 1972 paper would have predicted.

Proponents of the eat-less-salt campaign tend to deal with this contradictory evidence by implying that anyone raising it is a shill for the food industry and doesn’t care about saving lives. An N.I.H. administrator told me back in 1998 that to publicly question the science on salt was to play into the hands of the industry. “As long as there are things in the media that say the salt controversy continues,” he said, “they win.”

When several agencies, including the Department of Agriculture and the Food and Drug Administration, held a hearing last November to discuss how to go about getting Americans to eat less salt (as opposed to whether or not we should eat less salt), these proponents argued that the latest reports suggesting damage from lower-salt diets should simply be ignored. Lawrence Appel, an epidemiologist and a co-author of the DASH-Sodium trial, said “there is nothing really new.” According to the cardiologist Graham MacGregor, who has been promoting low-salt diets since the 1980s, the studies were no more than “a minor irritation that causes us a bit of aggravation.”

This attitude that studies that go against prevailing beliefs should be ignored on the basis that, well, they go against prevailing beliefs, has been the norm for the anti-salt campaign for decades. Maybe now the prevailing beliefs should be changed. The British scientist and educator Thomas Huxley, known as Darwin’s bulldog for his advocacy of evolution, may have put it best back in 1860. “My business,” he wrote, “is to teach my aspirations to conform themselves to fact, not to try and make facts harmonize with my aspirations.”

A Robert Wood Johnson Foundation Independent Investigator in Health Policy Research and the author of “Why We Get Fat.”
==============================================================
Read the full article here.

More data in the Salt Wars - Aug 14, 2014; http://www.medpagetoday.com/Cardiology/Hypertension/47203

An article by Marion Nestle - http://www.foodpolitics.com/2014/08/its-salt-arguments-again-new-research-arguments-over-public-health-recommendations-and-issues-of-conflicts-of-interest/

 

Low Salt Diet Increases Cardiovascular Mortality

Read the full article with links and references here.

 

Another article here.

More data in the Salt Wars - Aug 14, 2014; http://www.medpagetoday.com/Cardiology/Hypertension/47203
 

====================================================

Low Salt Diet Increases Cardiovascular Mortality by Jeffrey Dach MD

from Jeffrey Dach MD Bio-Identical Hormone Blog by Jeffrey Dach MD

Low Salt Diet Found to Increase Mortality by Jeffrey Dach MD The Low Salt Diet Revisited A recent study on the effect of a low salt diet made headlines, finding that a low salt diet increases mortality for patients with congestive heart failure.(1-6) The study concluded there was not enough evidence to advise a low-salt diet for the rest of us. They doubted a low salt diet would benefit the population.(6) In this article we will re-examine the low salt diet, clear away the confusion, and make recommendations about salt intake, hypertension, and health. Above left image, harvesting sea salt courtesy of wikimedia commons. (Salt Farmers - Pak Thale.jpg) Health Benefits of Salt We know from many years of published studies that increasing salt intake increases blood volume and also blood pressure. Salt is essential for maintaining blood volume, blood pressure, and overall health. The salt content of blood is similar to ocean water. Both have sodium chloride, also known as salt. Importance of Salt One example of the importance of salt is the common practice of starting an intravenous solution of salt and water as the first line treatment for the trauma patient upon arrival to the hospital Emergency Room. Low Salt Diet to Reduce Blood Pressure One of the central dogmas of mainstream medicine is the "low salt diet" as a treatment for reducing blood pressure in the hypertensive patient. Indeed, popular wisdom says that the "low salt diet" is also healthy for the rest of us "normal" people who don't have hypertension.(25) Along with the rest of my medical school class, I was indoctrinated to believe this. Is this really true? Many studies have looked at this question. They show the "low salt diet" will in fact reduce blood pressure slightly. However, this effect is minimal, and is counteracted by compensatory mechanisms that release harmful substances into the bloodstream, hormones and chemical mediators that counteract the "low salt diet". The released chemical mediators include insulin, epinephrine, norepinephrine, renin, aldosterone, etc. These are harmful and damaging to the vascular system. (7-11) Low Salt Diet Increases Cardiovascular Mortality In addition, a number of studies have found that a "low salt diet" increases cardiovascular mortality. (5) A study published in the 1995 Hypertension found 4.3 times greater mortality in hypertensive men on a low salt diet.(12) They also found higher plasma renin in these men, a hormone produced by the body which causes salt and water retention by the kidney to compensate for the low salt diet.(12-15) A 2011 JAMA provides the reasons for this increased mortality and says ... (16) The underlying mechanisms explaining the inverse association between cardiovascular mortality and 24-hour urinary sodium excretion might be that a salt intake low enough to decrease blood pressure also increases sympathetic nerve activity, decreases insulin sensitivity, activates the renin-angiotensin system, and stimulates aldosterone secretion. (16) A 1998 JAMA report found that a low salt diet increased plasma renin 3.6-fold and aldosterone by 3.2-fold, increases that were proportional to the degree of sodium restriction. (17) The authors also reported the "low salt diet" increased other harmful substances such as noradrenaline, cholesterol, and low-density lipoprotein cholesterol (LDL). (17) A 1999 report in American Journal of Hypertension found that "moderate salt restriction aggravates both systemic and vascular insulin resistance." (18) The Difference Between Refined Salt and Natural Sea Salt In his book, Salt Your Way to Health, Dr. David Brownstein points out the difference between Refined Salt, commonly used in all processed foods, and Natural Sea Salt.(21) White refined salt is processed so that all the trace minerals are removed, and instead has chemicals added (up to 2% of weight). The added chemicals are ferrocyanide, aluminum, ammonium citrate, etc and are used for anti-caking, free-flowing, and to prolong shelf life. The final result is a lifeless, unnatural salt product which tends to acidify the body also called refined salt. Natural Sea Salt, on the other hand, retains all the trace minerals naturally found in the ocean. In addition it alkalinizes the body and has many health benefits. Natural Sea Salt is made by evaporating ocean water, and then collecting or harvesting the salt. Popular brands of natural sea salt include: 1) Celtic Sea Salt®, Light Grey, By The Grain & Salt Society, Coarse Ground, 1 lb 2) Roland Fine Sea Salt, 27.8-Pound Package (See all Sea Salt) Case reports from Dr Brownstein's Natural Ocean Sea Salt Book Case Number One- Food Allergies (from the Salt book) 61 year old female with numerous allergies. The patient switched from refined salt to natural sea salt, measured urine and saliva pH, which went up (alkaline) and noted allergies resolved. Case Number Two-Male Hypertension on Meds, Jack 63 year old hypertensive on two BP meds, Dyazide and Lopressor causing fatigue and erectile dysfunction. He switched from a low salt diet to natural sea salt and two months later blood pressure was lower. Pt reduced BP meds to dyazide at half dose. Case three, Barbara -Hypertension, 53 y/o went to primary care doctor for check up and was shocked to find her BP was 165/100. She had been on a low salt diet for years. Blood tests showed a low sodium level (137). She was then placed on natural sea salt, half tsp per day, and vitamin-mineral regimen, and eliminated refined foods. Two months later her blood pressure was 110/70, and she felt better. Case Four Sandra, similar story to Barbara. Case Five, Seizure Disorder. Jerry 12 years old with recurrent seizures on meds.Sodium was 138 on low salt diet. Switched to natural sea salt. Seizures decreased by 50%. Case Six Migraines. Lisa 31 , three migraines per month, clinically dehydrated, low sodium 139. Instructed to take half tsp Celtic Sea Salt per day, and 2 liters of water per day. Migraine headaches disappeared. Case Seven- Fibromyalgia . Judy 35 y/o , five years with fibromyalgia. BP drops upon standing. Adrenal Fatigue. RX adrenal hormones (DHEA, cortisol, pregnenolone, testosterone, progesterone ) , and natural sea salt., whole foods, plentiful water. Immediate improvement. Clinical Uses of Natural Sea Salt Adrenal Exhaustion: Sea Salt is essential for treatment of adrenal fatigue. Diabetes, Elevated Blood Sugar- It is impossible to control blood sugar on a "low salt diet". These do well on sea salt. Muscle Cramps - often relieved by minerals in Sea Salt. Osteoporosis Treatment requires minerals found in Sea Salt Hypertension-Low salt diet causes increased mortality. Use natural sea salt, with reduction in blood pressure noted in any cases. How to Reduce Blood Pressure Naturally -Salt Substitutes The low sodium, high potassium, high magnesium salt substitute (26) A number of studies have looked at substituting table salt with a variant with reduced sodium, and increased potassium, and magnesium, which has shown to reduce blood pressure. (26) Magnesium alone is an excellent mineral supplement which may be effective for blood pressure control in hypertensive patients.(27) Salt Substitute From Finland Jonathan Wright's clinic offers a salt substitute which contains potassium, magnesium, and lysine which was found beneficial in a Finland.(28)(29) WrightSalt is available through the Tahoma Clinic Dispensary (www.tahomadispensary.com 888-893-6878 ), or Ayush Herbs (800-925-1371), L-Arginine and the ADMA Connection In 1998 the Nobel Prize in Medicine was awarded to Furchgott and colleagues for the discovery of the role of Nitric Oxide in blood pressure regulation (among other things). (29-31) Recently, a new test has been devised called the ADMA from Metametrix Labs which is useful in hypertensive patients, showing the ability (or inability) to manufacture Nitric Oxide. If ADMA is found to be high, indicating low Nitric Oxide production, then increases can be achieved with a simple amino acid supplement called L-Arginine. (29-31) The increased Nitric Oxide brings down and controls blood pressure.(32) The references for the ADMA test can be found here. No Iodine Added to Natural Sea Salt Remember, Natural Sea Salt does not contain added iodine, so it is important to test for iodine levels, and supplement with iodine if found low. Iodine supplementation is our most important means for breast cancer prevention. Credit and thanks goes to the book, Salt Your Way to Health, by David Brownstein MD for much of the information in this article. Jeffrey Dach MD 7450 Griffin Suite 190 Davie Florida 954 792-4663

What about salt?

Salt consumption is discouraged these days and it seems to be zeroed in on the effects of blood pressure on heart disease and stroke. But wait a minute. Read this from Health Impact News Daily
=================================================================

To Salt or Not to Salt, That is the Question

Newswise — A new eight year long European study concludes that salt consumption is not dangerous and may in fact be beneficial. This is certainly contrary to advice from American Medical Association, American Heart Association and the Center for Disease Control and Prevention, which says higher sodium consumption can increase the risk of heart disease. It’s not unusual to see differing opinions, but what are we ordinary folks to make of the controversy?

The study followed 3,681 middle-aged Europeans who did not have high blood pressure or heart disease at the start of the study. They were divided into three groups: low salt; moderate salt; and high salt consumption. There were 50 deaths in the low salt group, 24 in the moderate consumption group and only 10 in the high consumption group. In fact, the heart disease risk in the low consumption group was 56% higher in the low salt group. What they concluded was that the less salt the participants ate, the more likely they would die from heart disease.

“The optimal level of salt in our diets has been a controversial subject for at least 20 years,” say co-authors Dian Griesel, Ph.D. and Tom Griesel of the new book, TurboCharged: Accelerate Your Fat Burning Metabolism, Get Lean Fast and Leave Diet and Exercise Rules in the Dust (BSH, 2011). The problem they say generally boils down to the effect (or lack thereof) salt has on blood pressure.

“There is no disagreement that high blood pressure (even moderately high) is a risk factor for heart disease and stroke,” say the Griesels. “However, salt consumption does not seem to have the same effect on everyone. In addition, there is usually no distinction on the type of salt used. There are many naturally harvested salts that also contain many trace minerals, which undoubtedly have an effect. Medical literature on salt consumption (like many other things) is inconsistent.”

The main take away from all this is the importance of knowing what your blood pressure is and making an effort to do whatever is necessary to have consistent readings in the healthy range of 120/70 or less. If you are a person who is sensitive to salt consumption, a reduction is definitely needed or perhaps even a switch to a natural alternative like sea salt might help. But beware of hidden salt. The biggest source of salt in our diet is the refined and processed foods purchased at the grocery store along with food served in restaurants, particularly fast-food which amounts to about 75% of salt consumption for the average person.

Read the Full Article Here: http://www.newswise.com/articles/to-salt-or-not-to-salt-that-is-the-question
See also:  Change in season: Why salt doesn’t deserve its bad rap and here.

More data in the Salt Wars - Aug 14, 2014; http://www.medpagetoday.com/Cardiology/Hypertension/47203