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Huh? Low-salt diet ups risk of fatal heart attack?
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Huh? Low-salt diet ups risk of fatal heart attack?
Huh? Low-salt diet ups risk of fatal heart attack?

By Amanda Gardner

Doctors and public health officials have been telling us for years that eating too much sodium can increase the risk of heart attack or stroke by raising blood pressure to unsafe levels. So how to explain a new study that suggests low salt intake actually increases the risk of dying from those causes?

The study, which followed 3,681 healthy European men and women age 60 or younger for about eight years, also found that above-average sodium intake did not appear to up the risk of developing high blood pressure (hypertension) or dying of a heart attack or stroke.

The findings, reported in the May 4 issue of the Journal of the American Medical Association, certainly seem counterintuitive, especially in light of the ongoing public-health campaign to lower sodium consumption across the U.S. by urging restaurants and food manufacturers to curtail their use of the ingredient.

In fact, says Jan A. Staessen, M.D., the senior author of the study and the head of the hypertension laboratory at the University of Leuven, in Belgium, the findings "do not support the current recommendations of a generalized and indiscriminate reduction of [sodium] intake at the population level."

Salt lovers shouldn't break out their shakers just yet, though. A closer look at the findings shows that they're not as out of line with the low-sodium mantra as they might seem.

For starters, the participants' sodium consumption was gauged by measuring the sodium content of their urine over just one 24-hour period at the beginning of the study. Although this method is considered the gold standard for estimating sodium intake, that lone urine test may not provide an accurate snapshot of the participants' everyday intake over the full eight-year study, as the researchers themselves note.

Even more important, the participants had blood pressure in the normal range at the beginning of the study and were white, relatively young, and slimmer on average than the typical American. Past research has shown, however, that people with hypertension, blacks, older people, and heavier people tend to react more negatively to sodium.

"Maybe it would be better to pinpoint specific subgroups," says Jerome Fleg, M.D., a medical officer in the division of cardiovascular sciences at the National Heart, Lung and Blood Institute, in Bethesda, Maryland. "This is probably not the group that would get the biggest bang for the buck in terms of restricting sodium intake."

Staessen and his colleagues divided the study participants into thirds according to their estimated sodium intake. Although higher salt intake was not linked to an increased risk of hypertension, it was associated with very small increases in systolic blood pressure (the top number).

Slightly more than 6 percent of the participants had a heart attack, stroke, or other cardiovascular emergency during the study, roughly one-third of which were fatal. Those who consumed the least salt had a 56 percent higher risk of death from a heart attack or stroke compared with those who had the highest consumption, even after controlling for obesity, cholesterol, smoking, diabetes, and other risk factors.

The researchers don't have a firm explanation for this finding, but they speculate that sodium intake low enough to decrease blood pressure may also decrease sensitivity to insulin, encourage a stress response in the nervous system, and affect hormones that regulate blood pressure and sodium absorption. "Each of these effects might have unfavorable impact on cardiovascular mortality," Staessen says.

He and his coauthors emphasize, however, that people with hypertension -- who were not included in the study -- will still benefit from a low-salt diet.

Most Americans consume more sodium per day than is considered healthy. Federal guidelines recommend limiting consumption to 2,300 milligrams per day, or 1,500 milligrams for blacks and people with hypertension. Some health organizations have been lobbying the federal government to drop the goal for everyone to 1,500 milligrams a day, Fleg says.

Despite the study's shortcomings, the findings do suggest that sodium guidelines should perhaps take into account differences among individuals, says Randal Thomas, M.D., a preventive cardiologist at the Mayo Clinic, in Rochester, Minnesota.

"We know that not everybody is as sensitive to sodium in their diet as others. Even among people with high blood pressure, no more than half are probably sodium sensitive, and in the general population, it's probably less than 10 percent," Thomas says. "In setting up a public policy, it's important to recognize the need to have a policy that doesn't punish the majority for the benefit of the minority."


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05-15-2013 09:47 AM
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Post: #2
RE: Huh? Low-salt diet ups risk of fatal heart attack?
Quote:"Maybe it would be better to pinpoint specific subgroups," says Jerome Fleg, M.D., a medical officer in the division of cardiovascular sciences at the National Heart, Lung and Blood Institute, in Bethesda, Maryland. "This is probably not the group that would get the biggest bang for the buck in terms of restricting sodium intake."

^^This.

I think that's what it is going to come down to. Europeans, as a unit, seem to also do better with regular wine intake while Americans do not. Has the proverbial melting pot scrambled our basic regional genes? And has our junk food diet ruined our chances of establishing healthy regional genes?

It would also be interesting to see if it was the low salt food itself and not just the lack of salt. What is done to food to make it palatable yet be low salt? There's just too many variables.

I was first diagnosed with hypertension at age 16. I went low salt for years but it never helped. I even went no-salt for a year after college. No change. It actually got worse. I was finally put on medication and all is well-ish. Come to find out, my hypertension is not diet related at all. No surprise to me.

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05-15-2013 01:02 PM
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Sleepster Offline
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Post: #3
RE: Huh? Low-salt diet ups risk of fatal heart attack?
Salt is so prevalent in the history of the human diet that we have actually developed taste buds that are sensitive to it.

That should tell us something.

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05-15-2013 02:45 PM
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John J Offline

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Post: #4
RE: Huh? Low-salt diet ups risk of fatal heart attack?
For whatever it's worth, here's my take on this. In the United States, EVERYTHING is loaded with sodium. Yes I said it, LOADED. We are a society where we oversalt everything. From a public health perspective, it is a huge problem. Obesity, hypertension, and a host of other maladies come from this issue. Many who make the foods use salt as a substitute for more expensive herbs and spices which make the food taste appealing. Add to that the tremendous amounts of salt in fast and processed foods, and you wonder why? Besides, I don't think there are too many people in danger of Hyponatremia in this country. So I'm not buying what they're selling, at least for Americans
05-16-2013 08:59 AM
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Post: #5
RE: Huh? Low-salt diet ups risk of fatal heart attack?
Salt is good. Eat-popcorn

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05-16-2013 09:41 AM
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Shastzi Offline

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Post: #6
RE: Huh? Low-salt diet ups risk of fatal heart attack?
The Chinese don't need to worry about taking over the U.S. All they need to do is poison our Big Mac's & Fries. Smile

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05-16-2013 10:03 AM
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DocWils Offline

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Post: #7
RE: Huh? Low-salt diet ups risk of fatal heart attack?
Salt sensitivity is a specific that seems to be linked to early diet amongst other factors. It may well be that there is no good general rule about salt intake - it is a question not just of the overall intake but the balance of the diet as a whole - the French and Japanese both have relatively high salt diets,a s do most Mediterranean countries, et lowered heart disease risk than the Germans or English. In both cases, there are other diet and lifestyle factors that balance out the intake levels. Current thinking is more or less the Golden Mean method - do things reasonable and balanced, well i taste and satisfaction, and balanced by a healthy attitude toward cuisine, and it may well make the difference.

I just was at a conference that covered amongst other things, the Roeschtigraben, the divide between the German and French Swiss cultures and how we see differing health problems on either side of the divide. Among other things, even in this small country, there is a divide between the cultures in terms of heart disease and hypertension, and it shows up nicely in things like lifestyle and diet.

I suspect the best advice is eat reasonably, neither too much nor too little of salt or anything else, balance it with slat absorbing foods, a nice Red Wine (not Plonk, please! and only one glass!) and walk a bit after. Most importantly, take your time when you eat - savour the food, enjoy the spiritual aspect of eating. One thing the French teach us is that hasty eating leads to disease as much as anything does. Taking the time to eat and digest, take a postprandial walk, etc is more important that you can imagine. And try not to eat fast food - it is not the best way to find peace and pleasure in your food. There is no spiritual aspect to a Big Mac, regardless of what Harold and Kumar would like us to believe.

And that brings me to a bigger point - the amount of sugar in preprepared foods, especially fast foods, is likely the biggest culprit of all here. so keep that in check and be sensible. The med type guy has spoken.
05-16-2013 03:59 PM
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Post: #8
RE: Huh? Low-salt diet ups risk of fatal heart attack?
I love salt!

Salt has gotten a bad rap for too long. People act like salt is the one and only thing that causes hypertension.

I went super-low sodium for years trying to keep my blood pressure down, but it kept going up. Nine months on PAP and 3 or 4 months back on the salt shaker and my blood pressure isn't just under control - it is low...with NO medication.

I guess sodium might cause problems for some people; but, instead of just blaming salt, it would probably be best for most people to start looking into whatever else might be causing hypertension.

That's just my 2 cents.
05-16-2013 04:50 PM
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Post: #9
RE: Huh? Low-salt diet ups risk of fatal heart attack?
quote of the day and every day
a glass or two of australian shiraz a day keep the doctor away
enjoy
(This post was last modified: 05-16-2013 04:59 PM by zonk.)
05-16-2013 04:58 PM
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Post: #10
RE: Huh? Low-salt diet ups risk of fatal heart attack?
better make that Sirah than Aussie Shiraz, just better, that's all. And testing on the theory of red wine has shown that pinot noire and Cabernet are the most effective in health benefits.
05-16-2013 08:28 PM
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