More on the Salt Debate!

The onus about our need for salt is becoming more of a burden for each person and we are the ones that need to make the decision of how much salt our body needs. The salt debate has now taken a more serious turn with some science behind it. How unbiased the science is will still be part of the debate, but at least I know what my body needs and am learning more each day of what my body it telling me for salt needs.

Most feel that a high salt intake has been linked to increased blood pressure and greater risk for heart problems. The AHA recommended limit of salt is 1,500 milligrams per day. This is the position of the American Heart Association and they will never admit to making a mistake. Now new research is saying that low salt intake may be more harmful.

This study was published in The Lancet and found that low salt intake may raise the risk of heart attack, stroke, and death when compared with an average salt intake.

The study, involving more than 130,000 people from 49 countries, was led by investigators of the Population Health Research Institute (PHRI) of McMaster University and Hamilton Health Sciences.

They looked specifically at whether the relationship between sodium (salt) intake and death, heart disease and stroke differs in people with high blood pressure compared to those with normal blood pressure.

The researchers showed that regardless of whether people have high blood pressure, low-sodium intake is associated with more heart attacks, strokes, and deaths compared to average intake.

“These are extremely important findings for those who are suffering from high blood pressure,” said Andrew Mente, lead author of the study, a principal investigator of PHRI and an associate professor of clinical epidemiology and biostatistics at McMaster’s Michael G. DeGroote School of Medicine.

“While our data highlights the importance of reducing high salt intake in people with hypertension, it does not support reducing salt intake to low levels. Our findings are important because they show that lowering sodium is best targeted at those with hypertension who also consume high sodium diets.”

The Dietary Guidelines for Americans recommend that Americans consume less than 2,300 milligrams of sodium each day - the equivalent to 1 teaspoon of salt.

However, a report from the Centers for Disease Control and Prevention (CDC) earlier this year revealed that around 90 percent of Americans consume salt at levels above the recommended limit.

Low salt intake in the study was defined as an intake of less than 3,000 milligrams a day, which is above current recommendations in the United States.

The researchers found that only individuals with high blood pressure appeared to be subject to the risks associated with high salt intake - defined as more than 6,000 milligrams daily.

This new study shows that the risks associated with low-sodium intake – less than three grams per day – are consistent regardless of a patient’s hypertension status. The findings show that while there is a limit below which sodium intake may be unsafe, the harm associated with high sodium consumption appears to be confined to only those with hypertension.

Only about 10 per cent of the population in the global study had both hypertension and high sodium consumption (greater than 6 grams per day).

Study Says Salt's Effect on Blood Pressure Insignificant

Now if the American Heart Association would believe this we could be on to something. I do expect to see something from them and it will be a rebuttal if I am right. It turns out they don't need to as the American Diabetes Association did it for them in DiabetesPro SmartBrief. It carried an article by Reuters of people with diabetes ignoring salt uptake warnings. Both articles were dated September 8, 2014. The salt controversy just won't go away.

Previously on August 26, 2014, Eric Topol, editor of Medscape, used two studies and compares them. I will quote this from his article, “Our crackerjack cardiovascular news managing editor, Shelley Wood, published a superb article on Medscape - the heart.org, with many of the parties and leading experts weighing in. For me, the real coup de grâce was the Wall Street Journal's editorial column, "The Salt Libel," which highlighted this conclusion: "[T]he illusion that science can provide some objective answer that applies to everyone...is a special danger."

I believe that adequately sums up all there is to say about sodium, at least for now. The AHA, however, isn't backing off from its 1.5 g/d sodium guideline. But I think there's a big lesson here about guidelines without adequate evidence: They can do harm. Hopefully this lesson will prove to be impactful, because that certainly has not been the case to date (as in cholesterol/LDL, BP, PSA, mammography, and a very long list of poorly conceived, nonanchored guidelines).

Isn't it about time to recognize that there shouldn't be rules for populations? Some people are exquisitely sensitive to salt intake, while others are remarkably resistant.”

New research should play a role in determining public health initiatives for reducing epidemic hypertension. It is unfortunate that hypertension is the world's most prevalent chronic disease. I was even surprised that it was so common at the younger ages. It affects more that 30 percent of adults at age 25 and above. It accounts for 9.4 million deaths every year.

With hypertension's increasing prevalence and the difficulty the global health community has in managing it, more should be done to identify casual behavioral relationships to blood pressure outcome that can lead to better strategies for preventing hypertension.

It is obvious that the salt debate will continue until the different medical groups decide to find science for their guidelines instead of what they call “expert opinion” and consensus. The science is slowly building and showing that there is more than just “expert opinion.”