The Salt Controversy Won't Go Away

Even though this article says salt intake has become a major health concern in the United States, the main concern should be the lack of clear and good science in how salt affects the body for the different age groups and with different health problems. Whenever one point is pushed, everyone has to add their point of the argument and there is some science behind their points, but very poor science.

From reading the article several times, the one part that keeps rearing its head is what is the correct amount for salt consumption. This is where everyone disagrees. Most people have their numbers picked out and will not agree to any other number for salt intake. All the following are for one day.

• American Heart Association – 1500 milligrams
• Dietary Guidelines for Americans – 2300 milligrams
• Most US adults – more than 3400 milligrams
• Food and Drug Administration – 2300 milligrams
• Institute of Medicine – 2300 milligrams
• Grocery Manufacturers Association (GMA) – want more research

Earlier this month, the FDA issued draft guidelines for the reduction of sodium in processed foods, which accounts for around 75 percent of all salt consumption.

These guidelines aim to lower salt intake for consumers to the recommended level of 2,300 milligrams daily. This is proposed to reduce the health risks associated with high salt consumption.

How much sodium is in your food?

• A single slice of bread contains anywhere from 80-230 milligrams of sodium
• Some breakfast cereals can contain up to 300 milligrams of sodium before milk is added
• One slice of frozen pizza can contain 370-730 milligrams of sodium.

It is well known that the body needs some salt; it is important for nerve and muscle function, and it helps regulate bodily fluids.

One study, published in the journal Cell Metabolism last year, even suggested that salt consumption could stave off harmful bacteria and reduce the risk of infection.

There are many studies on salt, but few are definitive. Most have an agenda or bias in the way they were done. Some of the problems discovered include:

• Numerous studies have indicated that consuming too much salt can increase the risk of serious health problems.
• Research links high salt intake to hypertension, stroke, and heart disease.
• A study earlier this year also suggested a high-salt diet may cause liver damage.
• Another study linked high salt intake to increased risk of multiple sclerosis (MS).
• A study last month suggested that even 3,000 milligrams of sodium daily may be too little and could put health at risk. It found that adults who consumed less than 3,000 milligrams of salt a day were at greater risk of heart attack, stroke, and premature death than those with an average sodium intake. The team questioned the health risks of high salt intake, finding that it was only adults who already had high blood pressure who were at greater risk of heart disease and stroke with high salt intake - defined as 6,000 milligrams daily.
• Another 2014 study found that reducing salt intake to less than 2,500 milligrams a day was not linked to reduced risk of the health conditions associated with high salt consumption.

Despite such findings, the FDA concludes there is an "overwhelming body of scientific evidence" that reducing daily sodium intake to less than 2,300 milligrams can prevent the health risks of a high-salt diet. All government agencies are in agreement that people should consume less than 2300 milligrams of salt.

While it seems many health experts are in support of government strategies to reduce salt intake among the general public, others say more research should be conducted on the long-term health effects of low-salt diets before making recommendations.

Additionally, many researchers and organizations - including the Grocery Manufacturers Association (GMA) - believe further research is required to pinpoint the exact salt intake that is most beneficial for health.

"Like others inside and outside of government, we believe additional work is needed to determine the acceptable range of sodium intake for optimal health," says Leon Bruner, chief science officer of the GMA. "This evaluation should include research that indicates health risks for people who consume too much sodium as well as health risks from consuming too little sodium."

What surprises me the most is the way everyone is entrenched in their belief and won't consider other opinions and even many studies, flawed or not. The other objection I have is most will not consider ethnic groups and their salt needs or sensitivity. A one-size-fits-all approach is even adding more folly to the entrenched positions. A mentioned need is studies by age and comorbidities. This could help in conjunction with the different ethnic groups to determine salt needs.

AHA Denying Science on Salt

I knew this would happen. The American Heart Association denies the latest science - a study published last Friday in The Lancet, which suggested that salt restriction in the diet, won't benefit most people and may actually cause harm. Although the study did also suggest that salt restriction might help the 11% of the population who have high blood pressure and consume a lot of salt, the AHA says it "strongly refutes the findings" of a "flawed study" which "you shouldn't use ... to inform yourself about how you're going to eat."

This sounds like a doubling down on their position of less salt is better philosophy. Sounds a lot like the way they have handled the low carb high fat and the statin controversies. The AHA still believes in the low fat way of eating and they have expanded the numbers of people down to children that they believe should be taking statins.

Makes me wonder about conflicts of interest and why the AHA follows paths that the crowd has abandoned. But in fact, the AHA position is really a strong blow against science and the scientific process.

The key point here is that the authors of the Lancet study make no claim that their study is definitive. Instead, they point out that the study was performed in the first place in response to earlier, less definitive studies hinting at possible harms associated with severe salt restriction.

The average American consumes about 3,400 mg per day of sodium. The AHA recommends that sodium levels be cut by more than half to 1,500 mg/day. Several other health organizations also recommend reduced salt intake, though their recommendations are less severe than the AHA's (which is itself a good indication of the lack of scientific consensus).

A former president of the AHA, Elliott Antman, described the AHA as a "a science-based organization dedicated to saving and improving lives." "Confusion about something as dangerous as excess sodium is unacceptable. We owe it to the public to provide the most scientifically sound dietary advice."

But although "confusion" about sodium may be "unacceptable", it may also be inevitable, at least for now. Despite what Antman and the AHA say, there is no widespread scientific consensus about salt. In its statements, the AHA never acknowledges the lively ongoing debate about salt.

It is known that the AHA and its officers will not admit to anything and yet say they have science behind them. There is little actual science and there is much disagreement among the experts about salt.

Back in the 1980s, the AHA developed enormously influential guidelines on cholesterol and diet. These guidelines helped spark the campaign against dietary fat and had the catastrophic consequence of pushing people to consume more carbohydrates, including sugar, instead of fat and protein. We will probably never know the full extent of the damage, but many have speculated that this may have contributed to the obesity and diabetes epidemics. Let's make sure this doesn't happen again with salt.

The AHA can't be judge and jury and simply declare themselves the winner in the court of science.

High Salt Consumption Can Cause Weight Gain

One group publishes a study and another group answers with their study. This group takes a different approach and talks about weight gain being caused by salt, actually too much salt.

Researchers say the studies - published in the Journal of Nutrition and Chemical Senses - support calls for the food industry to lower the salt, or sodium, intake of food products. Both studies were conducted by Prof. Russell Keast and colleagues from Deakin University in Australia.

While you may not be heavy handed with the salt shaker, it is processed foods and restaurant meals that are the primary culprit, accounting for more than 75% of our sodium intake.

Previous research from Prof. Keast and colleagues, including a study reported by Medical News Today earlier this year, suggested that individuals who are more sensitive to the taste of fat are more likely to eat fatty foods, putting them at greater risk of obesity.

Their latest studies build on that research, suggesting that the amount of salt in a certain food may influence how much we eat, as salt could mask our fat preferences.

For the first study, the team set out to investigate the effects of salt on the taste of fat and food preference.

The researchers enrolled 49 healthy participants aged 18-54 and asked them to taste a variety of tomato soups that had four different fat concentrations (0%, 5%, 10% and 20%) and five different salt concentrations (0.04% - no added salt - 0.25%, 0.5%, 1% and 2%).

Fast facts about salt

• Grains, meat and processed poultry, soups and sandwiches are top contributors to Americans' salt intake
• A single slice of bread can contain anywhere from 80-230 mg of salt
• One slice of pizza can contain up to 730 mg of salt.

After consuming the soups, participants were asked to rank the pleasantness and desire to eat each soup, as well as the perceived fattiness and saltiness of each soup.

Fat taste sensitivity among participants was measured by their ability to taste oleic acid - a fatty acid in vegetable fats and oils - at various concentrations in long-life skimmed milk.

The researchers found that salt is a major player in the pleasantness of a food, with rating of food pleasantness varying greatly dependent on different salt contents; a salt concentration of 0.25-5% rated as most pleasant.

For the second study, the team wanted to examine the effect of salt on food intake. They enrolled 48 healthy adults aged 18-54. As in the first study, participants' fat taste sensitivity was determined by their ability to taste oleic acid.

Over a 6-day period, participants were required to attend four lunchtime sessions. Lunches consisted of elbow macaroni and sauce, and sauces contained varying concentrations of fat and salt.

The researchers measured subjects' food intake over the study period, and participants were required to rate the pleasantness of each food. The team found that participants consumed around 11% less food and energy when their lunches contained low salt and high fat.

"However, when given high-salt high-fat foods, those same subjects consumed significantly more food and energy," explains Prof. Keast. "Those who were less sensitive to fat consumed the same amount in each salt condition." Overall, the authors say their studies indicate that salt may interfere with the body's biological processes that stop us from eating too much.

Salt Continues to Be Controversial

The shame of this is the lack of science being applied to salt needs of the body. Each side proclaims their agenda, but cannot show any definitive science to prove their claims. This article is one of the better articles and applies reason in place of lack of science.

If you have tried to find science to help you figure the best salt intake, you have probably read some of the controversy. "The less the better,” has been the message for the last 30-40 years. That dogma is not being challenged. This is also the reason that the low carb diet may be affecting the amount of salt we need. To understand some of this, we need to examine the controversy.

In July 2015, before the 2015 Dietary Guidelines were released, the Guidelines for Americans say that the “general population” should restrict their sodium intake to 2300 mg (about a teaspoon of salt). However, about half the population is not apparently in the "general population", as people over 50, African-Americans, and others in groups at a risk for high blood pressure are told to restrict their intake to 1500 mg. The American Heart Association maintains that everyone should stay at 1500 mg.

However, no one does this, as this is very difficult to do! We could have a long conversation as to whether it is a good idea to recommend something that only a small number of people worldwide can attain.

But instead, let's turn to the science). The reason for recommending salt intake is that there is an association between eating a lot of salt and high blood pressure. However, there are a couple of caveats:

1) While going from a high-salt intake to a moderate-salt intake does tend to lower blood pressure, for most people going from a moderate intake to a low intake does very little good.

After looking into the matter, in 2013 the Institute of Medicine reported that there is no evidence that reducing sodium intake below 2300 mg provides benefit. Other recent analyses have shown little correlation in the general population between blood pressure and salt intake, although there are definitely people who do benefit, which brings us to:

2) The people who benefit the most from salt reduction are what is called "salt sensitive", which is thought to be about 10-20% of the general population.

Older people, African-Americans, and people who have high blood pressure are more likely to be salt sensitive.

If you are salt sensitive, it is probably good to know it, although the only real way to find out is to wait until you have high blood pressure and then see if reducing salt helps. But, there is actually evidence that people who are salt sensitive are at a greater risk for heart disease even if their blood pressure is kept normal. One thought is that whatever is causing the salt sensitivity may be causing inflammation and possibly other bad effects. There is much to learn about this.

What is considered a moderate salt intake? There is a lot of controversy on this point! Some experts say that the average amount of sodium people tend to eat (around 3500 mg, or 3.5 grams) is way too much, while others say that this is the very definition of moderate.

If you cook from scratch and mostly eat at home, you are probably eating a moderate or lowish amount of salt by any definition. But if you eat out a lot and/or eat prepared and packaged foods, the grams can add up fast! According to the Centers for Disease Control and Prevention, the average person in the United States gets about 3/4 of their sodium from restaurants, prepackaged, and processed foods, while only 5% is added during home cooking and 6% from the salt shaker at the table.

Okay, now we need to ask about what are the dangers from too little salt. There is little research about this, but some observational studies have shown increased "cardiovascular mortality" or "all-cause mortality" for people eating a low-salt diet. However, complicated interactions can always be in the mix, for example, sick people may eat less food, which means they eat less salt.

Why is it dangerous to eat too little salt? Blood and many other bodily fluids (lymph, sweat, and fluid around our organs) are fairly salty, for good reasons. Our bodies use salt in many ways, and it is easy to imagine that things could go awry if we don't have enough of it. One of the more interesting observations is that a low-salt diet could increase insulin resistance in the muscles of some people. The researchers of the diabetes study point out that interference in metabolic and neurohormonal pathways that could result from a low-salt diet, at least in some people, but admit that we know very little at this point.

Could eating a low-carb diet impact our need for salt? Some experts think so in some people. Particularly in the first two weeks of a very low-carb (ketogenic) diet, the body lets go of a lot of water, and some electrolytes such as sodium and potassium along with it. Some physicians who are familiar with working with low-carb diets in their patients actually advise their patients to consume more salt during this time to help mitigate the "Atkins flu," i.e., feeling sickly in the first week or so. They often advise drinking a couple of cups of bullion or broth each day during this time.

Other experts, notably Stephen Phinney and Jeff Volek, feel that people on long-term ketogenic diets may need more salt on an ongoing basis, particularly if they are athletes or very active. They point to evidence that people on ketogenic diets tend to excrete more sodium. In The Art and Science of Low Carbohydrate Living, they advise that such people add 2-3 grams of sodium to the diet each day, particularly if they are feeling lightheaded or poorly with exercise.

As those of us who benefit from low-carb diets know very well, recommendations from the government or large health organizations are not always the best for the individual! It's up to you to find out what works for you. Make sure your blood pressure gets checked. Stay away from processed foods. If your blood pressure is high, make sure you're following a healthy low-carb diet, which has been shown to help normalize blood pressure for many people. If that doesn't do the job, try cutting back on salt.

More on Nutrition for People with Diabetes

In the last blog, I covered eating patterns and started the macronutrients as covered in the October ADA dietary guidelines. Now I will write about protein and fat.

The macronutrient, protein. People with diabetes that don't have kidney disease might be surprised by this. There is no 'ideal' amount of protein that helps to improve blood glucose management, or even lowers the risk of heart disease. There are studies on both sides of this issue for both diseases and most are approached with a bias or what the author or funding agency is trying to prove.

The good news for those that have kidney disease do not have to follow a very low protein diet. More is the concern about malnourishment and the protein does not seem to affect the rate of progression of kidney disease. Even with all the hoop-la about red meat causing heart disease, it is more the highly processed meats that have an effect on the heart.

The macronutrient, fat. This section is more difficult and they are still trying to limit fat to a low fat diet. They of course want monounsaturated fats like olive oil and push vegetable oils. They are unanimous in eliminating trans fat as they should, but to curtail saturated fats with the evidence having been disproved still concerns me. I could agree if they had asked for moderation in the consuming of saturated fat.

The guidelines do say that there is no optimal mix of macronutrients. The statement is just made that evidence suggests that there is not an ideal percentage of calories from carbohydrate, protein, and fat for all people with diabetes; therefore, macronutrient distribution should be based on individualized assessment of current eating patterns, preferences, and metabolic goals.

Yet, they continue by saying it has been observed that people with diabetes eat about 45% of their calories from carbohydrate, 36–40% of calories from fat, and the remainder (16–18%) from protein. All this means is that the authors could care less about assessing people with diabetes and allowing them to have individualized eating plans. They are going to push for high carbohydrates.

They do cover omega 3 fatty acids and advise not to be taking fish oil supplements as there is no evidence that these help protect you from heart disease. The guidelines push the importance of getting your fish oils from food sources and that people eat at least two fish meals per week. This the guidelines say will help lower the risk of heart disease.

The dietary guidelines recommend that people who are 51 years of age, those who are African-American, or those that have high blood pressure, diabetes, or chronic kidney disease limit their sodium (salt) intake to 1500 milligrams (mg) per day. Restricting salt to this level is difficult and can make food unpalatable. Evidence does not support lowering salt level to this amount and the guidelines recommend capping salt intake at 2300 mg per day or the same recommendation as for the general public.

The guidelines do advise limiting alcohol as this can mask hypoglycemic symptoms and lead to problems for those on insulin. The guidelines also recommend high dietary fiber and liberal quantities of whole grains. Big Food is speaking here and for those on low-carbohydrate diets need to limit or eliminate wheat from their diets.

In rereading the guidelines for these two blogs, it has been interesting the conflicts in the advice given and how the leanings are still high-carbohydrate low-fat in nature.

Dehydration, 14 Forgotten Causes

I cannot call causes of dehydration surprising, probably because I learned a hard lesson early as a teenager and had several doctors give me a list of dehydration causes and how to avoid them. I have long since lost the list, but it helped me survive while in the military and especially basic training.

Because three of the listed causes of dehydration are common to women only, there are only eleven that are common to both sexes. The three for women are serious and I am not trying to minimize them. The first is a woman's monthly period. The second is pregnancy. The third is breastfeeding. During these times, a women's body often requires more fluids. Read thediscussion here and please take heed or talk to your doctor. The following are those common to both sexes.

#1. Diabetes People with diabetes, especially people who don't yet realize they have diabetes, are at increased risk of dehydration. It is important even for those with diabetes to know when blood glucose levels become too high, the body tries to eliminate the excess through increased urine output.

#2. Prescription medications Check the side effects of your prescription and don't forget the check with your pharmacist. Many medications have a diuretic effect on your body. They increase your urine output and your risk of dehydration. Blood pressure medications are known to cause this. Any drug that lists diarrhea or vomiting can also cause dehydration. Always think of increasing your water intake with these medications.

#3. Low-carb diets Many people are on low-carb meal plans, but forget that in the beginning to increase their water intake as when they decrease their carb intake, they lose water weight first causing dehydration.

#4. Stress That stressor, stress causes your adrenal glands to pump out stress hormones which causes the adrenals to become exhausted. The adrenals also produce the hormone aldosterone which helps regulate the body's levels of fluid and electrolytes. Finding ways to reduce stress is important because lower output of aldosterone causes dehydration and low electrolyte levels. Read my blog on diabetes and stress for suggestions to reduce stress.

#5. Irritable bowel syndrome Those that have had irritable bowel syndrome know that it is bad and if not managed causes nausea and chronic diarrhea which leads to dehydration. Talking to your doctor is advised and increasing water intake is needed to prevent dehydration.

#6. Your workout Most people attempt to stay hydrated when they exercise, but some people think this is for endurance athletes. Don't make this mistake if you are just walking or even swimming. Yes, swimming can lead to dehydration.

#7. Aging Unfortunately, as we age, our body's ability to conserve water declines. This is also true that the sensation of needing water declines. This is the reason the elderly are at higher risk for dehydration. In this, remember that not everyone needs the same amount of water, and often the elderly need more than the recommended eight glasses of water of they are active and exercising regularly.

#8. Dietary supplements Don't laugh this off. Just because it may be natural, does not mean that it can't send your bladder into overdrive. Parsley, celery seed dandelion, and watercress have all been known to increase urine output, which can cause dehydration. If you are consuming these or any dietary supplement, talk to your doctor about dehydration.

#9. High altitudes Traveling to high altitudes or living at high altitudes, your body adjusts by speeding up your breathing and increasing your urine output. Both are necessary to a healthy adjustment to the altitude and its oxygen levels; however, the constant urinating and panting causes you to exhale more water vapor than usual. Until you have adjusted to the altitude change, you are at increased risk of dehydration.

#10. Drinking alcohol Do you like to consume alcoholic beverages and do so past the point of becoming dehydrated. Many people do and people with diabetes should limit the amount of alcohol. Alcohol prevents or inhibits an antidiuretic hormone that would normally send some of the fluid you are consuming back into your body and instead sends it to your bladder for elimination.

#11. Eating too few fruits and vegetables The author is really pushing five servings of vegetables and fruit each day to help you stay hydrated. If you do not, then you are supposed to drink extra water. Dehydration may be the result if you don't eat five servings.

With all the above, make sure that you stay hydrated. Drink water until you feel satisfied, not just the recommended eight glasses per day. Some need more and others may need less. As you age, be careful and adjust accordingly. Contrary to what you may have been advised by doctors, when you are in periods of dehydration, consuming salt may be the boost you need. Salt helps hold water in your body and prevent severe dehydration.

We All Need Salt

At least Dr. Malcolm Kendrick has humor and writes with it. The subject is serious and he takes it apart bit by bit and shows how we can be led astray by what we think we know. Even I have been caught in this. Talk about mistakes in blog writing, then read this where I made a serious mistake.

Keep in mind that salt (NaCl) and sodium (Na) are two different things. I like Dr. Kendrick's way of explaining it and I urge you to take time to read his blog linked in the first sentence.

Salt – Blood Pressure Debate Goes On

When scientists have an agenda, we get more conflicting views than scientific evidence. The salt-blood pressure message is one of the more hotly debated issues lately. One group says that reducing salt consumption would have no clear health effect and another group shows that the meta-analysis was faulty and proves it reasonably. Read the discussion here and read it carefully.

This is a good example of what bad science can do and how it misled people around the world with false headlines. At least others are continuing the debate and continue to encourage people to reduce salt intake.

Of course the salt industry body, the Salt Institute, does not agree and a vice president , Morton Satin plainly states, “this compulsion to regulate is being pushed by a gaggle of activist ideologues who have long ago abandoned science to take up the salt-bashing cudgel.” The Salt Institute is probably the group that has funded some of the worst science studies.

The World Health Organization has set a global goal to reduce dietary salt intake to less than 5g per person by 2025. The problem is not whether to reduce salt intake, but how to do it effectively. The problem is not the salt people add to food they cook, it is the salt that food processors add to food before it is sold and this is becoming a global trend.

They believe a four-point program is required and form the basis of a comprehensive policy. The first point would be establishing and evaluating a public awareness campaign for communication of the problem. Next would come a progressive salt targets for reformulating existing processed foods and engaging with the food industry in setting new standards for foods. This would be followed by surveying the population for salt intake, measuring the progress of reformulation and effectiveness of communications. Finally, engagement of the food industry, to include regulation to create a level playing field to not disadvantage the more enlightened and progressive companies.

The largest factor is the responsibilities of the food manufacturing industry to contribute to the process. To avoid future illness and expenses, everyone needs to participate to include industry, society, governments, academia, and health organizations. Denial and procrastination will only add cost to the outcome.

Writing in the British Medical Journal, UK researchers say that the United Nations needs to make reducing salt intake a global health priority. The also advocate that if voluntary measures do not work, nations should compel the food industry to cut salt levels in manufactured foods.

There are five articles related to this issue and I have listed one near the top and the other four are here for your information: Article 1, Article 2, Article 3, and Article 4.