Salt

It's hard to admit that you made a mistake. Many people dig in their heels and find ways to rationalize their point of view. That's true in health as well as in politics.

Take sodium, for example. The American Heart Association has been pushing the public for years to reduce sodium intake to less than 1,500 mg daily. Their experts believe that salt raises blood pressure and consequently increases the risk for heart attacks and strokes.

Very few people actually achieve the goal of limiting sodium intake to 1.5 grams or less. To do that, you would have to eliminate the saltshaker from the table. More importantly, you would have to avoid most processed foods, including soup, sandwiches, bread, crackers, chips, salsa, pizza, bacon, salad dressing, cereal and cookies.

How good is the evidence behind the low-salt policy? Over the past several years, a number of studies have questioned the benefits of drastic salt restriction.

The most recent was published in The Lancet and included data on approximately 95,000 middle-aged people in 18 different countries (Aug. 11, 2018). Urine tests were used to measure sodium and potassium intake, and the scientists followed up on their subjects for about eight years. They received information on blood pressure, strokes, heart attacks and deaths.

At moderate levels of intake (3 to 5 grams daily), increased sodium did raise blood pressure a little bit, but it lowered the risk of dying from a heart attack. People who consumed the least sodium were more susceptible to heart attacks and strokes. That flies in the face of the AHA recommendations.

Dr. Andrew Mente, the lead author on the study, notes that most people around the world consume between 3 and 5 grams of sodium daily. He suggests that such levels may actually be healthful.

People who consumed a lot of sodium (more than 5 grams a day) not only had elevated blood pressure but also a higher risk of strokes. Most of them were in China, where the source of sodium on the table is soy sauce rather than the saltshaker.

The most striking finding: More potassium is protective. People who got more potassium had a lower likelihood of heart attacks and strokes than those who consumed less. Perhaps this is why vegetables and fruits are so beneficial in our diets.

This is not the first study to suggest that following a very low sodium diet could backfire. A meta-analysis of 25 prior trials concluded that very low sodium and very high sodium intakes were both associated with an increased risk of death (American Journal of Hypertension, September 2014).

Dr. James DiNicolantonio of Saint Luke's Mid America Heart Institute has been critical of the move to restrict salt to extremely low levels. In a recent analysis, he joined with cardiologist Dr. James O'Keefe to conclude: "Prospective studies support the notion that those consuming the lowest amounts of salt are at the highest risk of cardiovascular events and premature death" (Current Opinion in Cardiology, July 2018).

Perhaps it is time, as Drs. O'Keefe and DiNicolantonio suggest, for dietary guidelines to be changed. Salt, in moderation, is not our enemy. Potassium is our friend, especially when we consume it in fresh fruits and vegetables.

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Joe Graedon is a pharmacologist. Teresa Graedon holds a doctorate in medical anthropology and is a nutrition expert. Their syndicated radio show can be heard on public radio. In their column, Joe and Teresa Graedon answer letters from readers. Write to them in care of King Features, 628 Virginia Drive, Orlando, FL 32803, or email them via their website: www.PeoplesPharmacy.com.

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