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Thewayheadlinessound,you'dgetthe
impressionthateatingabagofchipswillraise
yourbloodpressureenoughtohaveastroke
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What'sthedealwithsalt?Youknowyouneedsomeofit,buteverywhereyouseeadvertisingand
headlinestellingyoutoeatlessofit.Youmighthavesaltcravingsbutyoufeelguiltyindulgingin
thembecauseyou'veheardfromeveryone,thegovernmenttopersonaltrainerstoyourmother
inlaw,thatsaltisbadforyou.

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ByMarleneMerritt,DOM,LAc,ACN

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AcupunctureToday
August,2013,Vol.14,Issue 08

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LikeallthetopicsI'vewrittenabout,it'snot
thatsimpletosaysaltis"good"orbad."One
thingtokeepinmindisthatsaltissovitalfor
humanhealththat"sal"isthebasisoftheword
"salary"becausepeopleusedtobepaidinsalt.
Sodiumandchloridearebothvitalminerals,
usedfornervetransmission/impulse
conduction,fluidbalance,andmuscle
contraction.Nothavingenoughsodiumwill
causehyponatremia,alifethreatening
conditionthathappenswhensomeonesweatsouttoomuchsodium,ordrinkstoomuchwater,
andupsetsthefluidbalance.

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Saltisaprimedeterminantfortasteinfood(alongwithfat)and80percentofthesaltwe
consumeisinprocessedfoods,makingitdifficulttoavoid.Themessagepromotedbyboththe
NationalHeart,Lung,andBloodInstitute(NHLBI)andtheNationalHighBloodPressureEducation
Program(NHBPEP),acoalitionof36medicalorganizationsandsixfederalagenciesisthat
everyonenotjustpeoplewithhypertensionwouldbenefitfromadailyintakeof2,400mgor
sodium(6gramsofsalt,orabout1teaspoon)perday,whichis4gramslessthanourcurrent
average.
Theproblemliesinthefactthattheresearchdoesnotconclusivelyshowthatareductionhelps
withbloodpressureandactuallyshowsthatlowlevelscouldleadtohealthproblems."Youcan
saywithoutanyshadowofadoubt,thatthe
NHLBIhasmadeacommitmenttosalteducation
thatgoeswaybeyondthescientificfacts,"said
DrummondRennie,aJAMAeditoranda
physiologistattheUniversityofCalifornia.
Oneofthefirststudiesthatshowedhowdiet
loweredbloodpressurewasaDukeUniversity
clinicianwho,inthe1940s,showedhecould
successfullytreathypertensionwithalowsalt,
peachesandricediet.Ifpatients'hypertension
didn'timprove,Kempnersaiditshowedthatthe
patienthadclearlyfallenoffthediet.Itwascited
fordecadesasevidencethatlowsodiumdiets
couldtreathypertension,butthereareacoupleofverylargeproblemsthatwereconveniently
overlookedKempner'sdietwasalsolowincaloriesandfat,aswellashighinpotassium,and
thoseareallfactorsthatarealsoknowntolowerbloodpressure.
Amajorproblemwithsomeofthebiggeststudiesinvolvingsaltarethattheyareepidemiological
studies,whichareknownforshowingacorrelationandnotactualcausality.AsImentionedinmy
previousarticle"ThatStudyIsWrong:TheTruthAboutResearch,"epidemiologistsevensuspect
theirownstudiesandcallita"pseudoscience."Inthisparticularfield,itwouldbefairtosaythat
thereissomuchbiasthatresearcherswillnotconsiderresearchthatdoesn'tsupporttheirown
position,andcombinedwiththetendencytociteresearch,accurateornot,createsacasethat
looksasifapositionhasmore"evidence"thanitactuallydoes.

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Forexample,in1991,a14pageepidemiologicalstudywasprintedintheBritishJournalof
Medicine,concludingthatthesalthypertensionlinkwas"substantiallylarger"thanpreviously
thought.Thatsameyear,researcherJohnSwales,formerdirectorofresearchanddevelopmentfor
Britain'sNationalHealthService,dissectedthestudysocompletelythatnooneattheEuropean
SocietyforHypertension'sconferencewasleftunclearbyhowshoddytheresearchwas.Andyet
twoyearslater,thatsamepaperwascitedrepeatedlybytheU.S.NHBPEPascompellingevidence
toreducesodiumintake.Infact,Swalesrepeatsthisthoughtinapaperin2000,saying,"Reviews
biasedbytheinclusionofnonrandomizedstudiesexaggeratetheapparentbloodpressurefall
Nevertheless,citationanalysisshowsthattheyarequotedmuchmorefrequentlythanrigorous
reviewsreachingmorenegativeconclusions.Thisappearstobetheresultofanattempttocreate
animpressionofscientificconsensus."
Here'sthefirstthing:therearesomepeopleforwhomsaltisproblematic,butthereisnotestfor
"saltsensitivity"andeventheconditionitselfisnotfullyclarified.Itmayberelatedtorace(one
studysawanassociationwithAfricanAmericans),orgender,orage,aswellasapossiblegenetic
link.However,becauseyoucannotpredictwhoissaltsensitive,we'releftwithcreating
generalizedrecommendationsthatmaynotactuallybenefitsensitiveindividuals,butmayalso
harmtherestofthepopulation.
Sohowdoesloweringsaltintakecauseharm?Letuscounttheways,startingwithcardiovascular
disease.Whilehypertensionisoftenblamedasacauseforheartdisease,lowsodiumhasbeen
directlylinkedmultipletimestoincreasedcardiovasculardeaths,andanother2011study
confirmedthis.Infact,thislaststudyalsosawthatsodiumlevelsdidn'tpredicthypertension,and
thatanyassociationbetweenbloodpressureandsodiumdidn'tactuallytranslateintoless
morbidityorbettersurvival.
Lowsaltdietsalsoincreasecholesterolandtriglyceridesintheblood.Infact,peoplewithType2
diabetesaremorelikelytodieprematurelyonalowsaltdiet,duetocardiovasculardisease.A
Harvardstudyshowedthatlowsaltdietswerelinkedtoanimmediateonsetofinsulinresistance.
Andyetdoctorsareconsistentlyrecommendingsaltrestrictiondietstodiabetics.
Instudieswiththeelderly,sodiumrestrictioncanbeespeciallydamaging.Ithasbeenshownthat
lowsaltintakeleadstomorefallsandbrokenhips,anddecreasedcognitiveabilities.
Hyponatremia(lowsodium)iscommonlyfoundingeriatricpatients,andyetitisrepeatedad
nauseumthatolderpeopleshouldbeloweringtheirsaltintake.
Youmaynotrealizethis,butthisisnotnecessarilynewinformation.Therehavebeenarticlesin
theNewYorkTimesaboutthedangersoflowsaltintakeandtheresearchsupportingitin2010
andagainin2013.

AlternativeHealthNews

Sodiumintakehasn'tchangedmuchindecades,andthatcertainlyseemstostandtruein
ReducingInflammatory
research:instudiesmeasuringurinarysodiumexcretion,spanningfivedecades,over30countries,
MarkersinMSPatients
WithHighDoseVitaminD
andover50,000subjects,thenormalrangeofsodiumexcretionis3,500mg/day.Thislaststudy
Num e rousstudie ssugge st
alsopointsoutthatreninangiotensinaldosteronesystem(RAAS)isaprotectivemechanismto
lowle ve lsofvitam inDin

preventthelossofsodium.Assodiumisclearlythebackboneofextracellularfluid,ensures
the bloodare strongly
link e dtoincre ase drisk of
adequatebloodvolume,arterialpressureandultimatelyorganperfusion,tomake
de ve lopingm ultiple
recommendationsbelow2,760mg/d(whichactivatestheRAASreaction)assumesthatbasic
scle rosis(MS)andthat
biologyisbeingignored,andthatloweredintakesarenotharmful(andclearlythereisplentyof
MSpatie ntswithlowblood
le ve lsofvitam inD(25
researchshowingthis).In2009,McCarronetal.sawinthis26yearstudythatsincesodiumcan't
hydrox ychole calcife rol)are
bestored,itistightlyregulatedbythebody,regardlessofhowmuchisinthediet,and"that
m ore lik e lytohave
publichealthinitiativesdesignedtolowerintakesofthisnutrientbyalteringthefoodsupplyare
destinedtofail."
Whatistrueisthatlittletonodistinctionisbeingmadebetweenthesaltinprocessedfoodsand
whatisfoundnaturallyinfreshfoodsorwhatyoumightaddatthetable.Themainsourcesof
sodiumintheU.S.dietaregrainmixtures(mainlypasta,breadsandrolls),andprocessedmeats
likefrankfurters,sausagesandlunchmeats.ThiswouldbewhythefamousDASHdiet(Dietary
ApproachestoStopHypertension)withitsemphasisongenerousamountsoffreshfruit,
vegetablesanddairyiseffectiveforloweringbloodpressureitissimplyremovingmostsources
ofprocessedfoods.It'salsoconsideredbymanytobeapreferablealternativetoacrossthe
boardsodiumrestriction.
Whichisalsoexactlywhatisseeninresearchstudiesthatlookedatfreshfood,cookedat
home,(withsaltaddedforflavor)sawnoimpactonbloodpressure,butpeoplewhoateout
frequently,andateprocessedfoodsregularlyhadamuchhigherincidenceofhypertension.If
hypertensionisaconcern,itwouldbegoodtoalsoboostpotassium,asinadequatepotassiumwill
stillcausehypertension,evenifeatingalowsodiumdiet.Potassiumishighestinfreshfoodslike
leafygreens,bananas,avocados,melons,mangoandprunes.Additionally,weightlossand
reductionofalcoholintakeareknowntobeextremelyeffectiveatreducingbloodpressure.
ThecurrentU.S.recommendationsare2,300mg/day.TheAmericanHeartAssociationwouldprefer
thateveryoneconsumeaslittleas1,500mg/day,clingingtoantiquatedresearchnotproven.In
fact,inlightoftheoverwhelmingevidence,theDepartmentofHealthandHumanServiceswillbe
revisingthesodiumguidelinesin2015.Inthemeantime,bringbackyourcommonsenseabout
food,andavoid"quickfixes"withstoreboughtfoodandeatasmuchfreshfoodandfoodthatyou
preparedasoftenasyoucan.
References
1.Taubes,Gary."Threedecadesofcontroversyovertheputativebenefitsofsaltreduction
showhowthedemandsofgoodscienceclashwiththepressuresofpublichealthpolicy."
Science281(1998):898907.
2.Smith,G.andEbrahim,S."EpidemiologyIsItTimetoCallItaDay?"Int.J.Epidemiol.(2001)

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TheTruthAboutSalt
30(1):111
3.Swales,J.D."Dietarysaltandbloodpressure:theroleofmetaanalyses."Journalof
Hypertension.Supplement:officialjournaloftheInternationalSocietyofHypertension9.6
(1991):S42.
4.Swales,John."Populationadviceonsaltrestriction:thesocialissues."AmericanJournalof
Hypertension13.1(2000):27.
5.O'Donnell,MartinJ.,etal."Urinarysodiumandpotassiumexcretionandriskofcardiovascular
events."JAMA:thejournaloftheAmericanMedicalAssociation306.20(2011):22292238.
http://jama.jamanetwork.com/article.aspx?articleid=1105553
6.StolarzSkrzypek,Katarzyna,etal."Fatalandnonfataloutcomes,incidenceofhypertension,
andbloodpressurechangesinrelationtourinarysodiumexcretion."JAMA:thejournalofthe
AmericanMedicalAssociation305.17(2011):17771785.
7.Mann,Samuel."Urinarysodiumexcretionandcardiovascularevents."JAMA:TheJournalofthe
AmericanMedicalAssociation307.11(2012):11381139.
8.Tikellis,Chris,etal."Associationofdietarysodiumintakewithatherogenesisinexperimental
diabetesandwithcardiovasculardiseaseinpatientswithType1diabetes."ClinicalScience
124.10(2013):617626.
9.RajeshGarg,GordonH.Williams,ShelleyHurwitz,NancyJ.Brown,PaulN.Hopkins,GailK.
Adler.Lowsaltdietincreasesinsulinresistanceinhealthysubjects.MetabolismClinicaland
ExperimentalVolume60,Issue7,Pages965968,July2011
10.Geboy,AlexanderG.,DawnM.Filmyer,andRichardC.Josiassen."MotorDeficitsAssociated
WithMild,ChronicHyponatremia:AFactorAnalyticStudy."JournalofMotorBehavior44.4
(2012):255259.
11.Ayus,JuanCarlos,etal."Ischronichyponatremiaanovelriskfactorforhipfractureinthe
elderly?."NephrologyDialysisTransplantation27.10(2012):37253731.
12.DavidAMcCarron,TilmanBDreke,EdwardMStrickerSciencetrumpspolitics:urinarysodium
datachallengeUSdietarysodiumguideline.AmJClinNutrNovember2010vol.92no.51005
1006
13.McCarronDA,GeerlingJC,KazaksAG,etal.Candietarysodiumintakebemodifiedbypublic
policy?ClinJAmSocNephrol.20094:18781882.
14.DeSimone,JohnA.,etal."Sodiuminthefoodsupply:challengesandopportunities."Nutrition
reviews71.1(2013):5259.
15.RDMattesandDDonnelly.Relativecontributionsofdietarysodiumsources.JAmCollNutr
August1991vol.10no.4383393

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Jointhediscussion
barbaraburns,l.ac. 3yearsago

Nicejob.Compellingevidence,balancedoverview.Muchappreciateyoutakingonthe
"dinosaurs"ofnutritionwithfreshness,verveandauthority.
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