If you doubt that salt really is your health’s number one enemy, you’re probably not alone. And this is the fault of people like me. I’ll be blunt: a lot of journalism about sodium intake is bullshit.
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These stories often begin by reporting on new observational studies—of people, of course—and instead of talking about what we should take from all the research that’s been done, they start with some vague suggestions about what the latest piece of the scientific puzzle has revealed. . be completed .
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There are now enough high-quality studies to make no mistake. The truth, according to science now, is pretty simple: A diet too high in sodium (two teaspoons or more of salt a day) can be harmful. A very low sodium diet (less than one teaspoon per day) can also be harmful. About a teaspoon (or 2,300 milligrams) is fine for most people.
Most Americans get more than that, mostly from salt added during food processing. Here’s an interesting side to the salt debate: For some people, extra salt intake isn’t a big deal. (More on that below.) And it’s the same for others, and sodium intake—unlike obesity or stress—is one of the few risk factors we can control when it comes to heart health. Therefore, salt has become the focus of many health campaigns.
So what does this mean for you? Here’s everything you need to know about salt intake and health. These results are unlikely to change anytime soon, barring massive research that shakes up all previous salt science.
Blood pressure refers to the force your heart uses to pump blood through your circulatory system. When you have high blood pressure (called hypertension), blood is pumped too hard, sometimes through narrowed arteries, which puts pressure on the heart and makes it work harder than it should. slow
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What does this have to do with salt? Blood is mainly composed of platelets and red and white blood cells suspended in a salt water solution. (Salt is also found in urine, tears, and many other body fluids, so the average adult has about three or four servings of sodium.)
If you eat a lot of salt, it will definitely be absorbed by the body, but your body will retain water with it to keep the sodium to water ratio constant. (This is why you get thirsty when you eat too much salty food.) As your body retains water along with salt, your cells expand, including your blood cells. Therefore, your blood volume swells and the pressure in your veins increases.
Some people’s bodies filter out excess sodium well, while others don’t. “Salt sensitivity” increases with age and hardening of the arteries. It is also more common among African Americans, obese people, and people with chronic kidney disease. (These are all “high-risk” groups for high blood pressure.)
The reason it’s so important to health is simple: high blood pressure is linked to heart attacks and heart failure, the leading causes of death in the United States. If we reduce our salt intake, we reduce the risk of developing high blood pressure and ultimately all of its mortality and destruction.
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The question of how much reducing salt intake can affect significant health outcomes such as mortality and cardiovascular disease has been hotly debated among researchers for two reasons.
A: There are a number of factors affecting blood pressure: genetics, exercise, body weight, alcohol consumption, stress, age, general diet. So it’s not just salt.
Two: Many of the studies linking salt intake to hard points such as disease and death have looked at short-term changes in blood pressure. But blood pressure is only an indicator or “surrogate endpoint” in health research. It is not an actual health outcome such as a heart attack or death. Conducting a trial—assigning thousands of people to a certain level of salt intake over many years to determine whether their diet is associated with an increased risk of cardiovascular disease and death—is much more difficult and expensive.
So the question is whether the temporary increases in blood pressure we see in our studies actually have long-term effects on heart and overall health.
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To truly answer this question, some argue that we need a large, randomized trial that examines different levels of sodium restriction and its effects on cardiovascular disease and death over five years in 20,000 patients. So far, no one has funded such research.
One of the best trials relied on by major public health agencies, the DASH study, lasted only 30 days and compared blood pressure levels in two groups of people who ate a normal diet or a low-sodium diet. (Again, they didn’t look at long-term disease or death.)
A 2014 meta-analysis that reviewed all the best studies on sodium intake concluded: “There was weak evidence of benefit for cardiovascular disease, but the findings were equivocal, and among nursing home residents, salt intake reduced in a trial in home kitchens.” Another study published in 2011 concluded that “we do not know whether low-salt diets improve or worsen health outcomes” and “more research is needed. “Reduction in salt intake is needed.”
A few years ago, the Institute of Medicine—an independent, nonprofit organization that provides medical advice—convened an expert panel to review all the evidence on low-sodium diets and health outcomes.
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In 2013, the group published a report in which they agreed that reducing sodium intake worldwide is desirable, but found no evidence that a very low-sodium diet even benefits anyone. These high-risk groups (despite what the Centers for Disease Control and Prevention currently recommends for high-risk populations).
“The only conclusion we can draw is that there is not enough research to make a recommendation to reduce sodium intake below 2,300 milligrams (or about one teaspoon) per day,” says Maria Uria, a scientist at the Institute of Medicine. Worked on the report so the IOM said based on the best evidence that about 2,300 mg per day is good for most people.
That’s what every expert I spoke to for this story agreed. “There’s no evidence that cutting sodium below 2,300 milligrams will do you any good,” says Michael Alderman, a sodium expert and professor at Albert Einstein College of Medicine.
He also noted that there has never been a nutrient with a linear relationship with health that ends in zero. In other words, the health benefits of nutrients are usually “J” shaped: If you plot sodium intake on the y-axis and cardiovascular events on the x-axis, you’ll see people. The healthiest fall somewhere in the middle
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Andreas Kalogropoulos of Emory University, author of a new study on sodium in JAMA Internal Medicine, examined the effects of salt intake on death, cardiovascular disease, and heart failure in older adults (ages 71 to 80). (This was not a large experiment, but an observational study based on data collected for a different purpose.) He also found that extremes are not helpful.
“There appears to be a ‘sweet spot’ for salt restriction, after which it is difficult to see additional benefits with further restriction,” he said. “On the other hand, in all studies, including ours, high salt intake (eg, two (a teaspoon or more of salt per day) has been harmful.”
“If it’s fresh, you don’t have to worry about sodium. The fact that it’s not naturally high in salt should tell people something,” said Norman Kaplan, a blood pressure researcher at UT Southwestern.
In the helpful chart above the story, you’ll see that restaurant meals are high in sodium and very low in fruits and vegetables.
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About 80 percent of the sodium you eat comes from salt added during food processing. Therefore, the easiest way to reduce salt is to avoid packaged foods and restaurant foods as much as possible. You don’t have to worry about salt when you eat your food (unless you sprinkle your food with a snow white coating).
This may not be easy in an environment where many of us rely on fast food, so some health officials are still calling on governments and industry to find ways to reduce salt in food processing.
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