Dietary Salt And Heart Health—What To Believe?

People with high blood pressure are generally advised to reduce their intake of dietary salt. The average U.S. salt consumption is about 3,400 mg per day, but the latest Dietary Guidelines for Americans recommend keeping sodium intake below 2,300 mg per day for healthy people, and under 1,500 mg for people with high blood pressure and for those at risk of high blood pressure, most notably blacks and people over age 50. These groups make up about 70 percent of the U.S. population. The American Heart Association recommends that everyone should consume less than 1,500 mg of sodium per day.

These recommendations come from the results of the DASH (Dietary Approaches to Stop Hypertension) studies, which have found that a reduction of salt intake to below 1,500 mg per day is an effective method for reducing blood pressure.1 Whether or not the reduction of dietary salt leads to further cardiovascular benefits has been a subject of debate, however.

In July of this year, a controversial2 Cochrane Review published in the American Journal of Hypertension found that recommendations for a reduction in salt intake did lead to reduced salt consumption and a small reduction in blood pressure after six months, but that, “cutting down on the amount of salt has no clear benefits in terms of likelihood of dying or experiencing cardiovascular disease,” concluded the study.3 In fact, one finding of the study was an increase in the risk of death in people with congestive heart failure. The lead researcher stated, “We believe that we didn’t see big benefits in this study because the people in the trials we analyzed only reduced their salt intake by a moderate amount, so the effect on blood pressure and heart disease was not large.”

The saga continues with a recent Cochrane Review, also published in the American Journal of Hypertension, which reviewed 167 studies and found that reduction of dietary salt intake resulted in a modest 1 percent decrease in blood pressure in Caucasians with normal blood pressure and a 3.5 percent decrease in Caucasians with high blood pressure.4 Further, the study also found that salt reduction increased renin, aldosterone, adrenaline and noradrenaline (all hormones that affect blood pressure), in addition to raising cholesterol by 2.5 percent and triglycerides by 7 percent. These potentially harmful effects call into question the recommendation to reduce salt intake in Caucasians on cardiovascular risk overall.

The major source of sodium in the Standard American Diet (SAD) comes from processed food—cheese, bread, pizza, and grain-based foods and desserts being the main sources. This is a problem in itself. Perhaps it’s not the sodium that is the major contributor to cardiovascular risk, but rather the overall poor quality of the diet. Processed foods, refined grains, sugars, and chemical additives have turned the American diet into a ticking time bomb for heart disease—and most all chronic disease, for that matter. Remember that salt, in its natural form (from the sea) contains an array of minerals that help support nutrient sufficiency in the diet. Sea salt, like any salt, should be consumed in moderation—don’t overdo it, but you might not want to reduce levels as drastically as have been recommended.

The good news is there are other ways to eat a tasty (or even spicy) moderate amount of salt in your food:  Herbamare is a product which contains sea salt, lemon, fennel, leek, onions, chives, parsley, dill, basil, carrots, garlic, bay leaves,  marjoram, rosemary, thyme, chili, and kelp. Some varieties have hotter chili for those who like it. In addition, adding more kelp, nori, or dulse, all sea vegetables, adds more minerals (including iodine) in a natural form that would be beneficial for most everyone.  Through the use of medicinal foods like these, eating can be a joy that balances salt and herbs, providing much more than just table salt. And now for dessert:  It turns out that dark chocolate and almonds are quite beneficial in lowering blood pressure as well.

 

References

  1. F.M. Sacks, et al., “Effects on blood pressure of reduced dietary sodium and the Dietary Approaches to Stop Hypertension (DASH) diet. DASH-Sodium Collaborative Research Group.” N Engl J Med. 2001 Jan 4;344(1):3-10.
  2. F.J. He and G.A. MacGregor, “Salt reduction lowers cardiovascular risk: meta-analysis of outcome trials.” Lancet. 2011 Jul 30;378(9789):380-2.
  3. R.S. Taylor, et al., “Reduced dietary salt for the prevention of cardiovascular disease: a meta-analysis of randomized controlled trials (Cochrane review).” Am J Hypertens. 2011 Aug;24(8):843-53.
  4. G. Jurgens and N.A. Graudal, “Effects of low sodium diet versus high sodium diet on blood pressure, renin, aldosterone, catecholamines, cholesterols, and triglyceride.” Cochrane Database Syst Rev. 2004;(1):CD004022.
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