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    High Salt Intake Health Risk Debunked?
    By News Staff | May 15th 2008 12:45 PM | 15 comments | Print | E-mail | Track Comments
    High-salt diets may not increase the risk of death, contrary to long-held medical beliefs, according to investigators from the Albert Einstein College of Medicine of Yeshiva University.

    They reached their conclusion after examining dietary intake among a nationally representative sample of adults in the U.S. The Einstein researchers actually observed a significantly increased risk of death from cardiovascular disease (CVD) associated with lower sodium diets.

    The researchers analyzed data from the Third National Health and Nutrition Examination Survey (NHANES III), which was conducted by the federal government among a nationally representative sample of U.S. adults. These data were then compared against death records that had been collected by the government through the year 2000. The sample of approximately 8,700 represented American adults who were over 30 years of age at the time of the baseline survey (1988-1994) and were not on a special low-salt diet.

    After adjusting for known CVD risk factors, such as smoking, diabetes and blood pressure, the one-fourth of the sample who reported consuming the lowest amount of sodium were found to be 80% more likely to die from CVD compared to the one-fourth of the sample consuming the highest level of sodium. The risk for death from any cause appeared 24% greater for those consuming lower salt, but this latter difference was not quite large enough to dismiss the role of chance.

    “Our findings suggest that for the general adult population, higher sodium is very unlikely to be independently associated with higher risk of death from CVD or all other causes of death,” says Dr. Hillel W. Cohen, associate professor of epidemiology and population health at Einstein.

    Since the first NHANES survey in the early 1970s, data from NHANES have been used extensively to describe patterns of nutrition and health in the U.S. The results from this current study are consistent with findings reported previously from two earlier NHANES surveys. While the federal government currently repeats NHANES surveys every two years, NHANES III is the latest available survey that can be compared with later death records.

    Since NHANES III was an observational study and not a clinical trial, no definite conclusions about cause and effect were possible, says Dr. Cohen. “However, our findings do again raise questions about the usefulness or evensafety of universal recommendations for lower salt diets for all individuals, regardless of their blood pressure status or other health characteristics,” he cautions.

    Article: Hillel W. Cohen, Susan M. Hailpern and Michael H. Alderman, 'Sodium Intake and Mortality Follow-Up in the Third National Health and Nutrition Examination Survey (NHANES III)', Journal of General Internal Medicine ISSN 0884-8734 (Print) 1525-1497 (Online) DOI 10.1007/s11606-008-0645-6

    Comments

    Laura Collins
    It is always refreshing to see scientific observation of chronically retailed ideas!
    Laura Collins www.EatingWithYourAnorexic.com
    This makes sense. People on sodium-restricted diets are on them because of extant health problems, such as high blood pressure.

    FREE ADVICE ABOUT SALT IN THE DIET BORDERS ON THE CRIMINAL SIDE OF LIFE. Too much or too little salt is fatal. Many other health problems result from salt excess or deficiency.

    In the 1930 there was a popular movement to eliminate salt in the diet. One of my sisters died of salt deficiency during that time. My other sister went into convulsions but recovered. My brother was hospitalized from salt deficiency. Our family doctor saved my life by injecting me with salt water in the hospital emergency room. Then the popular movement declined and was largely forgotten.

    A British health care study of infant fatalities in the 1980's reported on BBC short wave World Wide Service concluded that the cause of sudden death for 50,000 babies was salt loss during minor childhood illness. Now every parent has the rehydration fluids that are essential salt water with minerals.

    In the 1990’s salt replacement of sodium with potassium became popular. It continued until the families that practiced it had kidney stones in the father, or one of the children died.

    Of the many popular movements the one I like best is for use of refined sea salt in moderation.

    Moderation was popular for 3000 years as a help for good health. In recent times everything is done to excess, leading to a variety of disasters.

    The readers may realize that a lot of books that say use no salt, are written by people from Phoenix where the salt river provides the local water supply. That would have been a joke if so many people had not died.

    Many years ago in defense of my dissertation, one question was about an area of California that gets enough rain to wash all of the minerals out of the soil. My research topic was not environmentally friendly, but I survived the questions by quoting from an old study of podsolized soil in north west Russia.

    If a person lives in such a place, then a balance of salt is vital for life. One historian has claimed that a salt shortage forced Napoleon to withdraw from Moscow in bad weather.

    There is a lot of nonsense about salt in the diet. The same advice is not good for everyone. In the past week an older lady remarked that her doctor has restricted her to 1500 milligrams of sodium per day. That is 1.5 grams of sodium or the equivalent of 3.8 grams of table salt, about one and a half teaspoons of salt. I replied that it sounded like a lot, and I didn’t know anyone who actually uses that much salt.

    It pays to read the labels on prepared food. Another friend showed me a package of noodles that has 900 milligrams of sodium in it.

    Different people have different needs. One group of people eat mostly steak and potatoes with salt on it. That is the antidote for a low level of chronic fluoride poisoning. Is it really a good idea to give free advice on what to eat, and the same advice to everyone?

    The answer on salt is that every one needs to get advice that is appropriate to their own situation, and not follow fads and popular movements.

    This study is MAJORLY flawed. In controlling for blood pressure in assessing the relationship between sodium intake and CVD a primary pathway by which sodium consumption influences CVD is interrupted. This means that any association between sodium and CVD will be weakened, diminished altogether, or even reversed. I can't even believe this paper was published as is, unless the authors of this article just took a finding from the study that it wasn't meant to make. As a public health student who understands epidemiological research, I think this is appalling. Perhaps will use this article as a case example of POOR media reporting on scientific matter. Check out my blog for true public health/scientific news and analysis.

    This study was paid for by the food and beverage industry.

    Not only that but it goes against the consensus of scientific research. I would approach this study with a skeptical eye and be sure to read all the studies that confirm that salt has a deletrious effect on the cardiovascular system.

    By the way I'm to the right of Attila the Hun so the "nanny state" smear won't work on me.

    Hank
    All research is paid for by someone so disqualifying it on funding rather than merit is a logical fallacy as well as an ethical smear on the researchers.  Are some researchers for sale?  Sure, but saying that all are means 50% of Americans that are Republican can't believe the 75% of academics who are Democrats and that is just not the case.
    NHANES III was an observational study and not a clinical trial, no definite conclusions about cause and effect were possible
    This audience is not composed of subliterate hillbillies and the ? at the end of the title means it is not a statement but rather a question about whether or not previous research was overreacting.

    'Consensus' is a bad word in science.   People don't vote on accurate data.   The IPCC's reputation went right to hell after 2001 when they threw out everyone who disagreed about the causes and impacts of global warming and simply voted on what temperature rise to tell the public to expect.
    The idea that salt does not contribute to high blood pressure in an otherwise healthy individual is nothing new. High blood pressure is a symptom of organ damage. If your organs, particularly your kidneys, are not healthy then you will likely end up with high blood pressure. Attempting to "cure" high blood pressure by limiting salt intake is akin to trying to "cure" cancer by giving the patient pain meds. Sure he's still got a disease killing him, but at least the symptoms are being covered up.

    Does the body flush salt daily - or mantain the intake from day to day.

    Good to know about the discovery!
    home health aide certification

    My wife and I are in our middle to late 70's. We virtually live on animal protein (venison, fish, crustaceans and fowl) and use salt quite liberally. We both have blood pressure readings in the 105-110 over 60-65. Cholesterol readings are low and we have had no major illnesses.
    What I'm leading up to is just this. We're totally healthy and quite active hiking nearly every day and working on our liveaboard sailboat. How is it that all those on the recommended diet are so sickly? They have arthritis, gout, cancer, colon disease and seem to always have some respiratory disease. Give me a break. There's something wrong with that recommended diet since it definitely does not promote even marginally good health.

    My wife and I are in our middle to late 70's. We virtually live on animal protein (venison, fish, crustaceans and fowl) and use salt quite liberally. We both have blood pressure readings in the 105-110 over 60-65. Cholesterol readings are low and we have had no major illnesses.
    What I'm leading up to is just this. We're totally healthy and quite active hiking nearly every day and working on our liveaboard sailboat. How is it that all those on the recommended diet are so sickly? They have arthritis, gout, cancer, colon disease and seem to always have some respiratory disease. Give me a break. There's something wrong with that recommended diet since it definitely does not promote even marginally good health.

    My wife and I are in our middle to late 70's. We virtually live on animal protein (venison, fish, crustaceans and fowl) and use salt quite liberally. We both have blood pressure readings in the 105-110 over 60-65. Cholesterol readings are low and we have had no major illnesses.
    What I'm leading up to is just this. We're totally healthy and quite active hiking nearly every day and working on our liveaboard sailboat. How is it that all those on the recommended diet are so sickly? They have arthritis, gout, cancer, colon disease and seem to always have some respiratory disease. Give me a break. There's something wrong with that recommended diet since it definitely does not promote even marginally good health.

    I don't think you have to be a doctor to know that not having enough salt can be bad for you, but I think this study is very hard to take seriously. For example, there were only about 40 deaths from the people that were on a low salt diet, and I remember reading somewhere that almost half of them had preexisting things like being a smoker that made them more susceptible to heart disease. All of the test subjects were also 40, which is a little weird since I thought that most heart disease doesn't hit you until you're past your 50s.

    This is a surprise? Sodium balance is regulated by the kidneys, studies dating back to the 1980's have shown that sodium ingestion and sodium excreted in the urine share a positive linear relationship (with a high confidence level p=<0.0001). Although the relationship is not perfect (i.e. 1mg Na+ in is not equal to 1mg Na+ out in urine), this can be easily explained by the fact that the colon (and upper GI tract) is not a perfectly efficient system of electrolytic absorption, and sodium is lost in the form of sweat and tears. So if the functional sodium level in the blood stream is always kept constant (the plasma is cycled/filtered ~50-60 times per day in an average, healthy human male) how could it possibly be a risk factor, unless one has a congenital disease which modifies their basal sodium balance.

    Moreover, it should be made clear that nutritionist thought (in the last decade) is not that a long term diet that is high in sodium is a risk factor for heart disease and other circulatory dysfunctions, but that having rare to occasional meals that are high in sodium over an extended period of time would cause the aforementioned disorders. This line of reasoning has no grounding in reality, so I think we should be asking ourselves why this theory is so prevalent and what other commonly held axioms of modern nutritionists are also falsehoods. We are returning to the primitive.

    J T Holbrook, K Y Patterson, J E Bodner, L W Douglas, C Vellon, J L Kelsay, W Mertz, & J C Smith. Sodium and potassium intake and balance in adults consuming self-selected diets. Am J Clin Nutr. 40: 786-793 (1984).