Salt May Not be the Devil We Thought

June 01, 2011

Salt May Not be the Devil We Thought 

 Competency:  Safe Electrolytes Reference:  JAMA, May 4, 2011 

 This is downright confusing!  What’s a person to believe?  This study comes out and made headlines all over the place that a LOW SALT DIET RAISES YOUR RISK OF A HEART ATTACK.  Exactly opposite what we are meant to believe.  What did this study do to show that and how do I get some understanding? Here is what the researchers did.  They took a 24-hour urine sample on 3,681 healthy European men and women, under age 60 and measured the total amount of sodium they excreted.  This is the accurate gold standard for determining the amount of salt you eat.  So, their first measurement was precise.  

Then, they followed them for eight years to see what happened.  And the answer was….. Surprise!  They were all healthy when they started and didn’t have high blood pressure.  Over the course of the study, 6% of them had a heart attack, and 2% died of heart attacks or strokes.  What they found was that those with the LEAST sodium consumption had a 56% GREATER risk of death from a heart attack or stroke than those with the most. That’s backwards!  It’s meant to be the other way around.  

Science is so frustrating when it turns us on our expectations with good data.  Was this good data?  It may not have been.  They only took one sodium sample by way of 24-hour urine.  That may not have been an accurate portrayal or real intake.  A few more over those 8 years would have helped.  And they were all rather slender folks, compared to us Americans.  And they were all pretty Caucasian, and Americans are now black, white, brown, and everything in between.  

So, does it apply to us? What’s my personal bias?  Well, I’ve made a switch in my beliefs in the last 5 years.  I used to think hypertension and heart disease was all linked to salt.  I don’t anymore.  I think hypertension is a reflection of inflammation in the arteries, “endothelial dysfunction” if you will.  And our arteries are pretty simple little devils. They can only do a few things:  relax and stretch or constrict and narrow.  Or they can put out hormones and call in the helper troops – like white cells when they get stressed out.  Where does inflammation come from? A lot of sources, but salt isn’t necessarily one of them.  

Sugar and white carbs, however, are.  Sugar, with its fructose forces you to put out uric acid and uric acid wipes your arteries clean of nitric oxide.  And nitric oxide is what makes your arteries relax.  Hence, I believe its sugar that really causes hypertension.   Insulin, induced by sugars of all kinds, is a very potent stimulus for the kidneys to retain salt.  Salt makes it worse once it’s in place.  But the core enemy is sugar. 

 WWW. What Will Work for me.  I think it’s important to know that we are currently trying to cut down on sodium.  I don’t add it to any food anymore.  I believe we should use less.  There is so much data out there, it’s hard to refute with one study.  But I believe sugar is worse.  It’s harder to cut down on sugar than salt.    But this was a well-done study, conducted prospectively.  I’m going to watch for more.  Still not adding the saltshaker back.

Column written by Dr.John E. Whitcomb, MD at Brookfield Longevity, Brookfield, WI.