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Old 10-24-2010, 10:34 AM
bardos bardos is offline
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Is there any proof that salt is related to hypertension?

I know it's taken for granted and is ingrained in the public mind as well as 99.9% of all doctors. But what is the proof of this relationship?
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Old 10-24-2010, 10:47 AM
WhyNot WhyNot is offline
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Except for a very small portion of patients with kidney problems, no.

And yes, most doctors know this. The thing is, patients like to "do something" when they're ill, and letting people reduce their sodium intake is something they can do to take control of their diet. Furthermore, by reducing sodium, people tend to inadvertently make actually useful changes as a side effect, like choosing less processed foods which are high in sodium and more fresh vegetables low in sodium. Finally, reducing sodium is not going to hurt them. No one, simply no one, is actually deficient in sodium in our culture unless they've got some really rare disorder. Even "hyponatremia" (low serum sodium level) is not because of too little sodium, but because of too much water in the blood making the sodium hang out in the wrong place in the body.

So, it won't hurt. It might, secondarily, lead people to make better food choices which will help. But no, for the vast majority of people, simply eating sodium isn't going to cause hypertension.

http://www.health-report.co.uk/sodiu...lt_myths2.html
http://www.ajcn.org/cgi/content/full/71/5/1013
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Old 10-24-2010, 10:52 AM
Bill Door Bill Door is offline
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While most people, 90% or more, are not salt sensitive and will not have their blood pressure increased by dietary sodium, if you are hypertensive, you're probably in the group that is salt sensitive. If you don't have hypertension, don't worry about sodium, but if you do, cutting back couldn't hurt.
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Old 10-24-2010, 12:54 PM
abderian abderian is offline
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I'm not so sure about reduced sodium being advisable for only those with kidney issues or salt-sensitivity. See this (my emphasis added):

Arterial hypertension and salt intake (2010)
http://www.ncbi.nlm.nih.gov/pubmed/20649075

From the abstract:
“High salt intake increases total peripheral vascular resistance, induces oxidative stress and inflammation, thus accelerating the atherosclerotic process. . . . Interventional studies have shown that salt intake reduction is associated with lower blood pressure and lower cardiovascular morbidity and mortality. Reducing salt intake in daily meals should be the main measure in primary prevention of cardiovascular and renal diseases, and it should be repeatedly emphasized not only to hypertensive patients, but also to the population at large.”


The effect of nutrition on blood pressure (2010)
http://www.ncbi.nlm.nih.gov/pubmed/20645853

From the abstract:
“. . . High sodium chloride intake strongly predisposes to hypertension. Increased alcohol consumption may acutely elevate blood pressure. High intakes of potassium, polyunsaturated fatty acids, and protein, along with exercise and possibly vitamin D, may reduce blood pressure. Less-conclusive studies suggest that amino acids, tea, green coffee bean extract, dark chocolate, and foods high in nitrates may reduce blood pressure. Short-term studies indicate that specialized diets may prevent or ameliorate mild hypertension; most notable are the Dietary Approaches to Stop Hypertension (DASH) diet, which is high in fruits, vegetables, and low-fat dairy products, and the DASH low-sodium diet. Long-term compliance to these diets remains a major concern.


Does the consumption of salt and food rich in sodium influence in the blood pressure of the infants? (2010)
http://www.ncbi.nlm.nih.gov/pubmed/20640298
From the abstract:
“ The medium consumption of salt found in this population was of 7.66 g (3098.81 mg or 133.86 mEq), which is above the recommended in the present literature. Canned food was related to be rich in sodium and to be associated with high levels of systolic blood pressure. In conclusion, as higher the salt consumption, higher the systolic blood pressure.”


Influence of Dietary Potassium and Sodium/Potassium Molar Ratios on the Development of Salt Hypertension (1972)
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2139217/

From the abstract:
“Among genetically hypertension-prone rats, dietary sodium (chloride) was demonstrably hypertensinogenic and potassium (chloride) antihypertensinogenic . . . At equivalent molar ratios, the respective effects of these two ions on blood pressure were dominated by that of sodium. It was concluded that the dietary Na/K molar ratio can be an important determinant for the severity, or even development, of salt-induced hypertension.”

Salt-sensitive hypertension is triggered by Ca2+ entry via Na+/Ca2+ exchanger type-1 in vascular smooth muscle (2004)
http://www.nature.com/nm/journal/v10...bs/nm1118.html

From the abstract:
“Excessive salt intake is a major risk factor for hypertension.”


Effect of sodium loading/depletion on renal oxygenation in young normotensive and hypertensive men (2010)
http://www.ncbi.nlm.nih.gov/pubmed/20308608

From the abstract:
“These data demonstrate that dietary sodium intake influences renal tissue oxygenation, low sodium intake leading to an increased renal medullary oxygenation both in normotensive and young hypertensive subjects.”


Restriction of salt intake in the whole population promises great long-term benefits (2009)
http://www.ncbi.nlm.nih.gov/pubmed/19418415

From the abstract:
“Restricting salt intake not only leads to a decrease of blood pressure and a reduction in the incidence of arterial hypertension but also to a fall in cardiovascular morbidity and mortality. But high sodium intake is not only a risk factor for hypertension but also for cardiovascular diseases. “


The relationship between hypertension and salt intake in Turkish population (2010)
http://www.ncbi.nlm.nih.gov/pubmed/20698734

From the abstract:
A positive linear correlation between salt intake and systolic and diastolic blood pressures was demonstrated (r = 0.450, p = 0.020; r = 0.406, p = 0.041; respectively), and each 100 mmol/day of salt intake resulted in 5.8 and 3.8 mmHg increase in systolic and diastolic blood pressures, respectively. Salt intake and systolic blood pressure was significantly correlated in normal weight individuals (r = 0.257, p < 0.01).”


Salt restriction for the prevention of cardiovascular disease (2010)
http://www.ncbi.nlm.nih.gov/pubmed/20644699

From the abstract:
Restricting the dietary intake of sodium chloride is associated with a reduction of the arterial blood pressure by approximately 4/2 mm Hg in hypertensive patients and by approximately 1/0.6 mm Hg in normotensive persons. As the cardiovascular risk is known to rise steadily with systolic blood pressure values starting from 115 mm Hg, lowering the mean blood pressure of the general population by dietary salt restriction would seem to be a practicable form of primary prevention of cardiovascular disease.”
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Old 10-25-2010, 12:43 AM
BigT BigT is offline
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I find it hard to understand why it wouldn't increase blood pressure. Your body likes to dilute its sodium. So if if you have a high sodium in your blood (where it must be if it is being filtered by the kidneys), the dilution is going increase the amount of blood produced, which, since it is at a fairly costant volume, will increase pressure.

The big thing is that reducing salt doesn't help nearly so well, since the problem is usually the sodium content of other chemicals used in processing. Very little of the sodium in processed foods is used for adding saltiness.

One more thing--there are studies linking high sodium with lack of satiety. The one I found on Google says that salty foods actually have mild opiate properties.
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Old 10-25-2010, 01:42 AM
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Originally Posted by BigT View Post
The big thing is that reducing salt doesn't help nearly so well, since the problem is usually the sodium content of other chemicals used in processing. Very little of the sodium in processed foods is used for adding saltiness.
You mean that reducing only the amount of salt that you consume in order to acheive a salty taste doesn't work so well. But I think most people know that, if you need to reduce your salt intake, you need to reduce your consumption of food with a high salt content, whether or not it tastes salty to you.
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Old 10-25-2010, 02:58 AM
Nava Nava is offline
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Portwest, got anything about salt on hypotensive subjects? I've had to calm down both medical personnel and pharmacy techs when they saw my BP and claimed there was no way I could be upright with those numbers; the "quick and dirty" solution for when I'm feeling dizzy, as ordered by several doctors throughout the years is a handful of salty peanuts (if that doesn't work, there are stronger measures, but that often makes the dizzy go away).
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Old 10-25-2010, 03:44 AM
bardos bardos is offline
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Barry Groves has this to say about salt and hypertension:

http://www.second-opinions.co.uk/sal...ertension.html
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Old 10-25-2010, 05:30 AM
KarlGauss KarlGauss is offline
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I'm loathe to enter this discussion (experience teaches me that some people seem to get very emotional about this subject), but let's look at a bit of recent evidence.

In the British Medical Journal in 2009 a study examined data from over 177,000 patients collected in 13 separate studies. The results indicated that high salt intake increased the risk of stroke by more than 20 percent, and the risk of cardiovascular disease in general by about 15 percent. The authors noted that imprecision in determining salt intake likely makes these results an underestimate.

For those interested in computer simulations and projections, an article published this year in the New England Journal of Medicine concluded that:"Reducing dietary salt by 3 g per day is projected to reduce the annual number of new cases of coronary disease by 60,000 to 120,000, stroke by 32,000 to 66,000, and myocardial infarction by 54,000 to 99,000 and to reduce the annual number of deaths from any cause by 44,000 to 92,000. All segments of the population would benefit . . ." Note that 3 g of salt is a bit more than half a teaspoon - not very much at all. ("myocardial infarction" = heart attack)

There are approximately 4 zillion other studies purporting to demonstrate benefits of dietary salt restriction.
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Old 10-25-2010, 07:59 AM
Chief Pedant Chief Pedant is offline
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Originally Posted by bardos View Post
I know it's taken for granted and is ingrained in the public mind as well as 99.9% of all doctors. But what is the proof of this relationship?
There is a lot of evidence. Find it by searching for "salt" and "hypertension."

Part of the dilemma is the individual variation. Some folks can excrete excess salt and handle an acute or chronic salt load without problems. Others don't.

Salt handling varies by individual and by large gene pools--i.e. different ethnic groups respond differently as an average for that group. See here , for instance. However the same article (and many others) shows benefit across all groups, so even though some groups are at higher risk for hypertension and even though that hypertension might be related to a higher prevalence of crappy salt-handling genes in that particular population, the reasonable thing is to recommend a more modest salt intake for everyone (recognizing that for some lucky individuals it won't make a difference at all).
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Old 10-25-2010, 03:32 PM
abderian abderian is offline
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Originally Posted by Nava View Post
Portwest, got anything about salt on hypotensive subjects? I've had to calm down both medical personnel and pharmacy techs when they saw my BP and claimed there was no way I could be upright with those numbers; the "quick and dirty" solution for when I'm feeling dizzy, as ordered by several doctors throughout the years is a handful of salty peanuts (if that doesn't work, there are stronger measures, but that often makes the dizzy go away).
Nava, I did a quick search --- note that I am not a doctor --- as a matter of fact, I can hardly understand most of the abstract for the first item listed here below.

A search for “hypotension” and “sodium” didn’t appear to bring up anything relevant, but I used to have what my doctor labelled as “orthostatic hypotension” --- where you get dizzy and nearly pass out if you rise too quickly from a reclining position --- and so I used that term and found this:

Sodium paradoxically reduces the gastropressor response in patients with orthostatic hypotension (2006)
http://www.ncbi.nlm.nih.gov/pubmed/16785332

From the abstract:
Orthostatic hypotension (OH) can cause syncope that is difficult to treat. . . . OH patients are routinely advised to increase their sodium intake to augment their blood volume. . . . Both oral water and salt water increase BP in patients with OH.


Efficacy of high sodium intake in a boy with instantaneous orthostatic hypotension (2002)
http://www.ncbi.nlm.nih.gov/pubmed/12102449

We report the case of a 14-year-old boy with instantaneous orthostatic hypotension (INOH) with symptoms of orthostatic intolerance. . . . 48 hours after sodium intake, orthostatic tolerance was markedly improved with a concomitant increase in blood pressure in the orthostatic test. By measuring the patient's body water before and after the high sodium intake, we were able to document the increase in plasma volume. We conclude that high sodium intake is an effective treatment for orthostatic hypotension in combination with vasoactive drugs.


Postural hypotension, hyponatremia, and salt and water intake: case reports (2004)
http://www.ncbi.nlm.nih.gov/pubmed/15162884

From the abstract:
In [quadriplegic patients with spinal cord injuries], severe [Postural Hypotension] PH was accompanied by avid conservation of water and impaired retention of sodium in the sitting position, as well as limited salt and water intake.

Dietary instead of pharmacological management to counter the adverse effects of physiological adaptations to space flight (2000)
http://www.ncbi.nlm.nih.gov/pubmed/11200975

Dietary sodium restriction has also been shown to improve calcium balance, bone mineralization, and the effectiveness of neurohumoral defenses against orthostatic hypotension. It is proposed that these simple alterations in the astronauts' diets may be easily implemented to lessen the adverse effects of physiological adaptations to space flight, and to enhance or even replace prescribed pharmacological counter-measures.
-------------

In case you want to look further, all I did was go to http://www.ncbi.nlm.nih.gov/pubmed and type in search terms such as "orthostatic hypotension" and "sodium".

Hope that helps.
  #12  
Old 10-25-2010, 03:42 PM
beowulff beowulff is online now
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Quote:
Originally Posted by KarlGauss View Post
I'm loathe to enter this discussion (experience teaches me that some people seem to get very emotional about this subject), but let's look at a bit of recent evidence.

In the British Medical Journal in 2009 a study examined data from over 177,000 patients collected in 13 separate studies. The results indicated that high salt intake increased the risk of stroke by more than 20 percent, and the risk of cardiovascular disease in general by about 15 percent. The authors noted that imprecision in determining salt intake likely makes these results an underestimate.

For those interested in computer simulations and projections, an article published this year in the New England Journal of Medicine concluded that:"Reducing dietary salt by 3 g per day is projected to reduce the annual number of new cases of coronary disease by 60,000 to 120,000, stroke by 32,000 to 66,000, and myocardial infarction by 54,000 to 99,000 and to reduce the annual number of deaths from any cause by 44,000 to 92,000. All segments of the population would benefit . . ." Note that 3 g of salt is a bit more than half a teaspoon - not very much at all. ("myocardial infarction" = heart attack)

There are approximately 4 zillion other studies purporting to demonstrate benefits of dietary salt restriction.
Reduce by 3g per day?
The current guidelines are to consume less than 1.5g / day - which shows just how much extra salt most people consume.
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Old 10-25-2010, 05:27 PM
Deeg Deeg is offline
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Does sweating via exercise help reduce salt levels?
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Old 10-25-2010, 05:43 PM
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Does sweating via exercise help reduce salt levels?
IIRC, sweat is hypotonic, so if anything sweating would somewhat increase sodium concentration.
  #15  
Old 10-25-2010, 10:50 PM
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I have heard a general rule of thumb that if a food has more mgs of salt than calories, it has too much salt. That got me looking at labels. Turns out acceptable foods by that criterion are surprisingly difficult to find.

That's why I'm on a celery and salted butter diet. (The latter: 100 calories per serving, 90 mg salt. Oh yeah!)
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Old 10-25-2010, 11:10 PM
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Originally Posted by Shmendrik View Post
IIRC, sweat is hypotonic, so if anything sweating would somewhat increase sodium concentration.
Sweat does have less salt than plasma, but exercise certainly can deplete your sodium levels. Here's a relevant article
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Old 10-26-2010, 01:42 AM
Nava Nava is offline
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Originally Posted by Portwest View Post
In case you want to look further, all I did was go to http://www.ncbi.nlm.nih.gov/pubmed and type in search terms such as "orthostatic hypotension" and "sodium".

Hope that helps.
Thanks, on three counts:
for the specific info,
the info on where to look next time,

and because this provides evidence from the other end of the scale that yes, there appears to be a correlation between "salt intake" and "blood pressure"; enough to justify both telling people with high BP to lay off the salt and for us with low BP to claim our right to a salt shaker ("it's what the doctor ordered"). People tend to focus on one end of the scale only, because it's the end that has the reputation of being a killer.
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Old 05-04-2011, 12:02 PM
Surreal Surreal is offline
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http://www.nytimes.com/2011/05/04/he...esearch/04salt

Quote:
The investigators found that the less salt people ate, the more likely they were to die of heart disease — 50 people in the lowest third of salt consumption (2.5 grams of sodium per day) died during the study as compared with 24 in the medium group (3.9 grams of sodium per day) and 10 in the highest salt consumption group (6.0 grams of sodium per day). And while those eating the most salt had, on average, a slight increase in systolic blood pressure — a 1.71-millimeter increase in pressure for each 2.5-gram increase in sodium per day — they were no more likely to develop hypertension.

“If the goal is to prevent hypertension” with lower sodium consumption, said the lead author, Dr. Jan A. Staessen, a professor of medicine at the University of Leuven, in Belgium, “this study shows it does not work.”
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Old 07-12-2011, 02:03 PM
Surreal Surreal is offline
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Originally Posted by KarlGauss View Post
I'm loathe to enter this discussion (experience teaches me that some people seem to get very emotional about this subject), but let's look at a bit of recent evidence.

In the British Medical Journal in 2009 a study examined data from over 177,000 patients collected in 13 separate studies. The results indicated that high salt intake increased the risk of stroke by more than 20 percent, and the risk of cardiovascular disease in general by about 15 percent. The authors noted that imprecision in determining salt intake likely makes these results an underestimate.

For those interested in computer simulations and projections, an article published this year in the New England Journal of Medicine concluded that:"Reducing dietary salt by 3 g per day is projected to reduce the annual number of new cases of coronary disease by 60,000 to 120,000, stroke by 32,000 to 66,000, and myocardial infarction by 54,000 to 99,000 and to reduce the annual number of deaths from any cause by 44,000 to 92,000. All segments of the population would benefit . . ." Note that 3 g of salt is a bit more than half a teaspoon - not very much at all. ("myocardial infarction" = heart attack)

There are approximately 4 zillion other studies purporting to demonstrate benefits of dietary salt restriction.
You might be interested in the latest Cochrane Review, which completely debunks the studies you listed above.

http://onlinelibrary.wiley.com/o/coc...217/frame.html

Quote:
Plain language summary

Cutting down on the amount of salt has no clear benefits in terms of likelihood of dying or experiencing cardiovascular disease.

Cardiovascular disease includes heart attacks, strokes, and the need for heart surgery and is a major cause of premature death and disability. This review set out to assess whether advice to cut down on salt in foods on altered our risk of death or cardiovascular disease. Intensive support and encouragement to reduce salt intake did lead to a reduction in salt eaten and a small reduction in blood pressure after more than six months. There was not enough information to understand the effect of these changes in salt intake on deaths or cardiovascular disease. Further research in needed to confirm our finding that dietary advice to reduce salt may increase deaths in people with heart failure.
  #20  
Old 07-12-2011, 02:21 PM
RaftPeople RaftPeople is offline
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Originally Posted by Nava View Post
Thanks, on three counts:
for the specific info,
the info on where to look next time,

and because this provides evidence from the other end of the scale that yes, there appears to be a correlation between "salt intake" and "blood pressure"; enough to justify both telling people with high BP to lay off the salt and for us with low BP to claim our right to a salt shaker ("it's what the doctor ordered"). People tend to focus on one end of the scale only, because it's the end that has the reputation of being a killer.
My daughter has the same thing as you. After numerous specialists and a zillion tests, the final conclusion (or at least partially) was - intake salt before sporting events and if feeling faint, etc. It has made a huge difference.
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Old 07-12-2011, 04:18 PM
KarlGauss KarlGauss is offline
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Originally Posted by Surreal View Post
You might be interested in the latest Cochrane Review, which completely debunks the studies you listed above.

http://onlinelibrary.wiley.com/o/coc...217/frame.html
"Completely debunks"? Hardly.

Let's see: with their analysis confined to seven studies involving fewer than 7,000 subjects (in contrast, for example, to the 2009 meta-analysis above involving 177,000 subjects), the authors concluded, "There was not enough information to understand the effect of these changes in salt intake on deaths or cardiovascular disease. Further research (is) needed . . .".

To say that such a modest and essentially neutral conclusion "debunks" decades of research involving hundreds of thousands of subjects is just a tad of an overstatement.

Last edited by KarlGauss; 07-12-2011 at 04:20 PM.
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Old 07-12-2011, 04:46 PM
KarlGauss KarlGauss is offline
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By the way, today's issue of Archives of Internal Medicine contains the results of a study looking at the dietary salt (sodium) intake of more than 12,000 people followed for over 15 years.

And, what were the conclusions of this study?: ". . . higher sodium intake is associated with increased total mortality in the general US population".

Did the results appear to apply in general, or just to specific groups (such as those with high blood pressure, etc.)?: "(the) findings did not differ significantly by sex, race/ethnicity, body mass index, hypertension status, education levels, or physical activity."

Hey, I'm not saying this one, non-randomized trial "completely debunks" anything or proves very much. Rather, it's just the latest one of the many, many pieces of research which all point to the same conclusion: that high salt (sodium) intake is associated with bad outcomes.
  #23  
Old 07-14-2011, 03:03 PM
barbitu8 barbitu8 is offline
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http://www.scientificamerican.com/po...SA_WR_20110714

This indicates that it is the combo of high salt and low potassium intakes that leads to problems.
  #24  
Old 07-14-2011, 03:08 PM
Ludovic Ludovic is offline
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Originally Posted by Shmendrik View Post
IIRC, sweat is hypotonic, so if anything sweating would somewhat increase sodium concentration.
But not if you replenish the water you lost it with a liquid containing less sodium than the sweat, such as straight water or many drinks.
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Old 11-18-2011, 01:05 PM
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Not that this will change the minds of the zealots who think that everyone needs to eliminate sodium from their diet, but here's the latest from the prestigious Cochrane Collaboration:

http://www.washingtonpost.com/blogs/...YW1M_blog.html

Quote:
The new analysis was conducted by Niels Graudal of Copenhagen University Hospital in Denmark for the Cochrane Collaboration, a highly respected international group that assesses scientific evidence for health issues. Graudal and his colleagues analyzed 167 studies conducted between 1950 and 2011 that compared people who consumed low-sodium versus high-sodium diets.
Low-sodium diets did cut blood pressure levels in people with high and normal blood pressure, the researchers found. But it also significantly increased other risk factors for heart disease, such as cholesterol levels, triglycerides, adrenaline and renin, the researchers reported in the American Journal of Hypertension.
The reduction in blood pressure in normotensives was only around 1%, but triglycerides increased by 7%.
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Old 11-18-2011, 02:26 PM
OpalCat OpalCat is offline
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Originally Posted by Nava View Post
Portwest, got anything about salt on hypotensive subjects? I've had to calm down both medical personnel and pharmacy techs when they saw my BP and claimed there was no way I could be upright with those numbers; the "quick and dirty" solution for when I'm feeling dizzy, as ordered by several doctors throughout the years is a handful of salty peanuts (if that doesn't work, there are stronger measures, but that often makes the dizzy go away).
I have low blood pressure as well, though as I've gotten older it's gone up a bit and is approaching normal now. I was told from a very early age by my doctor that I should eat salty foods and put salt on foods to keep myself from having dizzy/fainting spells.
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Old 11-18-2011, 02:53 PM
Chronos Chronos is offline
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Not that this will change the minds of the zealots who think that everyone needs to eliminate sodium from their diet,
Who, exactly, are those folks? Everyone agrees that we need some salt; the dispute is just over how much.
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Old 11-18-2011, 03:03 PM
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Who, exactly, are those folks? Everyone agrees that we need some salt; the dispute is just over how much.
I was kind of curious as to why he feels this has to be brought up every few months if he thinks it won't convince "them".
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Old 11-18-2011, 03:40 PM
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Yeah, I've seen CHFers decompensate by binging on salty food. Its bad, mmk?
  #30  
Old 11-18-2011, 04:23 PM
abderian abderian is offline
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Originally Posted by OpalCat View Post
I have low blood pressure as well, though as I've gotten older it's gone up a bit and is approaching normal now. I was told from a very early age by my doctor that I should eat salty foods and put salt on foods to keep myself from having dizzy/fainting spells.
I had the same issue and was told the same thing, Opal. But then I got old and fat and, well, here I am with regular old hypertension. It gets worse if I consume too much sodium.
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Old 11-18-2011, 05:53 PM
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My impression is that doctors have switched to prescribing expensive drugs that they get a kick back on from jawboning patients about using less salt.
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Old 11-18-2011, 07:03 PM
KarlGauss KarlGauss is offline
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My impression is that doctors have switched to prescribing expensive drugs that they get a kick back on from jawboning patients about using less salt.
We can't win. If docs advocate the low salt approach, we're lambasted by the likes of surreal. OTOH, if we prescribe meds for high blood pressure, you proceed to traduce us.

Well, if I'm going to get dissed either way, I might as well get paid for it. So, you can please point me in the direction of those "kick backs" I can be getting. How do I sign up? (note - I'm really depending on you for directions, because in thirty years I've never even been offered a kick back, let alone got one. Please don't let me down, okay?)
  #33  
Old 11-18-2011, 07:23 PM
Qadgop the Mercotan Qadgop the Mercotan is offline
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Well, if I'm going to get dissed either way, I might as well get paid for it. So, you can please point me in the direction of those "kick backs" I can be getting. How do I sign up? (note - I'm really depending on you for directions, because in thirty years I've never even been offered a kick back, let alone got one. Please don't let me down, okay?)
Me too. Though I got some free pens a few times. Cheap ones, but free.

Also a viagra-shaped stress ball.
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Old 11-18-2011, 07:29 PM
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To thelabdude:

I think your impression is due to the fact that many (if not most) people do not take high blood pressure seriously. Until the complications set in, there are essentially no symptoms. A patient who is told, "You are borderline hypertensive. Cut back on the salt, lose ten pounds, and come back to see me. We need to monitor your blood pressure."

If the patient returns in six months, chances are excellent he or she will have gained an additional ten pounds, and probably keeps eating the same amount of sodium. A BP check will show graduation into actual hypertension.

The first line of treatment will be a water pill. The patient will receive a prescription and told the same instructions: "Cut back on your salt, lose at least ten pounds, and get 30 minutes of exercise every day."

Wanna guess what happens at the next doctor appointment?


~VOW
  #35  
Old 11-18-2011, 07:55 PM
DSeid DSeid is offline
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I had, in the past, been offered nice dinners to come and listen to sales pitches ... always threw away the invite sayin' "everyone has their price but they aint hit mine yet." Then some salesperson left me a bouncy ball that lit up when you bounced it ... now you're talking my price!

To our Adult MDs -

Should the general population (normotensive) be on a lower salt diet than we currently are on? If so, how low? Just "no added salt" (NAS) or lower? How much sodium does someone on a NAS diet ingest typically?

What percent of those with hypertension will respond to a low salt diet? And how low do they need to go?
  #36  
Old 11-18-2011, 08:13 PM
KarlGauss KarlGauss is offline
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Quote:
Originally Posted by DSeid View Post
Should the general population (normotensive) be on a lower salt diet than we currently are on? If so, how low? Just "no added salt" (NAS) or lower? How much sodium does someone on a NAS diet ingest typically?
I can't do better than quoting the introductory paragraph from the NEJM link above:
Quote:
Originally Posted by NEJM
The U.S. diet is high in salt. The Departments of Agriculture and Health and Human Services recommend daily intake of less than 5.8 g of salt (2300 mg of sodium), with a lower target of 3.7 g of salt per day for most adults (persons over 40 years of age, blacks, and persons with hypertension). Despite these guidelines, during the period from 2005 through 2006, the average man in the United States is estimated to have consumed 10.4 g of salt per day and the average woman 7.3 g per day — amounts that exceed those in preceding years
Quote:
Originally Posted by DSeid
What percent of those with hypertension will respond to a low salt diet? And how low do they need to go?
Here is a detailed review. It's old but answers your questions. Basically, about half of hypertensives will respond to dietary salt restriction and even a quarter or so of normotensive people will do likewise (i.e. BP up with salt, and BP down when it's restricted).

How low? For most people, less than 4 grams may be ideal (again, see the NEJM paper, above).
  #37  
Old 11-18-2011, 08:17 PM
Ferret Herder Ferret Herder is offline
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Quote:
Originally Posted by thelabdude View Post
My impression is that doctors have switched to prescribing expensive drugs that they get a kick back on from jawboning patients about using less salt.
My husband's hypertension drug costs him $10/month. Cost without insurance might be $20. There are plenty of cheap anti-hypertension drugs.

(And speaking as someone who works in a doctor's office (ophthalmology), we don't even get free samples any longer, unless they're vitamins or OTC drops for dry eye. I got a couple pens, though.)

Side note: When should you worry about low blood pressure? I read at 90/60 at my most recent checkup, 95/78 before that.

Last edited by Ferret Herder; 11-18-2011 at 08:21 PM.
  #38  
Old 11-18-2011, 08:34 PM
KarlGauss KarlGauss is offline
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Quote:
Originally Posted by Ferret Herder View Post
My husband's hypertension drug costs him $10/month. Cost without insurance might be $20. There are plenty of cheap anti-hypertension drugs.
Great point. And they are as good, if not better, than anything else.

Quote:
When should you worry about low blood pressure?
I'd say only if the person is symptomatic - i.e. if they're getting light-headed. This underscores the point that many, young healthy women (in particular) have BPs in the 90's or even 80's. That is normal (unless, as stated, they're getting dizzy). The reason that isn't more appreciated is that docs (and BP research) focus on one end of the BP spectrum which tends to make us overlook the other, normal, end.
  #39  
Old 11-18-2011, 08:47 PM
DSeid DSeid is offline
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Quote:
Originally Posted by KarlGauss View Post
I can't do better than ...
Thank you. Yes those do suffice.

If I understand then, a NAS diet (with special emphasis on limiting intake of processed foods, which tend to be high in sodium) should be enough to get under the 4g mark.
  #40  
Old 11-18-2011, 09:38 PM
Hirka T'Bawa Hirka T'Bawa is offline
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Quote:
Originally Posted by Ferret Herder View Post
Side note: When should you worry about low blood pressure? I read at 90/60 at my most recent checkup, 95/78 before that.
Quote:
Originally Posted by KarlGauss View Post
I'd say only if the person is symptomatic - i.e. if they're getting light-headed. This underscores the point that many, young healthy women (in particular) have BPs in the 90's or even 80's. That is normal (unless, as stated, they're getting dizzy). The reason that isn't more appreciated is that docs (and BP research) focus on one end of the BP spectrum which tends to make us overlook the other, normal, end.
What I've always learned, was that what matters in low BP is the Mean Arterial Pressure (MAP). This measures the average BP, and when it is too low there is risk that the organs at the end of the line aren't getting enough blood and will become ischemic (not get enough oxygen).

MAP has a fancy calculation, to estimate, but the simplified version is the average of your systolic and diastolic BP's, so someone with a BP of 120/80, would have an estimated MAP of 100 (if you actually perform the equations, it comes out to approx 93, so in most cases the average is good enough, and WAY easier to remember).

A MAP of 60mmHg is normally considered good enough to avoid problems with a low BP.

KarlGauss, is that basically correct? I learned that during my Internal Med rotation, and it was the rule the MD's there used. Though, that was with really sick patients, so the "if symptomatic" approach wouldn't work.

Hirka T'Bawa, PharmD.

I've always wanted to sign a post that way, and think this is the first medical related post I've made since I graduated!
  #41  
Old 11-18-2011, 09:40 PM
Ferret Herder Ferret Herder is offline
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Excellent, I'm good in both cases. Haven't been faint-headed since high school or so.

Oh, and my husband's doctor started him on a reduced sodium, weight-reduction diet first, before adding antihypertensives. He's doing great now with that combination.

Last edited by Ferret Herder; 11-18-2011 at 09:42 PM.
  #42  
Old 11-19-2011, 07:27 AM
aruvqan aruvqan is offline
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I drive my cardiologist nuts - I rarely eat convenience foods, my allergies generally prevent me from using most convenience crap [palm oils, 'natural flavors' frequently have mushroom powder - plus they tend to taste like crap] and I can't do diuretics [they tend to trigger flares in my psudogout] so he can't make me change my diabetic nutritionist mandated diet, nor give me diuretics, and the joint problems seriously restrict the exercises I can do since I do not have access to a swimming pool nor will Tri-Care authorize more than 18 PT sessions per year nor do I really have access for transport to go the 30 miles to get to the Navy base so I could use the pool there for 50 cents per day/swim session.

I really need a clone body [or to be popped into a pod] *sigh*
  #43  
Old 11-19-2011, 12:52 PM
KarlGauss KarlGauss is offline
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Quote:
Originally Posted by Hirka T'Bawa View Post
A MAP of 60mmHg is normally considered good enough to avoid problems with a low BP.

KarlGauss, is that basically correct? I learned that during my Internal Med rotation, and it was the rule the MD's there used. Though, that was with really sick patients, so the "if symptomatic" approach wouldn't work.
That sounds like a pretty good rule of thumb. In fact, and as an example, I would have said that, symptoms or not, if your BP is less than 80/50, it's probably too low. Well, note that the MAP for an individual with a BP of 80/50 is exactly 60. So it all seems consistent.

As an aside, a formula for the MAP which is pretty accurate and relatively easy to use is:

MAP = 1/3 of (systolic + 2 X diastolic)

or equivalently,

MAP = 1/3 systolic + 2/3 diastolic

Quote:
Hirka T'Bawa, PharmD.
Well done!!
  #44  
Old 11-19-2011, 01:29 PM
gazpacho gazpacho is offline
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Originally Posted by Qadgop the Mercotan View Post
Me too. Though I got some free pens a few times. Cheap ones, but free.

Also a viagra-shaped stress ball.
My sister used to work for Phizer so the whole family got viagra tee shirts and the viagra stress balls.
  #45  
Old 11-19-2011, 02:06 PM
Oy! Oy! is offline
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Originally Posted by WhyNot View Post
No one, simply no one, is actually deficient in sodium in our culture unless they've got some really rare disorder. Even "hyponatremia" (low serum sodium level) is not because of too little sodium, but because of too much water in the blood making the sodium hang out in the wrong place in the body.
Ahem.

I have been warned multiple times by my doctor that my sodium level was dangerously low (as in, get drinking Gatorade right now and go to the hospital immediately if you feel bad or peculiar in any way!). This has in fact been triggered by the fact that I drink a lot of fluids, and I don't use air conditioning, so if the weather is hot, I perspire a great deal. The treatment, however, has in fact been to consume more salt. For me, it has been easiest to achieve this via salt tablets.

It took me a long time to realize that I didn't have some bizarre kind of kidney damage, and that this was triggered by a combination of drinking a lot of fluids, ambient heat, and a diet not particularly high in salt. But it is definitely possible, at least for some of us, to not eat enough salt.
  #46  
Old 05-16-2013, 02:13 PM
Surreal Surreal is offline
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Update: the Institute of Medicine recently analyzed actual outcomes data (not some silly computer simulation) and found no evidence to support the notion that dropping sodium intake below 2,300 mg/day was beneficial.

http://www.nytimes.com/2013/05/15/he...anted=all&_r=0

Quote:
But the new expert committee, commissioned by the Institute of Medicine at the behest of the Centers for Disease Control and Prevention, said there was no rationale for anyone to aim for sodium levels below 2,300 milligrams a day. The group examined new evidence that had emerged since the last such report was issued, in 2005.

As you go below the 2,300 mark, there is an absence of data in terms of benefit and there begin to be suggestions in subgroup populations about potential harms,” said Dr. Brian L. Strom, chairman of the committee and a professor of public health at the University of Pennsylvania. He explained that the possible harms included increased rates of heart attacks and an increased risk of death.
Quote:
One 2008 study the committee examined, for example, randomly assigned 232 Italian patients with aggressively treated moderate to severe congestive heart failure to consume either 2,760 or 1,840 milligrams of sodium a day, but otherwise to consume the same diet. Those consuming the lower level of sodium had more than three times the number of hospital readmissions — 30 as compared with 9 in the higher-salt group — and more than twice as many deaths — 15 as compared with 6 in the higher-salt group.

Another study, published in 2011, followed 28,800 subjects with high blood pressure ages 55 and older for 4.7 years and analyzed their sodium consumption by urinalysis. The researchers reported that the risks of heart attacks, strokes, congestive heart failure and death from heart disease increased significantly for those consuming more than 7,000 milligrams of sodium a day and for those consuming fewer than 3,000 milligrams of sodium a day.

There are physiological consequences of consuming little sodium, said Dr. Michael H. Alderman, a dietary sodium expert at Albert Einstein College of Medicine who was not a member of the committee. As sodium levels plunge, triglyceride levels increase, insulin resistance increases, and the activity of the sympathetic nervous system increases. Each of these factors can increase the risk of heart disease.

“Those are all bad things,” Dr. Alderman said. “A health effect can’t be predicted by looking at one physiological consequence. There has to be a net effect.”
  #47  
Old 05-16-2013, 02:27 PM
Smeghead Smeghead is offline
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Duly noted that this is a zombie, and fair warning that this post is only tangentially related. End disclaimer.

One interesting fact I learned from that book about the history of salt - I forget the title - Salt, A History, perhaps? - - is that modern people are actually consuming record low amounts of salt compared to most of human history. This is thanks to the invention of refrigeration and canning, which means we are no longer dependent on preserving food through salting, which was just about the only option for most of that time.

Carry on.
  #48  
Old 05-16-2013, 04:42 PM
WhyNot WhyNot is offline
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Dunno how I missed this one last time around, so...howdy, zombie Oy!

Quote:
Originally Posted by Oy! View Post

It took me a long time to realize that I didn't have some bizarre kind of kidney damage, and that this was triggered by a combination of drinking a lot of fluids, ambient heat, and a diet not particularly high in salt. But it is definitely possible, at least for some of us, to not eat enough salt.
Or you're consuming the right amount of sodium while you're consuming excess fluids. Tomato, tomahto, I suppose.

I'd be quicker to recommend reducing fluid intake to a normal level, rather than raising the sodium intake. Not 'cause I'm a askeered of sodium (I'm not) but because you're making your kidneys work extra hard to process all that excess fluid you're drinking, to no benefit. But, of course, you should listen to your doctor, not some random pixels on the internet. For all you know, I'm an exceptionally literate golden retriever. Woof.
  #49  
Old 05-16-2013, 04:47 PM
rsat3acr rsat3acr is offline
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I take all those reports with a grain of salt. Sorry couldn't resist.
  #50  
Old 05-16-2013, 06:34 PM
KarlGauss KarlGauss is offline
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nm (for now)

Last edited by KarlGauss; 05-16-2013 at 06:35 PM.
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