[ExI] enjoy your salt!

[William Flynn Wallace]

Whatever made us think that medicine was a science?  They ought to be as
ashamed as Wall St. bankers.

(I'd send this as a link but a prior link to People's Pharmacy failed, so I
just copied it - bill).

For decades public health officials have been preaching a low-salt diet.
Ask the experts at the Centers for Disease Control & Prevention (CDC) and
they would probably say that you can't have too low a golf score or salt
intake. They preach that anyone over 50 should keep sodium intake under
1,500 mg daily. The American Heart Association (AHA) also recommends that
"all Americans reduce the amount of sodium in their diet to less than 1500
mg a day."

What if these prestigious organizations were not just wrong, but
dangerously so?

A study published in the American Journal of Hypertension on April 2,
2014<http://ajh.oxfordjournals.org/content/early/2014/03/26/ajh.hpu028.1.full.pdf+html>,
analyzed data from 25 previous research papers. This meta-analysis
concluded that a low-salt dietary strategy is associated with a higher risk
of death. You read right. In observational studies, the preponderance of
the data links the sodium recommendations of the CDC and the AHA to
increased mortality. Ouch! This kind of evidence undermines the credibility
of our most prestigious public health organizations.

This isn't the first time we have heard that a low-sodium diet might be
hazardous to your health. The Institute of Medicine (IOM) issued a report
that was published in *JAMA Internal Medicine* (online, Oct. 28,
2013)<http://archinte.jamanetwork.com/article.aspx?articleid=1761916>that
found there are no data demonstrating benefit from the CDC or AHA
low-sodium guidelines. Even worse, the report noted that when people with
diabetes, hypertension, kidney and cardiovascular disease achieve the goals
set out by the CDC and AHA, they may actually experience harm. Studies have
suggested that a low-sodium diet may stimulate a hormonally-induced stress
reaction that could lead to an increased risk of type 2 diabetes, heart
failure complilcations, worsening thyroid disease and death.

Keep in mind that the health professionals who are nominated to the
Institute of Medicine are among the smartest and most respected scientists
in the world. But wait, it gets worse still. Another review of the
low-sodium recommendations published in *The American Journal of
Medicine*<http://www.amjmed.com/article/S0002-9343%2813%2900594-9/abstract>titled
"Dietary
Sodium Restriction: Take It with a Grain of
Salt"<http://www.amjmed.com/article/S0002-9343%2813%2900594-9/abstract>came
to the following conclusions:

*"There is no conclusive evidence that a low sodium diet reduces
cardiovascular events in normotensive and pre-hypertensive or hypertensive
individuals. On the contrary, there is sound evidence that a low sodium
diet leads to a worse cardiovascular prognosis in patients with systolic
congestive heart failure or type 2 diabetes mellitus...Advising low sodium
diets seems misguided and potentially dangerous and illustrates the problem
of guidelines based on flawed studies using surrogate measures."*

Despite the growing evidence that its low-salt guidelines are just plain
wrong, neither the CDC nor the AHA seems likely to reverse gears any time
soon. Perhaps they fear that their credibility will be damaged if they
change direction after all this time. How very sad! Revising views on the
basis of evidence seems only rational.

Now, no one is saying that pigging out on salt is a good thing. Too much
can be at least as dangerous as too little. The new research makes it clear
that the sodium situation is a little like the story of Goldilocks and the
porridge. It shouldn't be too hot *or* too cold. There is a sweet spot in
the middle. The conclusion:

*"Both low sodium and high sodium intakes are associated with increased
mortality, consistent with a U-shaped association between sodium intake and
health outcomes."*

*BOTTOM LINE:*

The new study suggests that the sweet spot for sodium is between 2,645 and
4,945 mg per day. That is substantially above the recommendations by the
American Heart association and the CDC and probably is more in line with
what your grandmother was consuming. We continue to believe that
grandmothers the world over probably had more common sense about such
matters than some of our prestigious public health organizations. We leave
it to you and your health care professional to determine what would be
optimal for you.

In the meantime, here is a link to another People's Pharmacy Alert titled:
"Is a Low Salt Diet Dangerous for Your
Health"<http://www.peoplespharmacy.com/2013/11/04/is-a-low-salt-diet-dangerous-for-your-health/>should
you wish to read more.
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