Salt? We don't need no stinking salt shakers

The paragraph below is directly taken from the following source:

Examination of Front-of-Package Nutrition Rating
Systems and Symbols: Phase I Report
Ellen A. Wartella, Alice H. Lichtenstein, and Caitlin S.
Boon, Editors; Committee on Examination of
Front-of-Package Nutrition Ratings Systems and
Symbols; Institute of Medicine

The free PDF was downloaded from:
http://www.nap.edu/catalog/12957.html

 "Over the past four decades sodium intake in the United States has trended upward across both age and gender groups, and it currently averages 3,400 mg per day (IOM, 2010). This exceeds the Upper Intake (UL) levels of the Institute of Medicine and the recommendations of the 2005 Dietary Guidelines for a daily sodium intake of less than 2,300 m in the general population and less than 1,500 mg for higher-risk subpopulations; similarly it exceeds more recent recommendations from the 2010 Dietary Guidelines Advisory Committee that most Americans should consume only 1,500 mg of sodium per day (IOM, 2005, 2010; DGAC, 2010). The top contributors to sodium intake are mixed dishes (e.g., sandwiches, pizza with meat, and hamburgers and cheeseburgers), meat and meat alternates, and grain products (e.g., bread, cold cereal, and rice) (see Table 4-4) (IOM, 2010)."

I share the paragraph so you will have context for the news story I am going to link you to, which describes a strategy implemented in Argentina where they have similar problems.  The thing is, salt does not increase hypertension risk for everyone.  We have seen the numbers of persons with the disease go up in a correlation with the amount of salt in foods.  It certainly appears that the increase in processed foods and meats has led to a problem.  What I think has NOT changed is the amount of table salt people have used over the past thirty years - so um, good try Argentina - but I am not feeling very hopeful that taking salt shakers off the tables at restaurants is really going to make a difference in hypertension levels for the population.  However, I will offer these two bonus outcomes for you.

1) Patrons no longer insulting the chef by salting their food before they even taste it . (My Dad's pet peeve)

2) Wait persons will have less side work to do at the end of the shift (cleaning and filling salt shakers)

Here is the story.

Apoplectic

The most recent report for mortality statistics in the USA was released in 2009 and gives numbers for 2006. I have made mention of this report in past posts. The third leading cause of mortality is cerebrovascular disease - better known as stroke or CVA or colloquially - an apoplexy.

The American Heart Association is a supporter of efforts to reduce salt in processed or purchased foods in the USA. Why would they endorse this "invasion" into our food choices? “Lowering sodium is essential to reversing the trend of more Americans developing high blood pressure – a major risk factor for heart disease and stroke,” said Nancy Brown, the chief executive officer of the American Heart Association. Read more about the National Salt Reduction Initiative here.

The thought of having a stroke scares me pretty bad, maybe worse than having a heart attack. I take comfort in knowing that most strokes can be prevented and I will do everything in my power to make those modifications.

Many people get upset when the Government (big G) gets involved in what we eat and drink, and I can see that this would bother people. On the other hand, I am aware of industry tactics and a lot of the time, the food that we eat has harmful ingredients for no other reason than to get us to keep buying the product. Think of TFAs and HFCS and yes, sodium(salt). It is okay to add salt to your food if you like, but when the American Heart Association which has no ulterior motives suggests that we keep our levels at 1500mg a day - something has got to give change.

Here are the ways that cerebrovascular disease can be prevented:

Limit Salt Intake
Do Not Smoke
Drink only in Moderation - if you drink
Maintain a Healthy Weight (check BMI, WHR, blood work - not just the scale)
Eat a Plant Based Diet, limit red meat and add Omega 3 rich seafood
Exercise

It is more of the same isn't it - take care of yourself and then hope for the best! Makes more sense than ignoring the prevention piece and hoping for the best - that's a Russian Roulette scenario there.

In 2006, according to the CDC's report, about 140,000 persons died from this disease. There are cases where people have strokes though they have adhered to all the recommendations and were living what appears to be a healthy lifestyle. I KNOW, I try not to spend much of my energy worrying about that (it is much less common). WHY? I cannot control it - if you can control it - do so, if not, move on.

That being said, the next important thing is to know the symptoms of a stroke and to get help immediately. The symptoms can be reviewed here.

Is Salt More of a Threat After All?

In reviewing research out of Italy and published in the British Medical Journal BMJ, I began to doubt myself or my recent post.

The research involves the analyses of about 14 different studies that included measure of salt intake and the outcomes of stroke or cardiovascular disease. The studies are not the gold standard type that we like, nor could they really be, but the analyses of them is pretty tight.

The scientists and statisticians found that salt intake, which they measured in grams, is associated with higher risks for both of the above outcomes. Remember from a recent post that the sodium content is 40%, and so when they say 6 g of salt it equals about 2300 mg of sodium. The researchers say that most diets have upwards of 10g of salt per day (WOW) and that 10g a day puts a person at an amplified risk of stroke death and CVD diagnosis. The report I read in Medscape stated that for every additional 3 grams of salt we consume, our risk of heart disease rises by 6 percent.

My big question is this: Does that mean that we have a higher risk of getting hypertension and then the adverse outcomes, or is it regardless of a HTN diagnosis. That is a pretty important question as not everyone who consumes above 6g of salt a day gets or has high blood pressure.

Also I learned in the article by Susan Jeffrey that one of every strokes leads to death where as one in every five cases of heart disease leads to death. I didn't realize that so many strokes resulted in death, however, in some instances it might be the better outcome.

My curiosity did get the better of me, i.e. if the increase in salt led to the stroke or if the increase in salt led to the HTN that then led to the stroke. So I looked up the research myself.

Wow, this stuff can get confusing. I need more education! Anyways, the authors of the study do call it a direct link between intake and stroke or CVD but they also talk about HTN and obesity etc as factors for stroke and heart disease. It was said in the research article that about 62% of strokes ARE in those with HTN and almost 50 % of CVD cases are associated with HTN. Still, the research did find some cases of increase without the diagnosis of high blood pressure which gives weight to efforts for overall reductions in salt intake.

http://www.bmj.com/cgi/reprint/339/nov24_1/b4567

Keep in mind however that the scientists are presenting this data not for individual behavior change but for changes in the food industry that will have population wide effects to save millions of lives.

Salt and other misconceptions

Today's post is inspired in some part by what people say to me.

A perfect example is dinner out last night. There were about eight or nine of us and I ordered grilled fish and steamed veggies, i.e. no added fat, butter, oil or sauce and a side salad. I had as much if not more volume of food as anyone at the table, but the least calories. The waitress asked why I was ordering this way when I was so "skinny". This was not the first time something like that has been said to me, and I always use it as a teaching point. Perhaps you already have an idea of how I respond to comments like these. I say, "oh, you have it backwards." "I look like this because of how I eat and exercise, it isn't natural or genetic, it is purposeful." People often want to think that a little person can eat whatever they want and which can excuse them from having to eat less and move more which can be hard seeming. Thin persons can of course have horrible blood work if they eat crap and do not exercise, but I in fact, have great blood work.

To say that all more simply, being of low weight is not necessarily an invitation to gluttony but a consequence of forgoing it.

Another thing that I do that sometimes gets a reaction is adding salt to my food. I have long known and said to people that not everyone has to avoid salt and that some people have worse outcomes than others because of salt intake. Knowing it and reporting it in my blog are a little different so I researched the issue somewhat today.

I feel and the research supports that hypertension in this country is very much a response to environmental change. This change is in food preparation. We have mass production of highly processed foods which have far more sodium than a body needs. As a population, we have consumed these foods in excess and have in aggregate, the consequence of a blood pressure problem so huge that policy was created to lower sodium content in foods and label clearly the amount of sodium in them.

Our Institute of Medicine has determined that 1500mg of sodium a day is the Adequate Intake (AI) for most people. People who are very active and or work in extreme heat would need more than that. There IS a need for sodium, it isn't like sugar which has no nutritive benefit.

Research has also determined that an Upper Limit (UL) of sodium should be 2400mg a day. This is a recommendation based on the overwhelming percent of Americans who get too much salt. There is no benefit to getting more than 1500 mg a day, so there is no harm in limiting everyone to 2400mg.

Interestingly, study after study has shown that the excess salt, over 1500 mg, is from foods in the control of manufacturers, not from our use of table salt. Of course, adding table salt to say, your McDonald's french fries, canned vegetables or TV dinner would be problematic and some people do indeed do that.

There are also groups of people who more so than others, respond adversely to salt intake over the 1500 mg. This includes people already hypertensive, especially those that do not respond to blood pressure lowering medications as well as black persons, people who were low birth weight babies, middle aged persons and persons with a genetic predisposition to renal problems.

Here is a startling little piece of research info. There is a multi year clinical research study in place now that is referred to as NHANES and in review of the data collected prior to 2004, 100 % of us, regardless of sex or race, exceed the AI of 1500mg a day.

Back to me. Well, for the most part I do not eat processed foods and I happen to be very active with out door sports and I live in Florida. I add table salt to my popcorn and some of my food. So ingrained and so good a message has been delivered that people will look at me with raised eye brows, and relatives may even say, "salt?! oh but salt is so bad." This is their way of finding holes in my (obsessive) healthy lifestyle.

I wonder what we have to do to get the general public to avoid saturated and trans fats and all that sugar and maybe to exercise more?!

Still to be clear, I am not saying that we do not have a problem with too much salt nor am I saying that salt doesn't impact blood pressure, only that a minority of us do not have to watch our salt intake as closely as others.

In my research I also read that potassium intake can offset some of the adverse consequences of too much salt.

One last misconception - water. There is no "8x8 glasses a day" as an official recommendation. Think about it, how could a 95 pound athlete a 120 pound couch potato and a 200 pound construction work all need the same amount of water every day?

I leave you with your pondering... and hey, "hold the salt!"