UPDATED!! Time to end the war on Salt?

A place to get your questions answered from McDougall staff dietitian, Jeff Novick, MS, RDN.

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Re: UPDATED!! Time to end the war on Salt?

Postby JeffN » Wed Jun 29, 2016 11:27 am

An excellent editorial on the recent studies purporting to show that lowering sodium intake is harmful

In Health
Jeff

SOUNDING BOARD
Dietary Sodium and Cardiovascular Disease Risk — Measurement Matters
June 1, 2016
DOI: 10.1056/NEJMsb1607161
http://www.nejm.org/doi/full/10.1056/NEJMsb1607161

Hypertension is a common and major risk factor for the leading U.S. killer, cardiovascular disease.1-5 Reducing excess dietary sodium can lower blood pressure, with a greater response among persons with hypertension.6-9 Nine of 10 Americans consume excess dietary sodium, defined as more than 2300 mg per day.10,11 Many leading medical and public health organizations recommend reducing dietary sodium to a maximum of 2300 mg per day on the basis of evidence indicating a public health benefit.11-17 Yet this benefit has been questioned, mainly on the basis of studies suggesting that low sodium intake is also associated with an increased risk of cardiovascular disease.18-22

In science, conflicting evidence from studies with methods of different strengths is not uncommon. Studies that measure sodium intake vary widely in their methods and should be judged accordingly. Accurate measurement matters.23-26 Paradoxical findings based on inaccurate sodium measurements should not stall efforts to improve the food environment in ways that enable consumers to reduce excess sodium intake. Gradual, stepwise sodium reduction, as recommended by the Institute of Medicine,27 remains an achievable, effective, and important public health strategy to prevent tens of thousands of heart attacks and strokes and save billions of dollars in health care costs annually.28

Full article

http://www.nejm.org/doi/full/10.1056/NEJMsb1607161
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Re: UPDATED!! Time to end the war on Salt?

Postby JeffN » Sat Aug 13, 2016 6:49 am

Viewpoint
Sodium Reduction—Saving Lives by Putting Choice Into Consumers’ Hands
Thomas R. Frieden, MD, MPH
Centers for Disease Control and Prevention,
Atlanta, Georgia

http://news.medlive.cn/uploadfile/20160 ... 648887.pdf

Highlights

How Much Difference Would Sodium Reduction Make?
Nine of 10 US adults and children consume too much so- dium, and even modest reductions in sodium intake are as- sociated with substantial health benefits. Average sodium intake (≈3400 mg/d) is well in excess of the 2300 mg/d recommended by the 2015-2020 Dietary Guidelines for Americans. It is estimated that a decrease in sodium intake by as little as 400 mg/d could prevent 32 000 myocardial infarctions and 20 000 strokes annually.3 Reducing sodium intake by 1200 mg/d may reduce the number of people with hypertension by nearly 11 million. Over a de- cade, this reduction could prevent up to an estimated 500 000 deaths and may save an estimated $100 billion in health care costs.3,4 In addition to, and working syner- gistically with, improved treatment of hypertension, so- dium reduction is the most scalable intervention to reduce blood pressure; no other intervention would have as large a population reach and effect.

Could Sodium Reduction Harm Some People?
Some researchers claim that sodium reduction could harm a segment of the general population. Although there are short-term physiologic responses to marked short-term sodium reduction, interventions lasting 4 weeks or longer do not adversely affect blood lipids, catecholamine levels, insulin metabolism, or renal function. In contrast, excess dietary sodium intake, even in the absence of elevated blood pressure, may adversely affect the heart, kidneys, brain, and blood vessels. Reducing sodium in the food supply will not cause in- sufficient sodium consumption.

Recommended sodium intake is far higher than physiologic need; the estimated average requirement of 1500 mg/d accommodates groups with extreme physiologic sodium excretion (eg, profes- sional athletes). If proposed targets are met, there will be minimal change in the proportion of the population consuming less than 1500 mg/d of sodium, cur- rently 1%. In sum, there are definite harms associated with excess sodium, clear benefits from reducing sodium intake to levels recom- mended in the Dietary Guidelines for Americans, and mini- mal risk of harm from inadequate sodium intake.

There is no evidence that lower sodium intake will increase cardiovascular disease or all-cause mortality. The most rigorous studies find a consistent relationship between sodium intake and blood pressure and between blood pressure and cardiovascular disease. Flawed research should not stall public health interventions to increase consumer choice over sodium intake and save lives.
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Re: UPDATED!! Time to end the war on Salt?

Postby JeffN » Sun Oct 09, 2016 3:06 pm

Sodium Intake and All-Cause Mortality Over 20 Years in the Trials of Hypertension Prevention.
J Am Coll Cardiol. 2016 Oct 11;68(15):1609-1617.

doi: 10.1016/j.jacc.2016.07.745.

https://www.ncbi.nlm.nih.gov/pubmed/27712772

METHODS:
Two trials, phase I (1987 to 1990), over 18 months, and phase II (1990 to 1995), over 36 months, were undertaken in TOHP (Trials of Hypertension Prevention), which implemented sodium reduction interventions. The studies included multiple 24-h urine samples collected from pre-hypertensive adults 30 to 54 years of age during the trials. Post-trial deaths were ascertained over a median 24 years, using the National Death Index. The associations between mortality and the randomized interventions as well as with average sodium intake were examined.

RESULTS:
Among 744 phase I and 2,382 phase II participants randomized to sodium reduction or control, 251 deaths occurred, representing a nonsignificant 15% lower risk in the active intervention (hazard ratio [HR]: 0.85; 95% confidence interval [CI]: 0.66 to 1.09; p = 0.19). Among 2,974 participants not assigned to an active sodium intervention, 272 deaths occurred. There was a direct linear association between average sodium intake and mortality, with an HR of 0.75, 0.95, and 1.00 (references) and 1.07 (p trend = 0.30) for <2,300, 2,300 to <3,600, 3,600 to <4,800, and ≥4,800 mg/24 h, respectively; and with an HR of 1.12 per 1,000 mg/24 h (95% CI: 1.00 to 1.26; p = 0.05). There was no evidence of a J-shaped or nonlinear relationship. The HR per unit increase in sodium/potassium ratio was 1.13 (95% CI: 1.01 to 1.27; p = 0.04).

CONCLUSIONS:
We found an increased risk of mortality for high-sodium intake and a direct relationship with total mortality, even at the lowest levels of sodium intake. These results are consistent with a benefit of reduced sodium and sodium/potassium intake on total mortality over a 20-year period.
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Re: UPDATED!! Time to end the war on Salt?

Postby JeffN » Wed Feb 22, 2017 7:15 am

Salty food preference is associated with osteoporosis among Chinese men.
Asia Pac J Clin Nutr. 2016 Dec;25(4):871-878. doi: 10.6133/apjcn.102015.06.

http://apjcn.nhri.org.tw/server/APJCN/25/4/871.pdf

Abstract

BACKGROUND AND OBJECTIVES:
The main purpose of this study was to evaluate the associations between salty food preference and osteoporosis (OP) in general Chinese men.

METHODS AND STUDY DESIGN:
We conducted a largescale, community-based, cross-sectional study to estimate the associations by using self-report questionnaire to evaluate the salty food preference. The total of 1,092 men was available to data analysis in this study. Multiple regression models controlling for confounding factors to include salty food preference variables were employed to explore the relationships for OP.

RESULTS:
We found negative correlations between preference for salty food and T-score (p=0.006). Multiple regression analysis showed that the preference for salty food was significantly positively associated with OP (p<0.05 for all). The men with preference for salty food habits had a higher prevalence of OP.

CONCLUSION:
The findings indicated that salty food preference was independently and significantly associated with OP. The prevalence of OP was more frequent in Chinese men preferring salty food habits.
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Re: UPDATED!! Time to end the war on Salt?

Postby JeffN » Thu Mar 09, 2017 2:56 pm

JAMA | OriginalInvestigation
Association Between Dietary Factors and Mortality
From Heart Disease, Stroke, and Type 2 Diabetes
in the United States
JAMA March 7, 2017 Volume 317, Number 9
JAMA. 2017;317(9):912-924.
doi:10.1001/jama.2017.0947

IMPORTANCE
In the United States, national associations of individual dietary factors with specific cardiometabolic diseases are not well established.

OBJECTIVE
To estimate associations of intake of 10 specific dietary factors with mortality due to heart disease, stroke, and type 2 diabetes (cardiometabolic mortality) among US adults.

DESIGN, SETTING, AND PARTICIPANTS A comparative risk assessment model incorporated data and corresponding uncertainty on population demographics and dietary habits from National Health and Nutrition Examination Surveys (1999-2002: n = 8104; 2009-2012: n = 8516); estimated associations of diet and disease from meta-analyses of prospective studies and clinical trials with validity analyses to assess potential bias; and estimated disease-
specific national mortality from the National Center for Health Statistics.

EXPOSURES
Consumption of 10 foods/nutrients associated with cardiometabolic diseases: fruits, vegetables, nuts/seeds, whole grains, unprocessed red meats, processed meats, sugar-sweetened beverages (SSBs), polyunsaturated fats, seafood omega-3 fats, and sodium.

MAIN OUTCOMES AND MEASURES
Estimated absolute and percentage mortality due to heart disease, stroke, and type 2 diabetes in 2012. Disease-specific and demographic-specific (age, sex, race, and education) mortality and trends between 2002 and 2012 were also evaluated.

RESULTS
In 2012,702308 cardiometabolic deaths occurred in US adults, including 506100 from heart disease (371 266 coronary heart disease, 35 019 hypertensive heart disease, and 99 815 other cardiovascular disease), 128 294 from stroke (16 125 ischemic, 32 591 hemorrhagic, and 79 578 other), and 67 914 from type 2 diabetes. Of these, an estimated 318 656 (95% uncertainty interval [UI], 306 064-329 755; 45.4%) cardiometabolic deaths per year were associated with suboptimal intakes—48.6% (95% UI, 46.2%-50.9%) of cardiometabolic deaths in men and 41.8% (95% UI, 39.3%-44.2%) in women; 64.2% (95% UI, 60.6%-67.9%) at younger ages (25-34 years) and 35.7% (95% UI, 33.1%-38.1%) at older ages ( 75 years); 53.1% (95% UI, 51.6%-54.8%) among blacks, 50.0% (95% UI, 48.2%-51.8%) among Hispanics, and 42.8% (95% UI, 40.9%-44.5%) among whites; and 46.8% (95% UI, 44.9%-48.7%) among lower-, 45.7% (95% UI, 44.2%-47.4%) among medium-, and 39.1% (95% UI, 37.2%-41.2%) among higher-educated individuals. The largest numbers of estimated diet-related cardiometabolic deaths were related to high sodium (66 508 deaths in 2012; 9.5% of all cardiometabolic deaths), low nuts/seeds (59 374; 8.5%), high processed meats (57 766; 8.2%), low seafood omega-3 fats (54 626; 7.8%), low vegetables (53 410; 7.6%), low fruits (52 547; 7.5%), and high SSBs (51 694; 7.4%). Between 2002 and 2012, population-adjusted US cardiometabolic deaths per year decreased by 26.5%. The greatest decline was associated with insufficient polyunsaturated fats (−20.8% relative change [95% UI, −18.5% to −22.8%]), nuts/seeds (−18.0% [95% UI, −14.6% to −21.0%]), and excess SSBs (−14.5% [95% UI, −12.0% to −16.9%]). The greatest increase was associated with unprocessed red meats (+14.4% [95% UI, 9.1%-19.5%]).

CONCLUSIONS AND RELEVANCE
Dietary factors were estimated to be associate dwith a substantial proportion of deaths from heart disease, stroke, and type 2 diabetes. These results should help identify priorities, guide public health planning, and inform strategies to alter dietary habits and improve health.

From the full text…

Among unhealthful foods/nutrients, the present findings suggest that sodium is a key target. Population-wide salt reduction policies that include a strong government role to educate the public and engage industry to gradually reduce salt content in processed foods (for example, as implemented in the United Kingdom and Turkey) appear to be effective, equitable, and highly cost-effective or even cost-saving.31,32 Such population approaches can also minimize challenges of public taste preferences, placing all companies on a level playing field and allowing the population’s taste receptors for salt to gradually up regulate, preventing any major perception of changes in taste.33 Functional benefits of salt in foods, such as for texture or food safety, must also be further addressed by advances in food processing.33"

31. Wyness LA, Butriss JL, Stanner SA.Reducing the population’s sodium intake: the UK Food Standards Agency’s salt reduction programme. Public Health Nutr. 2012;15(2):254-261.

32. Webb M, Fahimi S, Singh GM,etal.Cost effectiveness of a government supported policy strategy to decrease sodium intake: global analysis across 183 nations. BMJ. 2017;356:i6699.

33. Institute of Medicine Committee on Strategies to Reduce Sodium Intake. Reports funded by National Institutes of Health. In: Henney JE, Taylor CL, Boon CS, eds. Strategies to Reduce Sodium Intake in the United States. Washington, DC: National Academies Press; 2010.


From the accompanying editorial

Attributing Death to Diet
Precision Counts
Noel T. Mueller, PhD, MPH; Lawrence J. Appel, MD, MPH
JAMA March 7, 2017 Volume 317, Number 9

“The highest proportion of CMD deaths was estimated to be related to excess sodium intake (9.5% of CMD deaths);”
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Re: UPDATED!! Time to end the war on Salt?

Postby JeffN » Thu Apr 20, 2017 1:04 pm

Effects of dietary salt levels on monocytic cells and immune responses in healthy human subjects: a longitudinal study.
Transl Res. 2015 Jul;166(1):103-10. doi: 10.1016/j.trsl.2014.11.007. Epub 2014 Nov 22.

https://www.ncbi.nlm.nih.gov/pubmed/25497276

Abstract
Increasing evidence indicated that excess salt consumption can impose risks on human health and a reduction in daily salt intake from the current average of approximately 12 g/d to 5-6 g/d was suggested by public health authorities. The studies on mice have revealed that sodium chloride plays a role in the modulation of the immune system and a high-salt diet can promote tissue inflammation and autoimmune disease. However, translational evidence of dietary salt on human immunity is scarce. We used an experimental approach of fixing salt intake of healthy human subjects at 12, 9, and 6 g/d for months and examined the relationship between salt-intake levels and changes in the immune system. Blood samples were taken from the end point of each salt intake period. Immune phenotype changes were monitored through peripheral leukocyte phenotype analysis. We assessed immune function changes through the characterization of cytokine profiles in response to mitogen stimulation. The results showed that subjects on the high-salt diet of 12 g/d displayed a significantly higher number of immune cell monocytes compared with the same subjects on a lower-salt diet, and correlation test revealed a strong positive association between salt-intake levels and monocyte numbers. The decrease in salt intake was accompanied by reduced production of proinflammatory cytokines interleukin (IL)-6 and IL-23, along with enhanced producing ability of anti-inflammatory cytokine IL-10. These results suggest that in healthy humans high-salt diet has a potential to bring about excessive immune response, which can be damaging to immune homeostasis, and a reduction in habitual dietary salt intake may induce potentially beneficial immune alterations.

PMID: 25497276


FYI

12 grams of salt is 4800 mg sodium

6 grams of salt is 2400 mg sodium (the old recommended UL)
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Re: Time to end the war on Salt?

Postby JeffN » Mon May 01, 2017 7:58 am

JeffN wrote:
RawDad wrote:Interesting. Dr. McDougall says in this video we are supposed to eat salt & seek salt......@ ~ 1:15 into the video....


We have to keep this in perspective and know the difference between sodium (which the body needs) and table salt, which is sodium chloride (the number on contributor of sodium to the diet). Dr McDougall's recommendations and my recommendations are virtually identical as shown in the quote below from The Starch Solution. The difference is, the approach but the target is the same.

Human beings require sodium not salt. Salt is a compound molecule that contains sodium.

We get all the sodium we need from what occurs naturally in whole plant foods when someone follows the guidelines and recommendations here.

RawDad wrote:why is it the foremost taste we seek ?


Is it?

:)

In Health
Jeff



viewtopic.php?f=1&t=53973&p=549878&#p549878

JeffN wrote:Let's put this concern in perspective and I will address the S (sugar) and the S (salt). We can save the O for another day.

First, The evidence for S-S Free is virtually non existent. However, the evidence for low(er) S-S is abundant. Neither Dr McDougall, Dr Esselstyn, Dr Klaper or I recommend S-S Free just low(er) S-S. Dr Goldhamer recommends S-S free but acknowledges the evidence is only for low S-S but sees no reason to recommend S-S or use it. I have a running thread on added sugar and one on added salt. [To be perfectly clear, I would say I do recommend S-S free but allow for both (low S-S & S-S free), within my guidelines.]

For the record, if you are trying to follow a S-S free diet, you may want to read my article on this issue as many are using products that contain added S-S and don't realize it.

https://www.facebook.com/notes/jeff-nov ... 6400521819

"Adding a half teaspoons of salt at the table to your starch-based meals over the course of a day adds about 1,100 mg of sodium, for a daily total of about 1,600 mg, 700 mg below the 2010 USDA Dietary Guidelines of less than 2,300 mg daily and 400 mg below the 2,000 mg low-sodium diet fed to hospital patients following a massive heart attack.

With these naturally low levels, I have no concerns about inviting people following my starch-based diet to sprinkle a little salt on their food......."




He goes on to say that he doesn't recommend cooking with salt, but doesn't mind it when adding a little salt to the food. I believe he has table salt available for people to use at his 10 day program.

Dr. McDougall does not claim that his food plan is SOS free. He realizes that some people might need a pinch of salt or sugar to make the food more palatable (at first, at least). True North offers a truly SOS free plan.


In regard to added salt, the quote from TSS (and the comments) are correct but again, need to be put in perspective.

As per the quote, at the McDougall Program, it is announced in the first lecture that the food is (as often as possible) prepared with no added salt. However, there are salt shakers at the table and people are encouraged to use them if desired. It is not a salt-free diet.

So, add 1/2 tsp (which is ~1100 mg) to the food (which is ~500 mg) and you are at 1600.

Here is how the numbers work out..

The average person on the SAD diet adds about 200 mg during cooking and about 240 mg of salt at the table

The McDougall diet without added salt is around 300-500 mg. While consuming your food at the 10-Day Program, add in the 240 added at the table, and even add in the 200 that used to be added in during cooking, and we are at 790 to 990. Not even at the 1/2 tsp yet. So, if you really wanted, you can add in another 240 and you are at 1030-1230, roughly a 1/2 tsp and still below the 2300, the 1600 and the 1500.

Since salt added to the food at the table that sits on top of the food, has a much more flavor impact then salt cooked into food, many find that it is not even necessary to add in all this as a few shakes (or two) of the salt shaker at each meal is more then enough and will end up around 550-1000

However, this does not justify the liberal unbridled use of salt or any processed foods, even WFPB/Vegan processed foods, that have excessive amounts of salt in them.

This is also inline with the other WFPB docs mentioned above as well as the Ornish, Pritikin, CHIP, PCRM programs too.

And, as many have found and reported in these forums, paying attention to the issue of added salt and cutting back (and in some cased, cutting out) has been of great benefit.

For more details on all these points, see my thread on salt.

In Health
Jeff


Just to be clear, here are the actual 2 quotes

From the 2008 newsletter, Dr. McDougall states:

"A basic diet of starches, vegetables, and fruits (the McDougall Diet) with no added sodium provides less than 500 mg of sodium daily. Adding a half-teaspoon of salt to the surface of your McDougall dishes daily adds about 1100 mg of sodium—making the total daily intake 1600 mg. The “low-sodium diet” fed to a hospitalized patient, following a massive heart attack, under the expert guidance of doctors and dietitians, contains 2000 mg of sodium. Now you understand why I am comfortable putting the saltshaker on the dining tables at our programs.”

From The Starch Solution

"Adding a half teaspoons of salt at the table to your starch-based meals over the course of a day adds about 1,100 mg of sodium, for a daily total of about 1,600 mg, 700 mg below the 2010 USDA Dietary Guidelines of less than 2,300 mg daily and 400 mg below the 2,000 mg low-sodium diet fed to hospital patients following a massive heart attack.

With these naturally low levels, I have no concerns about inviting people following my starch-based diet to sprinkle a little salt on their food. Assuming the food was not prepared with with sodium, you can add up to 3/4’s a tsp of salt per day and still stay within the USDA’s Dietary Guidelines."


Both are consistent with each other and consistent with my recommendations.
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Re: Time to end the war on Salt?

Postby JeffN » Mon May 15, 2017 8:44 am

JeffN wrote:Let me put it in perspective... :)

The need for sodium is so low and the amount occurs so easily in foods that there is no RDA for sodium. The National Academy of Sciences says humans can survive on as little as 125 mgs/day. However, a whole plant food diet would easily provide 350-500 in what occurs naturally in foods.

The AHA, IOM and others have set what is called an adequate intake (AI) which is the <1200-1500/day. This is based on age and health.

The Upper Limit (UL) is set at 2300.

Some of the national health organizations, like the USDA, just default to the Upper Limit and not the AI as it is more politically correct. However they have been publicly blasted by the AHA and IOM for doing so.

So, that's the recommendations.

In regard to intake...

The average sodium intake is estimated to be about 4000 mgs/day. Of that 4000, 10-12% occurs naturally in food, 5% is added at the table to the surface of the food, 5% is added during cooking, and about 75-80% is hidden in packaged processed foods and restaurant foods with the majority of that coming from packaged/processed foods.

So, if we eliminate the 75-80% of packaged/processed foods and the 5% we add during cooking that is 80-85% of the 4000, which leaves 600- 800 mgs per day which is way below the recommended intakes. And, that includes the 5% added at the table to the surface of the food.

Or if you look at it this way... you will get in about 350-500 mg of sodium from what occurs naturally in whole plant foods. Let say 500 to make math easier. The AI is <1200-1500 so lets use the 1500 to make math easier. And the UL is 2300. Subtract what occurs naturally in food from the AI (1500 minus 500) and from the UL (2300-500) and you get 1000- 1800 mgs.

As a tsp of salt is around 2200 - 2300 mg, that would allow for up to 1/2 to 3/4 tsp per day.

If you choose to do this, it would be best to add it to the surface of the food at the table as you will get the most flavor for the least amount. Right now, they estimate what we add at the table to be about 5% of the 4000 (which is 200). So, add the 200 to the 500 which occurs naturally and you are at 700 and safe.

Make sense?


The really good news is that we down regulate our taste buds to salt, very quickly and low salt to salt-free food begins to taste great.

http://ajcn.nutrition.org/content/36/6/1134.abstract

"These results demonstrate that the preferred level of salt in food is dependent on the level of salt consumed and that this preferred level can be lowered after a reduction in sodium intake. The implications of these findings for the maintenance of low sodium diets are discussed."

http://www.ncbi.nlm.nih.gov/pubmed/3728360

"Reduction in sodium intake and excretion accompanied a shift in preference toward less salt"

And the best way to get to reduce our intake is to get it out of all the food and if desired, sprinkle it on the food at the table.

http://www.ncbi.nlm.nih.gov/pubmed/3682116

"A substantial reduction in dietary sodium is possible if lowered-sodium foods are consumed in conjunction with ad libitum table salt."

In Health
Jeff


A very well done study came out this week re-confirming all the above information.

Circulation
ORIGINAL RESEARCH ARTICLE

Sources of Sodium in US Adults From 3 Geographic Regions
https://doi.org/10.1161/CIRCULATIONAHA.116.024446
Circulation. 2017;135:1775-1783
http://circ.ahajournals.org/content/135/19/1775

Abstract

Background:
Most US adults consume excess sodium. Knowledge about the dietary sources of sodium intake is critical to the development of effective reduction strategies.

Methods:
A total of 450 adults were recruited from 3 geographic locations: Birmingham, AL (n=150); Palo Alto, CA (n=150); and the Minneapolis–St. Paul, MN (n=150), metropolitan areas. Equal numbers of women and men from each of 4 race/ethnic groups (blacks, Asians, Hispanics, and non-Hispanic whites) were targeted for recruitment. Four record-assisted 24-hour dietary recalls were collected from each participant with special procedures, which included the collection of duplicate samples of salt added to food at the table and in home food preparation.

Results:
Sodium added to food outside the home was the leading source of sodium, accounting for more than two thirds (70.9%) of total sodium intake in the sample. Although the proportion of sodium from this source was smaller in some subgroups, it was the leading contributor for all subgroups. Contribution ranged from 66.3% for those with a high school level of education or less to 75.0% for those 18 to 29 years of age. Sodium inherent to food was the next highest contributor (14.2%), followed by salt added in home food preparation (5.6%) and salt added to food at the table (4.9%). Home tap water consumed as a beverage and dietary supplement and nonprescription antacids contributed minimally to sodium intake (<0.5% each).

Conclusions:
Sodium added to food outside the home accounted for ≈70% of dietary sodium intake. This finding is consistent with the 2010 Institute of Medicine recommendation for reduction of sodium in commercially processed foods as the primary strategy to reduce sodium intake in the United States.

Image
Naturally Occurring sodium in food - 14%
Packaged/Processed/Restaurant Foods - 71%
Added while cooking - 6%
Added att he table - 5%
Supplements/Tap Water - 1%



Article
How much sodium do we salt our foods with at home? Not as much as you may think.
David Schardt
May 15, 2017

Did your physician suggest cutting back on salt after your blood pressure started creeping up? If you banished the salt shaker from your dinner table, that move alone probably wasn’t enough.

Researchers at the University of Minnesota and elsewhere have meticulously charted the sources of sodium in the diets of 450 representative adults living in Alabama, California, and Minnesota. The study was funded by the Centers for Disease Control (CDC).

Read more...

http://www.nutritionaction.com/daily/sa ... h-at-home/
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Re: UPDATED!! Time to end the war on Salt?

Postby JeffN » Thu Aug 03, 2017 10:33 am

Half of Americans eat enough salt everyday to do heart damage.

Association of Estimated Sodium Intake With Adverse Cardiac Structure and Function
From the HyperGEN Study
Journal of the American College of Cardiology
Volume 70, Issue 6, August 2017
DOI: 10.1016/j.jacc.2017.06.036
http://www.onlinejacc.org/content/70/6/715

Abstract
Background
The optimal level of sodium intake remains controversial.

Objectives
This study sought to determine whether examination of left ventricular longitudinal strain (LS), circumferential strain, and e′ velocity can provide insight into thresholds for the detrimental effects of estimated sodium intake (ESI) on subclinical cardiovascular disease.

Methods
We performed speckle-tracking analysis on HyperGEN (Hypertension Genetic Epidemiology Network) study echocardiograms with available urinary sodium data (N = 2,996). We evaluated the associations among ESI and LS, circumferential strain, and e′ velocity using multivariable-adjusted linear mixed-effects models (to account for relatedness among subjects) with linear splines (spline 1: ESI ≤3.7 g/day, spline 2: ESI >3.7 g/day based on visual inspection of fractional polynomial plots of the association between ESI and indices of strain and e′ velocity). We performed mediation analysis to understand the indirect effects of systolic blood pressure and serum aldosterone on the relationship between ESI and strain and e′ velocity.

Results
Mean age of participants was 49 ± 14 years, 57% were female, 50% were African American, and 54% had hypertension. The median ESI was 3.73 (interquartile range: 3.24, 4.25) g/day. ESI >3.7 g/day was associated with larger left atrial and left ventricular dimensions (p < 0.05). After adjusting for speckle-tracking analyst, image quality, study site, age, sex, smoking status, alcohol use, daily blocks walked, diuretic use, estimated glomerular filtration rate, left ventricular mass, ejection fraction, and wall motion score index, ESI >3.7 g/day was associated with both strain parameters and e′ velocity (p < 0.05 for all comparisons), but ESI ≤3.7 g/day was not (p > 0.05 for all comparisons). There were significant interactions by potassium excretion for circumferential strain. Mediation analysis suggested that systolic blood pressure explained 14% and 20% of the indirect effects between ESI and LS and e′ velocity, respectively, whereas serum aldosterone explained 19% of the indirect effects between ESI and LS.

Conclusions
ESI >3.7 g/day is associated with adverse cardiac remodeling and worse systolic strain and diastolic e′ velocity.
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Re: UPDATED!! Time to end the war on Salt?

Postby JeffN » Tue Oct 31, 2017 2:09 pm

Effect of dietary sodium restriction on arterial stiffness: systematic review and meta-analysis of the randomized controlled trials.
D'Elia L, Galletti F, La Fata E, Sabino P, Strazzullo P.
J Hypertens. 2017 Oct 27. doi: 10.1097/HJH.0000000000001604. [Epub ahead of print]
PMID: 29084085
Abstract

OBJECTIVE:
Arterial stiffness is an independent cardiovascular risk factor and sodium intake could be a determinant of arterial stiffness. Nevertheless, the studies that investigated the effect of reducing dietary sodium intake on arterial stiffness in humans provided inconsistent results. Therefore, we performed a systematic review and a meta-analysis of the available randomized controlled trials of salt restriction and arterial stiffness to try and achieve more definitive conclusions.

METHODS:
A systematic search of the online databases available (from 1996 through July 2017) was conducted including randomized controlled trials that reported arterial stiffness, expressed by carotid-femoral pulse wave velocity (PWV), as difference between the effects of two different sodium intake regimens. For each study, the mean difference and 95% confidence intervals were pooled using a random effect model. Sensitivity, heterogeneity, publication bias, subgroup and meta-regression analyses were performed.

RESULTS:
Eleven studies met the predefined inclusion criteria and provided 14 cohorts with 431 participants and 1-6 weeks intervention time. In the pooled analysis, an average reduction in sodium intake of 89.3 mmol/day was associated with a 2.84% (95% CI: 0.51-5.08) reduction in PWV. There was no significant heterogeneity among studies and no evidence of publication bias was detected. No single feature of the studies analyzed seemed to impact on the effect of salt restriction on PWV.

CONCLUSION:
The results of this meta-analysis indicate that restriction of dietary sodium intake reduces arterial stiffness. This effect seems be at least in part independent of the changes in blood pressure.
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Re: UPDATED!! Time to end the war on Salt?

Postby JeffN » Sun Mar 18, 2018 9:39 am

On the new Blood Pressure Guidelines and a few new related studies on salt reduction

viewtopic.php?f=22&t=57369

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Re: UPDATED!! Time to end the war on Salt?

Postby JeffN » Fri Sep 07, 2018 4:26 am

Dietary Salt Intake is a Significant Determinant of Impaired Kidney Function in the General Population.
Kidney Blood Press Res. 2018 Aug 3;43(4):1245-1254. doi: 10.1159/000492406. [Epub ahead of print]
PMID: 30078009
https://www.karger.com/Article/Pdf/492406

Abstract
BACKGROUND/AIMS:
Kidney dysfunction is an important risk factor for cardiovascular disease and end-stage renal disease. This study investigated whether dietary salt intake predicts deterioration of kidney function in the general population.
METHODS:
In all, 12 126 subjects with a normal estimated glomerular filtration rate (eGFR ≥60 mL/min per 1.73m2) attending an annual check-up were enrolled in the study and were followed-up for a median of 1754 days; the endpoint was the development of impaired kidney function (eGFR < 60 mL/min per 1.73m2). Individual salt intake was estimated using spot urine analysis.
RESULTS:
At baseline, mean (± SD) salt intake and eGFR were 10.6 ± 3.4 g/day and 80.8 ± 12.9 mL/min per 1.73m2, respectively. During the follow-up period, 1384 subjects (25.2 per 1000 person-years) developed impaired kidney function. Multivariate Cox hazard regression analysis revealed salt intake as a significant predictor of the new onset of kidney impairment (hazard ratio 1.045; 95% confidence interval 1.025-1.065). Subjects were divided into two groups based on salt intake; the incidence of impaired kidney function was higher in the group with high than low salt intake (P < 0.001, log-rank test). Multivariate Cox hazard regression analysis indicated a 29% increased risk of developing impaired kidney function in the high-salt group. Multivariate linear regression analysis showed a significant correlation between salt intake and yearly decline in eGFR (β = 0.060, P < 0.001).
CONCLUSION:
Salt intake is associated with the development of impaired kidney function in the general population, independent of its effects on blood pressure. Salt restriction may help prevent the development of impaired kidney function.
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Re: UPDATED!! Time to end the war on Salt?

Postby JeffN » Tue Sep 11, 2018 2:39 pm

Effects of Sodium Reduction and the DASH Diet in Relation to Baseline Blood Pressure
Journal of the American College of Cardiology
Volume 70, Issue 23, 12 December 2017, Pages 2841-2848
https://doi.org/10.1016/j.jacc.2017.10.011

Abstract

Background
Both sodium reduction and the DASH (Dietary Approaches to Stop Hypertension) diet, a diet rich in fruits, vegetables, and low-fat dairy products, and reduced in saturated fat and cholesterol, lower blood pressure. The separate and combined effects of these dietary interventions by baseline blood pressure (BP) has not been reported.

Objectives
The authors compared the effects of low versus high sodium, DASH versus control, and both (low sodium-DASH vs. high sodium-control diets) on systolic blood pressure (SBP) by baseline BP.

Methods
In the DASH-Sodium (Dietary Patterns, Sodium Intake and Blood Pressure) trial, adults with pre- or stage 1 hypertension and not using antihypertensive medications, were randomized to either DASH or a control diet. On either diet, participants were fed each of 3 sodium levels (50, 100, and 150 mmol/day at 2,100 kcal) in random order over 4 weeks separated by 5-day breaks. Strata of baseline SBP were <130, 130 to 139, 140 to 149, and ≥150 mm Hg.

Results
Of 412 participants, 57% were women, and 57% were black; mean age was 48 years, and mean SBP/diastolic BP was 135/86 mm Hg. In the context of the control diet, reducing sodium (from high to low) was associated with mean SBP differences of −3.20, −8.56, −8.99, and −7.04 mm Hg across the respective baseline SBP strata listed (p for trend = 0.004). In the context of high sodium, consuming the DASH compared with the control diet was associated with mean SBP differences of −4.5, −4.3, −4.7, and −10.6 mm Hg, respectively (p for trend = 0.66). The combined effects of the low sodium-DASH diet versus the high sodium-control diet on SBP were −5.3, −7.5, −9.7, and −20.8 mm Hg, respectively (p for trend <0.001).

Conclusions
The combination of reduced sodium intake and the DASH diet lowered SBP throughout the range of pre- and stage 1 hypertension, with progressively greater reductions at higher levels of baseline SBP. SBP reductions in adults with the highest levels of SBP (≥150 mm Hg) were striking and reinforce the importance of both sodium reduction and the DASH diet in this high-risk group. Further research is needed to determine the effects of these interventions among adults with SBP ≥160 mm Hg.
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Re: UPDATED!! Time to end the war on Salt?

Postby JeffN » Thu Nov 08, 2018 1:36 pm

High sodium intake increases blood pressure and risk of kidney disease. From the Science of Salt: A regularly updated systematic review of salt and health outcomes (August 2016 to March 2017).
Malta D, Petersen KS, Johnson C, Trieu K, Rae S, Jefferson K, Santos JA, Wong MMY, Raj TS, Webster J, Campbell NRC, Arcand J.
J Clin Hypertens (Greenwich). 2018 Nov 7. doi: 10.1111/jch.13408. [Epub ahead of print]
PMID: 30402970
Abstract
The purpose of this review was to identify, summarize, and critically appraise studies on dietary salt and health outcomes that were published from August 2016 to March 2017. The search strategy was adapted from a previous systematic review on dietary salt and health. Studies that meet standards for methodological quality criteria and eligible health outcomes are reported in detailed critical appraisals. Overall, 47 studies were identified and are summarized in this review. Two studies assessed all-cause or disease-specific mortality outcomes, eight studies assessed morbidity reduction-related outcomes, three studies assessed outcomes related to symptoms/quality of life/functional status, 25 studies assessed blood pressure (BP) outcomes and other clinically relevant surrogate outcomes, and nine studies assessed physiologic surrogate outcomes. Eight of these studies met the criteria for outcomes and methodological quality and underwent detailed critical appraisals and commentary. Five of these studies found adverse effects of salt intake on health outcomes (BP; death due to kidney disease and initiation of dialysis; total kidney volume and composite of kidney function; composite of cardiovascular disease (CVD) events including, and risk of mortality); one study reported the benefits of salt restriction in chronic BP and two studies reported neutral results (BP and risk of CKD). Overall, these articles confirm the negative effects of excessive sodium intake on health outcomes.
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Re: UPDATED!! Time to end the war on Salt?

Postby JeffN » Thu Dec 27, 2018 5:36 pm

Errors in estimating usual sodium intake by the Kawasaki formula alter its relationship with mortality: implications for public health.
Int J Epidemiol. 2018 Dec 1;47(6):1784-1795.

doi: 10.1093/ije/dyy114.

Abstract

BACKGROUND:Several cohort studies with inaccurate estimates of sodium reported a J-shaped relationship with mortality. We compared various estimated sodium intakes with that measured by the gold-standard method of multiple non-consecutive 24-h urine collections and assessed their relationship with mortality.

METHODS: We analysed the Trials of Hypertension Prevention follow-up data. Sodium intake was assessed in four ways: (i) average measured (gold standard): mean of three to seven 24-h urinary sodium measurements during the trial periods; (ii) average estimated: mean of three to seven estimated 24-h urinary sodium excretions from sodium concentration of 24-h urine using the Kawasaki formula; (iii) first measured: 24-h urinary sodium measured at the beginning of each trial; (iv) first estimated: 24-h urinary sodium estimated from sodium concentration of the first 24-h urine using the Kawasaki formula. We included 2974 individuals aged 30-54 years with pre-hypertension, not assigned to sodium intervention.

RESULTS: During a median follow-up of 24 years, 272 deaths occurred. The average sodium intake measured by the gold-standard method was 3769 ± 1282 mg/d. The average estimated sodium over-estimated the intake by 1297 mg/d (95% confidence interval: 1267-1326). The average estimated value was systematically biased with over-estimation at lower levels and under-estimation at higher levels. The average measured sodium showed a linear relationship with mortality. The average estimated sodium appeared to show a J-shaped relationship with mortality. The first measured and the first estimated sodium both flattened the relationship.

CONCLUSIONS: Accurately measured sodium intake showed a linear relationship with mortality. Inaccurately estimated sodium changed the relationship and could explain much of the paradoxical J-shaped findings reported in some cohort studies.
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