UPDATED!! Time to end the war on Salt?

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

Moderators: JeffN, carolve, Heather McDougall

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

Postby JeffN » Wed Apr 16, 2014 11:51 am

Why is there a controversy over salt?

1) Dear Food Industry: Lower the Salt, Save Lives
Henry R. Black, MD, Graham MacGregor, MB BChir
Medscape Cardiology
Black on Cardiology

http://www.medscape.com/viewarticle/815133_1

Dr. Black: I want to talk about something that you have been interested in, possibly for your whole career: the so-called "salt controversy." Why is there a controversy?

Dr. MacGregor: That is a good question. I am not sure, but my guess is that it is mainly due to pressure from the salt and food industry.

The evidence for salt is overwhelming. Look at the wealth of the epidemiologic migration; all the animal evidence studies in chimpanzees; the treatment, genetic, and outcome studies that we have now. The evidence is overwhelming that salt raises blood pressure and is responsible for a very large number of strokes, heart attacks, and heart failure. In countries where it is high, such as China and Japan -- even higher than in the United States -- cancer of the stomach is very clearly related to a high salt intake.


2) His research ...

Salt reduction in England from 2003 to 2011: its relationship to blood pressure, stroke and ischaemic heart disease mortality.
BMJ Open. 2014 Apr 14;4(4):e004549. doi: 10.1136/bmjopen-2013-004549.

http://bmjopen.bmj.com/content/4/4/e004 ... l.pdf+html

Abstract

OBJECTIVES: To determine the relationship between the reduction in salt intake that occurred in England, and blood pressure (BP), as well as mortality from stroke and ischaemic heart disease (IHD).

DESIGN: Analysis of the data from the Health Survey for England.

SETTING AND PARTICIPANTS: England, 2003 N=9183, 2006 N=8762, 2008 N=8974 and 2011 N=4753, aged ≥16 years.

OUTCOMES: BP, stroke and IHD mortality.

RESULTS: From 2003 to 2011, there was a decrease in mortality from stroke by 42% (p<0.001) and IHD by 40% (p<0.001). In parallel, there was a fall in BP of 3.0±0.33/1.4±0.20 mm Hg (p<0.001/p<0.001), a decrease of 0.4±0.02 mmol/L (p<0.001) in cholesterol, a reduction in smoking prevalence from 19% to 14% (p<0.001), an increase in fruit and vegetable consumption (0.2±0.05 portion/day, p<0.001) and an increase in body mass index (BMI; 0.5±0.09 kg/m(2), p<0.001). Salt intake, as measured by 24 h urinary sodium, decreased by 1.4 g/day (p<0.01). It is likely that all of these factors (with the exception of BMI), along with improvements in the treatments of BP, cholesterol and cardiovascular disease, contributed to the falls in stroke and IHD mortality. In individuals who were not on antihypertensive medication, there was a fall in BP of 2.7±0.34/1.1±0.23 mm Hg (p<0.001/p<0.001) after adjusting for age, sex, ethnic group, education, household income, alcohol consumption, fruit and vegetable intake and BMI. Although salt intake was not measured in these participants, the fact that the average salt intake in a random sample of the population fell by 15% during the same period suggests that the falls in BP would be largely attributable to the reduction in salt intake rather than antihypertensive medications.

CONCLUSIONS: The reduction in salt intake is likely to be an important contributor to the falls in BP from 2003 to 2011 in England. As a result, it would have contributed substantially to the decreases in stroke and IHD mortality. 24732242

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

Postby JeffN » Sat Jun 07, 2014 10:47 pm

I doubt you will see this one in the news or making any headlines..

Jeff

Effect of lower sodium intake on health: systematic review and meta-analyses.
Aburto NJ, Ziolkovska A, Hooper L, Elliott P, Cappuccio FP, Meerpohl JJ.
BMJ. 2013 Apr 3;346:f1326. doi: 10.1136/bmj.f1326. Review.
PMID:23558163
Free Article
http://www.bmj.com/content/346/bmj.f132 ... d=23558163
http://www.bmj.com/content/346/bmj.f1326.pdf%2Bhtml

Abstract

OBJECTIVE: To assess the effect of decreased sodium intake on blood pressure, related cardiovascular diseases, and potential adverse effects such as changes in blood lipids, catecholamine levels, and renal function.

DESIGN: Systematic review and meta-analysis.

DATA SOURCES: Cochrane Central Register of Controlled Trials, Medline, Embase, WHO International Clinical Trials Registry Platform, the Latin American and Caribbean health science literature database, and the reference lists of previous reviews.

STUDY SELECTION: Randomised controlled trials and prospective cohort studies in non-acutely ill adults and children assessing the relations between sodium intake and blood pressure, renal function, blood lipids, and catecholamine levels, and in non-acutely ill adults all cause mortality, cardiovascular disease, stroke, and coronary heart disease.

STUDY APPRAISAL AND SYNTHESIS: Potential studies were screened independently and in duplicate and study characteristics and outcomes extracted. When possible we conducted a meta-analysis to estimate the effect of lower sodium intake using the inverse variance method and a random effects model. We present results as mean differences or risk ratios, with 95% confidence intervals.

RESULTS: We included 14 cohort studies and five randomised controlled trials reporting all cause mortality, cardiovascular disease, stroke, or coronary heart disease; and 37 randomised controlled trials measuring blood pressure, renal function, blood lipids, and catecholamine levels in adults. Nine controlled trials and one cohort study in children reporting on blood pressure were also included. In adults a reduction in sodium intake significantly reduced resting systolic blood pressure by 3.39 mm Hg (95% confidence interval 2.46 to 4.31) and resting diastolic blood pressure by 1.54 mm Hg (0.98 to 2.11). When sodium intake was <2 g/day versus =/> 2 g/day, systolic blood pressure was reduced by 3.47 mm Hg (0.76 to 6.18) and diastolic blood pressure by 1.81 mm Hg (0.54 to 3.08). Decreased sodium intake had no significant adverse effect on blood lipids, catecholamine levels, or renal function in adults (P>0.05). There were insufficient randomised controlled trials to assess the effects of reduced sodium intake on mortality and morbidity. The associations in cohort studies between sodium intake and all cause mortality, incident fatal and non-fatal cardiovascular disease, and coronary heart disease were non-significant (P>0.05). Increased sodium intake was associated with an increased risk of stroke (risk ratio 1.24, 95% confidence interval 1.08 to 1.43), stroke mortality (1.63, 1.27 to 2.10), and coronary heart disease mortality (1.32, 1.13 to 1.53). In children, a reduction in sodium intake significantly reduced systolic blood pressure by 0.84 mm Hg (0.25 to 1.43) and diastolic blood pressure by 0.87 mm Hg (0.14 to 1.60).

CONCLUSIONS: High quality evidence in non-acutely ill adults shows that reduced sodium intake reduces blood pressure and has no adverse effect on blood lipids, catecholamine levels, or renal function, and moderate quality evidence in children shows that a reduction in sodium intake reduces blood pressure. Lower sodium intake is also associated with a reduced risk of stroke and fatal coronary heart disease in adults. The totality of evidence suggests that most people will likely benefit from reducing sodium intake.
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Re: UPDATED!! Time to end the war on Salt?

Postby JeffN » Fri Jun 20, 2014 6:17 am

Blood pressure and incidence of twelve cardiovascular diseases: lifetime risks, healthy life-years lost, and age-specific associations in 1·25 million people.
Rapsomaniki E, Timmis A, George J, Pujades-Rodriguez M, Shah AD, Denaxas S, White IR, Caulfield MJ, Deanfield JE, Smeeth L, Williams B, Hingorani A, Hemingway H.
Lancet. 2014 May 31;383(9932):1899-911. doi: 10.1016/S0140-6736(14)60685-1.
PMID:24881994
Free PMC Article
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4042017/

Abstract

BACKGROUND: The associations of blood pressure with the different manifestations of incident cardiovascular disease in a contemporary population have not been compared. In this study, we aimed to analyse the associations of blood pressure with 12 different presentations of cardiovascular disease.

METHODS: We used linked electronic health records from 1997 to 2010 in the CALIBER (CArdiovascular research using LInked Bespoke studies and Electronic health Records) programme to assemble a cohort of 1·25 million patients, 30 years of age or older and initially free from cardiovascular disease, a fifth of whom received blood pressure-lowering treatments. We studied the heterogeneity in the age-specific associations of clinically measured blood pressure with 12 acute and chronic cardiovascular diseases, and estimated the lifetime risks (up to 95 years of age) and cardiovascular disease-free life-years lost adjusted for other risk factors at index ages 30, 60, and 80 years. This study is registered at ClinicalTrials.gov, number NCT01164371.

FINDINGS: During 5·2 years median follow-up, we recorded 83,098 initial cardiovascular disease presentations. In each age group, the lowest risk for cardiovascular disease was in people with systolic blood pressure of 90-114 mm Hg and diastolic blood pressure of 60-74 mm Hg, with no evidence of a J-shaped increased risk at lower blood pressures. The effect of high blood pressure varied by cardiovascular disease endpoint, from strongly positive to no effect. Associations with high systolic blood pressure were strongest for intracerebral haemorrhage (hazard ratio 1·44 [95% CI 1·32-1·58]), subarachnoid haemorrhage (1·43 [1·25-1·63]), and stable angina (1·41 [1·36-1·46]), and weakest for abdominal aortic aneurysm (1·08 [1·00-1·17]). Compared with diastolic blood pressure, raised systolic blood pressure had a greater effect on angina, myocardial infarction, and peripheral arterial disease, whereas raised diastolic blood pressure had a greater effect on abdominal aortic aneurysm than did raised systolic pressure. Pulse pressure associations were inverse for abdominal aortic aneurysm (HR per 10 mm Hg 0·91 [95% CI 0·86-0·98]) and strongest for peripheral arterial disease (1·23 [1·20-1·27]). People with hypertension (blood pressure =/>140/90 mm Hg or those receiving blood pressure-lowering drugs) had a lifetime risk of overall cardiovascular disease at 30 years of age of 63·3% (95% CI 62·9-63·8) compared with 46·1% (45·5-46·8) for those with normal blood pressure, and developed cardiovascular disease 5·0 years earlier (95% CI 4·8-5·2). Stable and unstable angina accounted for most (43%) of the cardiovascular disease-free years of life lost associated with hypertension from index age 30 years, whereas heart failure and stable angina accounted for the largest proportion (19% each) of years of life lost from index age 80 years.

INTERPRETATION: The widely held assumptions that blood pressure has strong associations with the occurrence of all cardiovascular diseases across a wide age range, and that diastolic and systolic associations are concordant, are not supported by the findings of this high-resolution study. Despite modern treatments, the lifetime burden of hypertension is substantial. These findings emphasise the need for new blood pressure-lowering strategies, and will help to inform the design of randomised trials to assess them.
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Re: UPDATED!! Time to end the war on Salt?

Postby JeffN » Tue Jul 22, 2014 6:43 pm

Dietary Sodium Intake and Incidence of Diabetes Complications in Japanese Patients with Type 2 Diabetes – Analysis of the Japan Diabetes Complications Study (JDCS)
Early Release, jc.2013-4315
July 22, 2014

DOI: http://dx.doi.org/10.1210/jc.2013-4315

Full text: http://press.endocrine.org/doi/pdf/10.1210/jc.2013-4315

Abstract

Context: Many guidelines recommend that patients with type 2 diabetes should reduce their dietary sodium intake. However, the relationship between dietary sodium intake and incidence of diabetic complications in patients with type 2 diabetes has not been explored.

Objective: To investigate the relationship between dietary sodium intake and incidence of diabetes complications.

Design, Setting, and Participants: A nationwide cohort of patients with type 2 diabetes aged 40–70y with HbA1c ≥6.5%.

Main Outcome Measures: After excluding non-responders to a dietary survey, 1588 patients were analyzed. Baseline dietary intake was assessed by the Food Frequency Questionnaire based on food groups. Primary outcomes were times to cardiovascular disease (CVD), overt nephropathy, diabetic retinopathy, and all-cause mortality.

Results: Mean daily dietary sodium intake in quartiles ranged from 2.8 to 5.9g. After adjustment for confounders, hazard ratios (HRs) for CVD in patients in the second, third, and fourth quartiles of sodium intake compared with the first quartile were 1.70 (95% confidence interval, 0.98–2.94), 1.47 (0.82–2.62), and 2.07 (1.21–3.90), respectively (trend p<0.01). In addition, among patients who had HbA1c ≥9.0%, HR for CVD in patients in the top vs. bottom quartile of sodium intake was dramatically elevated compared with patients with HbA1c<9.0% (1.16 (0.56–2.39) and 9.91 (2.66–36.87), interaction p<0.01). Overt nephropathy, diabetic retinopathy, and all-cause mortality were not significantly associated with sodium intake.

Conclusions: Findings suggested that high dietary sodium intake is associated with elevated incidence of CVD in patients with type 2 diabetes and that there is a synergistic effect between HbA1c values and dietary sodium intake for the development of CVD.
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Re: UPDATED!! Time to end the war on Salt?

Postby JeffN » Sat Jul 26, 2014 5:43 am

Salt: The Forgotten Killer
(...and FDA’s Failure to Protect the Public’s Health)

Michael F. Jacobson, Ph.D.
Center for Science in the Public Interest
Washington, D.C.

http://cspinet.org/salt/saltreport.pdf
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Re: UPDATED!! Time to end the war on Salt?

Postby JeffN » Sat Aug 02, 2014 8:54 pm

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."

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The New PURE Study is PURE Nonsense.

Postby JeffN » Thu Aug 28, 2014 6:17 pm

The New PURE Study is PURE Nonsense.

From my friend and colleague, Jay Kenney, PhD, RD and Tom Rafai, MD

Are low-sodium diets healthy? Unhealthy?
Two new studies suggest a link between low-sodium intake and disease. Are they right?
http://www.pritikin.com/are-low-sodium- ... __FaksvEdu

Did you read last week’s Wall Street Journal article “Low-Salt Diets May Pose Health Risks, Study Finds” or the WebMD Health News article “Studies Question Need to Watch Salt” or other media reports on two new studies in the August 14th issue of The New England Journal of Medicine?

If so, you were likely led to believe that these studies seriously undermine current World Health Organization and U.S. recommendations to reduce sodium, the main component of salt.

Faulty science

But don’t believe the media hype. And don’t believe that all studies are created equal. Some have serious shortcomings, and that’s the case for these two new studies.

Continue reading here...

http://www.pritikin.com/are-low-sodium- ... __FaksvEdu

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

Postby JeffN » Fri Aug 29, 2014 8:14 pm

Sodium Intake & MS

Sodium intake is associated with increased disease activity in multiple sclerosis
J Neurol Neurosurg Psychiatry doi:10.1136/jnnp-2014-307928
Mauricio F Farez1, Marcela P Fiol1, María I Gaitán1, Francisco J Quintana2, Jorge Correale1

http://www.neurology.org/content/82/10_ ... ent/P6.150

Abstract

Background
Recently, salt has been shown to modulate the differentiation of human and mouse Th17 cells and mice that were fed a high-sodium diet were described to develop more aggressive courses of experimental autoimmune encephalomyelitis. However, the role of sodium intake in multiple sclerosis (MS) has not been addressed. We aimed to investigate the relationship between salt consumption and clinical and radiological disease activity in MS.

Methods
We conducted an observational study in which sodium intake was estimated from sodium excretion in urine samples from a cohort of 70 relapsing-remitting patients with MS who were followed for 2 years. The effect of sodium intake in MS disease activity was estimated using regression analysis. We then replicated our findings in a separate group of 52 patients with MS.

Results
We found a positive correlation between exacerbation rates and sodium intake in a multivariate model adjusted for age, gender, disease duration, smoking status, vitamin D levels, body mass index and treatment. We found an exacerbation rate that was 2.75-fold (95% CI 1.3 to 5.8 ) or 3.95-fold (95% CI 1.4 to 11.2) higher in patients with medium or high sodium intakes compared with the low-intake group. Additionally, individuals with high-sodium intake had a 3.4-fold greater chance of developing a new lesion on the MRI and on average had eight more T2 lesions on MRI. A similar relationship was found in the independent replication group.

Conclusions
Our results suggest that a higher sodium intake is associated with increased clinical and radiological disease activity in patients with MS.
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Re: UPDATED!! Time to end the war on Salt?

Postby JeffN » Sat Aug 30, 2014 8:00 pm

Salt and Calcium Oxalate Stones

Effects of a low-salt diet on idiopathic hypercalciuria in calcium-oxalate stone formers: a 3-mo randomized controlled trial.
Nouvenne A, Meschi T, Prati B, Guerra A, Allegri F, Vezzoli G, Soldati L, Gambaro G, Maggiore U, Borghi L.
Am J Clin Nutr. 2010 Mar;91(3):565-70. doi: 10.3945/ajcn.2009.28614. Epub 2009 Dec 30.
PMID:20042524
http://ajcn.nutrition.org/content/91/3/565.long
http://ajcn.nutrition.org/content/early ... l.pdf+html
http://ajcn.nutrition.org/content/suppl ... pp_1-2.doc

Abstract

BACKGROUND: A direct relation exists between sodium and calcium excretion, but randomized studies evaluating the sustained effect of a low-salt diet on idiopathic hypercalciuria, one of the main risk factors for calcium-oxalate stone formation, are still lacking.

OBJECTIVE: Our goal was to evaluate the effect of a low-salt diet on urinary calcium excretion in patients affected by idiopathic calcium nephrolithiasis.

DESIGN: Patients affected by idiopathic calcium stone disease and hypercalciuria (>300 mg Ca/d in men and >250 mg Ca/d in women) were randomly assigned to receive either water therapy alone (control diet) or water therapy and a low-salt diet (low-sodium diet) for 3 mo. Twenty-four-hour urine samples were obtained twice from all patients: one sample at baseline on a free diet and one sample after 3 mo of treatment.

RESULTS: A total of 210 patients were randomly assigned to receive a control diet (n = 102) or a low-sodium diet (n = 108); 13 patients (2 on the control diet, 11 on the low-sodium diet) withdrew from the trial. At the follow-up visit, patients on the low-sodium diet had lower urinary sodium (mean +/- SD: 68 +/- 43 mmol/d at 3 mo compared with 228 +/- 57 mmol/d at baseline; P < 0.001). Concomitant with this change, they showed lower urinary calcium (271 +/- 86 mg/d at 3 mo compared with 361 +/- 129 mg/d on the control diet, P < 0.001) and lower oxalate excretion (28 +/- 8 mg/d at 3 mo compared with 32 +/- 10 mg/d on the control diet, P = 0.001). Urinary calcium was within the normal range in 61.9% of the patients on the low-salt diet and in 34.0% of those on the control diet (difference: +27.9%; 95% CI: +14.4%, +41.3%; P < 0.001).

CONCLUSION: A low-salt diet can reduce calcium excretion in hypercalciuric stone formers.
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Re: UPDATED!! Time to end the war on Salt?

Postby JeffN » Wed Sep 10, 2014 7:30 am

Image

PS the only people that need to be concerned about too little salt are those taking diuretics/ACE-inhibitors and/or other drugs that increase renal excretion of sodium and/or those with very impaired renal function or very rare hormone defects such as Addison's disease and, as the IOM report stated (above), those with advanced congestive heart failure with a reduced ejection fraction on aggressive medication.

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

Postby JeffN » Wed Sep 10, 2014 2:46 pm

Influence of Dietary Approaches to Stop Hypertension (DASH) diet on blood pressure: A systematic review and meta-analysis on randomized controlled trials
Saneei P, Salehi-Abargouei A, Esmaillzadeh A, Azadbakht L.
Nutr Metab Cardiovasc Dis. 2014 Jun 27. pii: S0939-4753(14)00205-1. doi: 10.1016/j.numecd.2014.06.008. [Epub ahead of print]
PMID:25149893

http://www.sciencedirect.com/science/ar ... 5314002051

Abstract

BACKGROUND AND AIMS: Findings were not consistent on the therapeutic effect of Dietary Approaches to Stop Hypertension (DASH) diet on blood pressure. We aimed to review systematically and perform a meta-analysis to assess the magnitude of the effect of the DASH diet on blood pressure in randomized controlled trials (RCTs) among adults.

METHODS AND RESULTS: We conducted a systematic review and random effects meta-analysis of all RCTs which evaluated the effect of the DASH diet on blood pressure including published papers until June 2013, using PubMed, ISI Web of Science, Scopus and Google scholar database. Subgroup analysis and meta-regression were used to find out possible sources of between-study heterogeneity. Seventeen RCTs contributing 20 comparisons with 2561 participants were included. Meta-analysis showed that the DASH diet significantly reduced systolic blood pressure by 6.74 mmHg (95%CI: -8.25, -5.23, I2 = 78.1%) and diastolic blood pressure by 3.54 mmHg (95%CI: -4.29, -2.79, I2 = 56.7%). RCTs with the energy restriction and those with hypertensive subjects showed a significantly greater decrease in blood pressure. Meta-regression showed that mean baseline of SBP and DBP was explained 24% and 49% of the variance between studies for SBP and DBP, respectively.

CONCLUSION: The results revealed the profitable reducing effect of the DASH-like diet on both systolic and diastolic blood pressure in adults; although there was a variation in the extent of the fall in blood pressure in different subgroups.
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Re: UPDATED!! Time to end the war on Salt?

Postby JeffN » Mon Oct 20, 2014 8:07 am

Results from an American Heart Association survey of 1,000 U.S. adults in November 2013

75% of Americans Want Less Sodium in Processed and Restaurant Foods

http://www.heart.org/HEARTORG/GettingHe ... rticle.jsp

On average, Americans eat more than 3,400mg of sodium daily, but 97% do not know or underestimate their intake.

Americans estimate their sodium consumption per day at:
Do not know - 35%
500mg - 12%
1,000mg - 17%
1,500mg - 14%
2,000mg - 11%
2,500mg - 5%
3,000mg - 3%
3,500mg - 2% (average intake)
4,000mg - 1%

Americans’ sodium intake comes from*:
Processed and restaurant foods 77%
Naturally occurring 12%
Added while eating 6%
Added while cooking 5%

58% have tried to reduce the amount of sodium in their diet.

57% want more choice or control over the sodium content in their food.

56% think the government should play a role in reducing sodium in foods by setting mandatory (31%) or voluntary (25%) limits

21% incorrectly believe that there are already limits on how much sodium can be added to processed foods

15% incorrectly believe there are already limits for restaurant foods


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

Postby JeffN » Sun Nov 02, 2014 11:43 am

Turns out that while Gourmet Salts may have slightly less sodium than table salt and a few more minerals, they also have more heavy metals.

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Analysis of Gourmet Salts for the Presence of Heavy Metals
http://www.spexcertiprep.com/knowledge- ... tSalts.pdf


Abstract:
Salt has been a common commodity and household staple for thousands of years. Over the past decade salt has transformed from common product into a gourmet item with various origins, processing methods, representing all the colors and flavors of the gourmet spice market. Gourmet salt sales exceed $250 million dollars a year. Some exotic varieties are luxury products retailing for more than $20 an ounce compared to regular table salt at $0.02 an ounce.

This study examined a variety of gourmet salts for the elemental composition and for the presence of heavy metals. The salt samples represented many different colors, production methods, textures and price points

Conclusions
This study shows that the highest concentration of elements were found in the darker or deeply colored salts. The Kala Namak Black mineral salt (#11) had the highest concentration of Arsenic, Mercury, Vanadium, Potassium, Zinc and Iron. The reagent grade NaCl and generic table salt contained the least amounts of the elements examined.
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Re: UPDATED!! Time to end the war on Salt?

Postby JeffN » Tue Dec 16, 2014 6:36 am

Headaches

Effects of dietary sodium and the DASH diet on the occurrence of headaches: results from randomised multicentre DASH-Sodium clinical trial

BMJ Open 2014;4:e006671 doi:10.1136/bmjopen-2014-006671
http://m.bmjopen.bmj.com/content/4/12/e006671.full

Abstract

Objectives
Headaches are a common medical problem, yet few studies, particularly trials, have evaluated therapies that might prevent or control headaches. We, thus, investigated the effects on the occurrence of headaches of three levels of dietary sodium intake and two diet patterns (the Dietary Approaches to Stop Hypertension (DASH) diet (rich in fruits, vegetables and low-fat dairy products with reduced saturated and total fat) and a control diet (typical of Western consumption patterns)).

Design
Randomized multicentre clinical trial.

Setting
Post hoc analyses of the DASH-Sodium trial in the USA.
Participants In a multicentre feeding study with three 30 day periods, 390 participants were randomised to the DASH or control diet. On their assigned diet, participants ate food with high sodium during one period, intermediate sodium during another period and low sodium during another period, in random order.

Outcome measures
Occurrence and severity of headache were ascertained from self-administered questionnaires, completed at the end of each feeding period.
Results The occurrence of headaches was similar in DASH versus control, at high (OR (95% CI)=0.65 (0.37 to 1.12); p=0.12), intermediate (0.57 (0.29 to 1.12); p=0.10) and low (0.64 (0.36 to 1.13); p=0.12) sodium levels. By contrast, there was a lower risk of headache on the low, compared with high, sodium level, both on the control (0.69 (0.49 to 0.99); p=0.05) and DASH (0.69 (0.49 to 0.98); p=0.04) diets.

Conclusions
A reduced sodium intake was associated with a significantly lower risk of headache, while dietary patterns had no effect on the risk of headaches in adults. Reduced dietary sodium intake offers a novel approach to prevent headaches.
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Re: UPDATED!! Time to end the war on Salt?

Postby JeffN » Fri Dec 26, 2014 9:13 am

Effects of dietary salt levels on monocytic cells and immune responses in healthy human subjects: a longitudinal study.
Yi B, Titze J, Rykova M, Feuerecker M, Vassilieva G, Nichiporuk I, Schelling G, Morukov B, Choukèr A.
Transl Res. 2014 Nov 22. pii: S1931-5244(14)00423-X. doi: 10.1016/j.trsl.2014.11.007. [Epub ahead of print]
PMID:25497276

http://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 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.


From a colleague...

"The increase in monocytes with increased salt intake is yet another reason to cut salt intake. The increase in monocytes likely contributes to more atherosclerosis as those are the WBCs that enter the artery wall, consume the cholesterol-rich apoB-containing lipoproteins and turn into macrophages. As macrophages these they accumulate cholesterol and turn into "foam cells". These foam cells form the "fatty yellow streaks" visible with the naked eye and widely recognized as the first step in the atherosclerotic disease process. Those macrophages also release inflammatory cytokines in the artery wall and in adipose tissue and so play a major role in the atherosclerotic process."

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