Adding additional salt to foods at a lower frequency is associated with a reduced risk of heart disease, heart failure and ischemic heart disease, according to a new study published today in the Journal of the American College of Cardiology (ACC). Even among those following a DASH-style diet, behavioral interventions to lessen salt consumption could further improve heart health.
There’s substantial evidence linking high sodium intake to high blood pressure, a major risk factor for cardiovascular disease. However, epidemiological studies investigating this link have produced conflicting results due to a lack of practical methods for assessing long-term dietary sodium intake. Recent studies suggest that the frequency at which an individual adds salt to their foods could be used to predict their individual sodium intake over time.
“Overall, we found that people who don’t shake on a little additional salt to their foods very often had a much lower risk of heart disease events, regardless of lifestyle factors and pre-existing disease,” said Lu Qi, MD, PhD, HCA Regents Distinguished Chair and professor at the School of Public Health and Tropical Medicine at Tulane University in New Orleans. “We also found that when patients combine a DASH diet with a low frequency of adding salt, they had the lowest heart disease risk. This is meaningful as reducing additional salt to food, not removing salt entirely, is an incredibly modifiable risk factor that we can hopefully encourage our patients to make without much sacrifice.”
In the current study, the authors evaluated whether the frequency of adding salt to foods was linked with incident heart disease risk in 176,570 participants from the UK Biobank. The study also examined the association between the frequency of adding salt to foods and the DASH diet as it relates to heart disease risk.
People who add extra salt to their food at the table are at higher risk of dying prematurely from any cause, according to a study of more than 500,000 people, published in the European Heart Journal Monday.
Compared to those who never or rarely added salt, those who always added salt to their food had a 28% increased risk of dying prematurely. In the general population about three in every hundred people aged between 40 and 69 die prematurely. The increased risk from always adding salt to food seen in the current study suggests that one more person in every hundred may die prematurely in this age group.
Replacing table salt with a reduced-sodium, added-potassium ‘salt substitute’ is cost-saving and prevents death and disease in people at high risk of having a stroke, according to new research. Salt substitution has been shown to reduce stroke risk by 14 percent and the number of strokes and heart attacks combined by 13 percent, but this new analysis revealed that the costs saved as a result outweighed the cost of the intervention.
Though reducing salt intake did not lead to fewer emergency visits, hospitalizations or deaths for patients with heart failure, the researchers did find an improvement in symptoms such as swelling, fatigue and coughing, as well as better overall quality of life.
“We can no longer put a blanket recommendation across all patients and say that limiting sodium intake is going to reduce your chances of either dying or being in hospital, but I can say comfortably that it could improve people’s quality of life overall,” said lead author Justin Ezekowitz, professor in the Faculty of Medicine & Dentistry and co-director of the Canadian VIGOUR Centre.
Avoid anything in a bag, box or can
The researchers followed 806 patients at 26 medical centers in Canada, Australia, Colombia, Chile, Mexico and New Zealand. All were suffering from heart failure, a condition in which the heart becomes too weak to pump blood effectively. Half of the study participants were randomly assigned to receive usual care, while the rest received nutritional counseling on how to reduce their dietary salt intake.
Everyone knows that they don’t want to eat too much salt. Unfortunately, many folks think that by cutting down what they take out of the salt shaker, they are reducing their salt intake. Not exactly correct. True, you shake less salt on your food. However, that is not the biggest source of salt in the diet.
Most of the salt that Americans consume comes from prepared and processed foods. The leading culprits include snack foods, sandwich meats, smoked and cured meats, canned juices, canned and dry soups, pizza and other fast foods, and many condiments, relishes, and sauces — for starters. But enough of it comes from the salt shaker at home that it’s worth finding alternatives. Here are five ways to cut back on sodium when cooking or at the table:
Use spices and other flavor enhancers. Add flavor to your favorite dishes with spices, dried and fresh herbs, roots (such as garlic and ginger), citrus, vinegars, and wine. From black pepper, cinnamon, and turmeric to fresh basil, chili peppers, and lemon juice, these flavor enhancers create excitement for the palate — and with less sodium.
Go nuts for healthy fats in the kitchen. Using the right healthy fats — from roasted nuts and avocados to olive, canola, soybean, and other oils — can add a rich flavor to foods, minus the salt.
Sear, sauté, and roast. Searing or sautéing foods in a pan builds flavor. Roasting brings out the natural sweetness of many vegetables and the taste of fish and chicken. If you do steam or microwave some dishes, perk them up with a finishing drizzle of flavorful oil and a squeeze of citrus.
Get your whole grains from sources other than bread. Even whole-grain bread, though a healthier choice than white, can contain considerable sodium. Bread contains quite a bit of salt — not just for flavor, but to ensure that the dough rises properly. You can skip that extra salt when you look for whole grains outside of baking. For example, instead of toast with breakfast, cook up steel-cut oats, farro, or other intact whole grains with fresh or dried fruit.
Know your seasons, and, even better, your local farmer. Shop for raw ingredients with maximum natural flavor, thereby avoiding the need to add as much (if any) sodium. Shop for peak-of-season produce from farmers’ markets and your local supermarket.
For more information on lifestyle changes that will help treat high blood pressure, buy Controlling Your Blood Pressure, a Special Health Report from Harvard Medical School.
Eating foods high in salt is known to contribute to high blood pressure, but does that linear relationship extend to increased risk of cardiovascular disease and death? Recent cohort studies have contested that relationship, but a new study published in the International Journal of Epidemiology by investigators from Brigham and Women’s Hospital and their colleagues using multiple measurements confirms it. The study suggests that an inaccurate way of estimating sodium intake may help account for the paradoxical findings of others.
“Sodium is notoriously hard to measure,” said Nancy Cook, ScD, a biostatistician in the Department of Medicine at BWH. “Sodium is hidden – you often don’t know how much of it you’re eating, which makes it hard to estimate how much a person has consumed from a dietary questionnaire. Sodium excretions are the best measure, but there are many ways of collecting those. In our work, we used multiple measures to get a more accurate picture.”
Sodium intake can be measured using a spot test to determine how much salt has been excreted in a person’s urine sample. However, sodium levels in urine can fluctuate throughout the day so an accurate measure of a person’s sodium intake on a given day requires a full 24-hour sample. In addition, sodium consumption may change from day to day, meaning that the best way to get a full picture of sodium intake is to take samples on multiple days.
While previous studies have used spot samples and the Kawasaki formula, the team assessed sodium intake in multiple ways, including estimates based on that formula as well as ones based on the gold-standard method, which uses the average of multiple, non-consecutive urine samples. They assessed results for participants in the Trials of Hypertension Prevention, which included nearly 3,000 individuals with pre-hypertension.
The gold-standard method showed a direct linear relationship between increased sodium intake and increased risk of death. The team found that the Kawasaki formula suggested a J-shaped curve, which would imply that both low levels and high levels of sodium consumption were associated with increased mortality.
“Our findings indicate that inaccurate measurement of sodium intake could be an important contributor to the paradoxical J-shaped findings reported in some cohort studies. Epidemiological studies should not associate health outcomes with unreliable estimates of sodium intake,” the authors wrote.
We hear a lot of talk about the amount of salt and sodium in our diets and the importance of trying to keep it limited. Some folks even remove their salt shakers from the tables. However, we get most sodium from our processed foods. So, we need to turn our focus to everything we eat, not just our salt shakers. Here is a study on how much salt can be found in the seemingly innocuous bread on our tables.
Canadian bread product saltiest in survey of global bread products
Some breads surveyed had as much sodium (salt) as seawater
More than a third of breads worldwide have more salt than UK maximum salt reduction target for bread (1.5 g of salt or 600 mg of sodium /100 g)
73% of Canadian breads exceeded Health Canada’s 2016 targets for sodium in bread products and 21% were above recommended maximum levels.
Bread features heavily in many diets worldwide, and is one of the biggest sources of salt in diets. A new survey by World Action on Salt and Health (WASH), based at Queen Mary University of London, has revealed the shocking levels of salt present in this essential staple. WASH surveyed over 2,000 white, wholemeal, mixed grain and flat breads from 32 countries and regions, including over 500 products from Canada collected by Professor Mary L’Abbe’s lab at the University of Toronto. Continue reading →
Most often linked to sports drinks, electrolytes are vital for good health
You’ve probably seen those ads for sports drinks that claim to offer better hydration than water during or after an intense workout. The reason, they say, is that sports drinks replenish electrolytes; water does not.
Are these claims valid, or are sports drink companies just trying to sell you their products? What, exactly, are electrolytes? And is it really so important to replace them?
Sodium serves a vital purpose in the human body as it helps nerves and muscles to function correctly, and it is an important compound involved in maintaining fluid balance. Most of our dietary sodium intake is provided through the consumption of sodium chloride (common or table salt). About 80 per cent of this would come from processed foods and 20 per cent from salt used at the table or in home cooking. Table salt is made up of just under 40 per cent sodium by weight, so a 6 g serving (1 teaspoon) contains about 2,400 mg of sodium (note that some of the calculations below use the more exact 39 per cent of sodium).
Apart from table salt, it has been estimated that a further ten per cent of dietary sodium intake would be provided from naturally occurring sodium or sodium-containing food additives.
So far so good, but unfortunately high intakes of sodium can increase…
Most people are aware that they need to cut down on their salt (sodium) intake. That’s a good start. However, some ‘facts of life’ prove extremely helpful in the lower sodium quest, according to the American Heart Association (AHA). Spoiler alert: your table salt shaker isn’t the main culprit.
Restaurant foods and commercially processed foods sold in stores accounted for about 70 percent of dietary sodium intake in a study in three U.S. regions.
Salt added at home during food preparation or at the table accounted for a small fraction of dietary sodium.
These findings confirm earlier recommendations from the Institute of Medicine to lower dietary sodium by decreasing the amount in commercially processed foods.
There is a lot of talk about fast foods and processed foods being not as healthy for us. Here is a fine example of that from the Center for Science in the Public Interest (CSPI).
An order of TGI Friday’s Jack Daniel’s Ribs & Shrimp with Seasoned Fries and Coleslaw has 4,000 milligrams (mg) of sodium—more than one-and-a-half times the daily sodium limit (2,300 mg a day) for healthy adults.
A diner who eats that entrée along with half a high-sodium appetizer and half a high-sodium dessert could end up swallowing 6,450 mg, or almost three days’ worth, of sodium. The nonprofit Center for the Science in the Public Interest is releasing the first of a series of “Salt Assaults” spotlighting the incredibly (and unnecessarily) high sodium content of many packaged and restaurant foods.
“Consumers can always add salt to their food but they can’t remove what’s already there,” said Jim O’Hara, CSPI’s director of health promotion policy. “Food companies, especially chain restaurants, are irresponsibly increasing their customers’ risk of heart disease by selling foods that are dangerously high in sodium. The Food and Drug Administration’s proposed voluntary sodium-reduction targets for packaged and restaurant foods, if finalized, would help put consumers back in control.”
The Ribs & Shrimp meal isn’t the only problem with TGI Fridays, according to CSPI—it’s the entire menu. If diners choose a typical entrée, they end up with 2,240 mg of sodium. Adding half a typical appetizer and half a typical dessert brings the total to 3,490 mg of sodium—more than one and a half days’ worth. (CSPI’s analysis did not include TGI Friday’s 474 menu, which offers “smaller portions of our signature dishes.”)
The Dietary Guidelines for Americans says that many adults can consume up to 2,300 mg of sodium, but adults with prehypertension and hypertension (about two-thirds of all adults) would do well to limit their consumption to 1,500 mg per day.
There are a lot of seductive ads circulating these days encouraging folks who exercise to partake of them. However, I learned early on that there is a basic threshold for using sports drinks. And that is, how much are you exercising? If you are a weekend warrior and go to the health club mainly to socialize and walk on the treadmill or elliptical machine for a half hour while you watch one of the TVs or read, you likely don’t need to use a sports drink and you may be doing yourself some harm if you are.
Sports drinks contain sodium which your body needs to replenish if you have been exercising at least moderately heavily and working up a sweat. In that case, you can be using a sports drink to bring your body’s electrolytes back into balance.
If you have been sweating a lot, getting sodium into your system is a good thing. But, if you haven’t, it isn’t necessarily.
Caitlin Howe, MS, MPH, of the American Heart Association Sodium Reduction Initiative says, “When it comes to winter physical activity, some people feel the need to consume energy and sports drinks during an afternoon walking in the cold air or skating on the lake. Sports drinks were initially designed for elite athletes, so most people can enjoy a winter workout without needing to replenish electrolytes or energy stores. Continue reading →
The American Heart Association strongly refutes the findings of a May 20, 2016 article in The Lancet by Mente, et al, that suggest low sodium intake is related to a higher risk of heart disease and death. On the contrary, the link between excessive sodium and high blood pressure – as well as higher risks of heart disease, stroke, heart failure and kidney disease – is indisputable. Lowering sodium is more important than ever.
Consider the following: • One-third of Americans have high blood pressure • 90% of all American adults will develop hypertension over their lifetime • Heart disease and stroke are the world’s two leading causes of death(my emphasis)
“The findings in this study are not valid, and you shouldn’t use it to inform yourself about how you’re going to eat,” said Mark A. Creager, M.D., president of the American Heart Association and director of the Heart and Vascular Center at Dartmouth-Hitchcock Medical Center. “The large body of science clearly shows how excessive amounts of sodium in the American diet can cause high blood pressure, which can lead to heart disease, stroke, and even death.” Continue reading →
New York city is at it again. This time requiring sodium warnings on the saltiest restaurant items. I have very mixed feelings on this. On the one hand, I want to eat healthy and have other folks do the same, therefore I limit my sodium intake. However, I do not think it is the government’s place to barge into people’s eating habits – even when they are harmful. I think we should be free to choose what we want even if it is not the most nutritious choice.
The Dairy Queen was one of the firms mentioned.
For the record: the American Heart Association recommends we limit our sodium consumption to 1500 mg per day.
Following are examples from the
Calories Sodium (mg)
Jersey Mike’s Buffalo Chicken Cheese Steak 1,740 7,795
Applebee’s Chicken Fajitas Rollup 1,090 3,600
Applebee’s4 Cheese Mac & Cheese (with extras) 1,830 4,290
Burger King’s BK Ultimate Brkfst Platter 1,420 3,020
More than 75 percent of sodium in the U.S. diet is found in the salt added to processed food. In the United States, about 9 of every 10 people consume too much sodium. The Salty Six foods – breads and rolls, cold cuts and cured meats, pizza, poultry, soup and sandwiches – are the leading sources of overall sodium in the U.S. diet.
Because of this it is really important to beware of eating processed food. Lots of folks cut down on their table salt, but that isn’t the real culprit in the sodium problem. They need to beware of the stealth sodium in the processed foods they eat.
Here are a few of the posts I have written on salt:
People who gradually increase the amount of salt in their diet and people who habitually eat a higher salt diet both face an increased risk of developing high blood pressure, according to a study published in the Journal of the American Heart Association.
In a Japanese study of more than 4,000 people who had normal blood pressure, almost 23 percent developed high blood pressure over a three year period. Those who ate the most salt were the most likely to have high blood pressure by the end of the study. Participants who gradually increased their sodium intake also showed gradually higher blood pressure.
The researchers estimated the amount of salt an individual was consuming by analyzing the amount of sodium in the urine of people who were visiting their healthcare provider for a routine check-up, and conducted follow-up urine analysis for approximately three years.