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Nalini Saligram

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Reducing Salt Can Save Lives

Posted: 08/10/2011 11:53 am

Co-Authored by Arun Chockalingam

Americans by and large consume too much salt, more than twice the one teaspoon they should each day. Is reducing salt important for good health? The answer is a resounding YES!

While most people inherently know that reducing salt is good for you, confusion on this topic has probably arisen from interpretations of a recent Cochrane Review. An important contribution to advancing science, the review analyzed seven studies (6,489 patients) to see if advice to reduce dietary salt had any direct impact on cardiovascular disease and death. The reviewers concluded that there was not enough information to understand the direct effect of the advice to cut down on salt intake on cardiovascular disease. In fact, the Cochrane Review press release mentions that they would need to have data from at least 18,000 individuals for more definitive results.

Let us dispel any confusion there may be. There is a direct correlation between salt and hypertension -- and hypertension leads to cardiovascular disease.

Overwhelming Scientific Evidence
1. Increased salt intake may lead to hypertension and reducing salt can lower blood pressure in many people. A large number of studies show that salt 
intake is the major factor increasing population blood pressure. The World Action on Salt and Health, WASH, believes that the evidence linking salt to blood
 pressure is as strong as that linking cigarette smoking to cancer and heart disease.

2. There is a direct link between hypertension and cardiovascular disease. In fact, raised blood pressure is the most important factor involved in the development of cardiovascular disease, and accounts for 60 percent of all strokes and 50 percent of all heart disease (WASH). According to the World Hypertension League, reducing blood pressure can lead to a 35-40 percent reduction in stroke and a 20-25 percent reduction in heart disease.

The health benefits of salt reduction should really not be debated. Instead, we should be asking: What are the best ways to reduce salt intake?

Beyond Table Salt
Many people think that not adding table salt to prepared food is the best way to reduce salt intake. Many people may not know that salt added at the table and to food cooked at home accounts for just 5-10 percent of the salt consumed every day. According to the FDA, about 75 percent of our total salt intake comes from salt added to processed foods by manufacturers and to cooked food in restaurants, cafeterias etc. Salt is added as a preservative to many foods, so we often consume salt without even knowing. Reduction of salt in packaged and restaurant foods is the most important way to reduce dietary salt.

Taking Bold Action
The UK has been a pioneer in salt reduction and has been successful in working with the food industry to gradually reduce salt in packaged foods so that it is not discernible to the public. Many countries have followed in the UK's footsteps and are making great strides in salt reduction.

We have already seen important developments in the U.S. In a 2010 report, the Institute of Medicine called for national action to phase down salt, asking the U.S. government to set standards and food manufacturers and restaurants to gradually reduce the amount of salt they use. New York City mayor Michael Bloomberg and health officials have pushed for a nationwide plan to reduce the amount of salt in packaged and restaurant foods by 25 percent over the next five years, and Walmart's voluntary pledge to reduce salt and sugar in the foods it sells is also noteworthy. The U.S. government's formation of an Interagency Working Group (between FTC, FDA, CDC and USDA), which developed a set of guidelines to improve the nutritional content of foods marketed directly to children, is perhaps the most promising step we have seen yet.

Increase Our Salt IQ
It is widely recognized that government action with the cooperation of the food and beverage industry is the best way to reduce salt. But commitments are not enough: we want to see action and results. However, there is also something we as individuals can do. We must each learn to read food labels more clearly and to reach for fresh foods and produce more often. We must learn that baked goods, soy sauce, frozen dinners and even some antacids can be high in salt. We must learn that a lunch of canned soup may contain a higher salt content than a hamburger and fries.

A "Best Buy" for Fighting NCDs
A recent Lancet article calls for a reduction in salt consumption as one of the top priority actions for the non-communicable disease (NCD) crisis. They say that reduction of population-wide salt consumption by only 15 percent -- through mass-media campaigns and reformulation of food products by the food industry -- would avert up to 8.5 million deaths in 23 high-burden countries over 10 years.

In fact, the WHO calls salt reduction one of the "Best Buys" in tackling NCDs because of its feasibility and cost-effectiveness. The two most important actions to combat NCDs -- full implementation of tobacco control and salt reduction -- are affordable in all countries and are estimated to cost about 20 U.S. cents per person per year in China and India.

1.5 billion people in the world today have hypertension. Hypertension leads to cardiovascular disease. Cardiovascular disease is the number one killer globally. Reducing salt is a simple prevention tool that I believe we must implement effectively.

Dr. Arun Chockalingam is the Secretary-General of the World Hypertension League. Nalini Saligram, Ph.D., is the Founder and CEO of Arogya World.

 

Follow Nalini Saligram on Twitter: www.twitter.com/arogyaworld

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HUFFPOST SUPER USER
stonemann
To argue with an idiot, can mistake you for one.
01:31 AM on 08/17/2011
I know your article is rather general, however, the real problem is Americans consume too much...period. Addressing that can solve sodium intake for most folks.
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HUFFPOST SUPER USER
Peaceride
Let your freak flag fly.
07:05 PM on 08/17/2011
I agree .. everything in moderation. Another big problem is that Americans aren't eating enough fresh fruits and veggies -- however, moderation means nothing if people are only eating processed foods that are jam-packed with high amounts of sodium.
HUFFPOST SUPER USER
robert horwitz
01:59 PM on 08/13/2011
Where did this cottage industry of telling folks how to lead healthier lives come from? Most of my former friends had been nagging me about how to lead a healthier life for years. I say former because most of them are now on the wrong side of the grass. True they were the healthiest people dieing in their chosen hospital. No pun intended "Cold Comfort" but a lot of good it did them. I do admit that I have made some concessions to aging as far as what I eat but let's not go overboard here. Got a light. I forgot my matches and I just can't drink coffee without a cigarette and pass the salt please.
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dickn2000b
omnes autem stulti me
11:53 AM on 08/12/2011
Another speculative piece of fluff with no objective, proveable conclusions. One thing is certain though, a reduced salt intake WILL save salt!
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undrgrndgirl
what's so funny 'bout peace, love & understanding?
11:24 AM on 08/12/2011
"Increased salt intake may lead to hypertension and reducing salt can lower blood pressure in many people."
"may" and "can"...man, there's some solid conclusions...
stay away from processed table salt. there are many better choices, look for something that hasn't been over processed like himalayan pink...not getting enough salt is also very dangerous. salt is an electrolyte and your body needs it to function properly. health or discover magazine had a terrific article on salt deficiency about 10 years ago...of course i can't find a link to it because it has been buried by 'salt is bad' information...
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10:19 AM on 08/12/2011
Himalayan salt (pink salt)....does not, I repeat not... raise blood pressure. Check out the research.
03:30 PM on 08/12/2011
Neither does any other kind of salt, apparently.
08:30 AM on 08/12/2011
Dear Nanny (otherwise known as our government) Stay the hell out of my kitchen. You are not welcome there.
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360Dunk
Feeder of slot machines
10:19 AM on 08/12/2011
Au contraire, remember the days when labeling nutritional content of food was not a requirement? Manufacturers could do anything to sell their product...use lard, msg, tons of salt, lots of trans-fats, and whatever else to make their food taste better. I welcome the government's intrusion and regulation in this case as it probably has added years to our lives.
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undrgrndgirl
what's so funny 'bout peace, love & understanding?
11:30 AM on 08/12/2011
nothing wrong with labeling...so long as it is honest. we have NO labeling for gmo's for example and the government is NOT requiring much to find out if gmos are actually safe for human and animal consumption...manufacturers are still using msg, sodium (as opposed to good salt), trans-fats, hfcs, etc...much of it hidden with word games. (hydrolized vegetable protein is essentially the same as msg, but foods containing hvp can claim no msg)...so yeah labeling, regulation and government intrusion is a mixed bag.
08:10 PM on 08/12/2011
Lard is healthy fat. Transfats and polyunsaturated oils are bad. Salt is good. Sugar is bad. If low fat foods had not been introduced, sugar and salt content would be lower in most processed foods, because they are increased to make up for the loss of flavour that occurs when the fat is removed. The fact is, food that falls under the heading of "product" is mostly not really food, but just food like substances being called food.
10:29 PM on 08/11/2011
"The health benefits of salt reduction should really not be debated. Instead, we should be asking: What are the best ways to reduce salt intake?" I completely disagree. The general public would benefit from understanding exactly what sodium is and how it functions in the body (although that itself is very complicated). What Saligram fails to say is that sodium is an important electrolyte. Not to say that we should consume all the salt we want, but it's not wise to demonize it either. That can be dangerous too.
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undrgrndgirl
what's so funny 'bout peace, love & understanding?
11:32 AM on 08/12/2011
fanned and faved.
09:34 AM on 08/11/2011
Stolarz-Skrzypek K Et Al. Fatal and nonfatal outcomes, incidence of hypertension, and blood pressure changes in relation to urinary sodium excretion. JAMA. 2011 May 4;305(17):1777-85.

"CONCLUSIONS:

In this population-based cohort, systolic blood pressure, but not diastolic pressure, changes over time aligned with change in sodium excretion, but this association did not translate into a higher risk of hypertension or CVD complications. Lower sodium excretion was associated with higher CVD mortality."
04:22 PM on 08/11/2011
Let's not let facts get in the way of Ms. Saligram keeping her job.

Her livelihood depends, among other things, on a "direct correlation" between salt consumption and hypertension. Therefore, such a correlation exists, regardless of any evidence to the contrary.
02:47 AM on 08/11/2011
Please stop refering to it as "salt".
It is sodium.
The form in which it is ingested makes all the difference.
The sodium in processed foods and table salt that has been refined/extracted through high heat is unusable by the body. It does not disolve, stays in the body and starts the arterial compromise that leads to HBP and other diseases.
Sodium in a usable form, is good for you and, found naturally in almost all real food.
So, put down the hot pockets, ramen noodles, canned soups etc., and eat more fresh fruits, veggies, and grains, along with some real(non hormone, non antibiotic) meats if you desire and you wont have to worry about the "salt" controversy.
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undrgrndgirl
what's so funny 'bout peace, love & understanding?
11:34 AM on 08/12/2011
fanned and faved
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HUFFPOST SUPER USER
stape45
No brag, just fact.
11:11 PM on 08/10/2011
High blood pressure is the most well known side effect of too much salt consumption.
08:46 AM on 08/12/2011
Kidney stones? transplants? dialysis? Where's the beef, uh, I mean proof?
Here is a better argument to save lives:
Crashes are absolutely proven to the most common cause of death from airplane accidents. If we took 15% of the seats out of every airplane and limited private planes to pilots only, or simply reduced the world's air traffic (especially military), we could eliminate nearly 15% of all deaths from airplane accidents.
However, in the sodium argument, everyone keeps skipping the proven connection they claim exists. They always say things like, "well known side effect," "most people inherently know," "lots of studies show," "and "overwhelming scientific evidence," without actually refuting the Cochran Review and many previous findings that, "reviewers concluded that there was not enough information to understand the direct effect of the advice to cut down on salt intake."
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HUFFPOST SUPER USER
stape45
No brag, just fact.
11:05 PM on 08/10/2011
Too much salt can cause painful conditions and even dangerous diseases.

Kidney stones are very painful and can require surgery.
Kidney failure can result in the need for dialysis. During dialysis your blood is taken from your body, put through a machine to clean it and put back into your body. Kidney transplants are often necessary because continued dialysis is too hard on your body to do indefinitely.
High blood pressure puts stress on your arteries and heart, and can lead to heart attacks and strokes.
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DrP
09:44 PM on 08/10/2011
The other problem I have with obsessing about salt is that it is a "red herring" that takes the attention of the real culprit in the diseases of civilization, including high blood pressure, which is excessive carbohydrate consumption.
09:41 AM on 08/11/2011
"the real culprit in the diseases of civilizati­on, including high blood pressure, which is excessive carbohydra­te consumptio­n. "

nonsense, if that were true we would expect to see per capita deaths from CV diseases higher in countries with higher CHO consumption, such as Asian countries, however that is not the case. Also one could look at the Kitavans and Okinawans who derive a huge portion of their daily caloric intake from CHO and not riddled with diseases
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DrP
10:32 PM on 08/11/2011
You like to bring up populations where the native diet is high in CHO, and where the population has obviously evolved the ability to handle carbs. I am speaking to a primarily Western (US and European) population where most of us have not evolved from our hunter-gatherer ancestry to handle a carb-based diet. The Kitavans and Okinawans are not insulin-resistant while those of us who suffer the health consequences of a carb-based diet are. It is ludicrous to continually refer to populations who thrive on carbohydrates and imply that a carb-based diet is appropriate for other populations with vastly different genetically-determined metabolisms.
06:13 AM on 08/12/2011
You will find that in populations in which they have a high proportion of the diet as carbs along with good health that the total calories consumed on average is very low. If western people dropped carb intake as low they would be on the Atkins protocol.
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DrP
09:37 PM on 08/10/2011
Wrong. Absolutely wrong.
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HerrMonk
Fighter, Trainer, Nat.Sec.Consultant, Libertine
05:03 PM on 08/10/2011
I don't get enough salt...
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DrP
09:39 PM on 08/10/2011
After exercise, I make sure to get plenty of salt. The low-carb writers such as Taubes, Phinney, and Volek explain beautifully why us low-carbers need to seek out extra salt. Otherwise, I get light-headed and dizzy. If people eat a proper low-carb, high-fat diet, then salt is their friend.
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DrP
09:43 PM on 08/10/2011
Of course, those of us who eat a proper diet don't get all of the salt from processed food. Eat whole foods, mostly fat, moderate protein, and low-carb, and blood pressure will normalize. It will be fine then to add as much salt as a person wants for flavor. Sea salt and celtic salt are especially nice.
06:15 AM on 08/12/2011
That's right. Eat healthy, natural salt as much as you like, and get rid of the carbs and processed foods!
12:55 PM on 08/10/2011
There is actually quite a bit of controversy about whether or not salt reduction is generally beneficial.
I'll let Gary Taubes provide the analysis:
http://www.stat.berkeley.edu/users/rice/Stat2/salt.html
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DrP
09:41 PM on 08/10/2011
Thanks for posting this. I was going to look for a reference to Taubes's debunking of the "science" used to promote the salt fallacy and you saved me the effort.