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Salt And Heart Attacks

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What Are The Benefits Of Cutting Down On Sodium

Low Salt Increases Your Risk of Heart Attacks

Eating less sodium can reduce your risk for high blood pressure and bloating,and stave off other effects of too much salt. And did you know that reducing sodium in the food supply could save money and lives?

One estimate suggested that if Americans moved to an average intake of 1,500 mg/day sodium, it could result in a 25.6 percent overall decrease in blood pressure and an estimated $26.2 billion in health care savings.

Another estimate projected that achieving this goal would reduce deaths from cardiovascular disease by anywhere from 500,000 to nearly 1.2 million over the next 10 years.

Do We Need Large Randomized Controlled Trials Of Sodium Reduction

There remain major gaps in our knowledge of the relationship of sodium intake with human physiology and health. A frequently cited deficit is the absence of large randomized controlled trials to establish the effectiveness and safety of lowering sodium intake on cardiovascular events and mortality, particularly in patients with heart failure., While such trials are expected to provide clarity on the effectiveness of reducing mean sodium intake by 0.51g/day, they will not answer the question of whether low sodium intake is effective and safe. We now know that larger differences in sodium intake between groups are difficult to achieve, even with intensive dietary counselling, and there is no available intervention that results in sustained low sodium intake. Ongoing randomized controlled trials can address whether specialist dietary counselling to reduce sodium intake reduces cardiovascular events, and whether it improves outcomes in patients with heart failure, but are unlikely specifically to evaluate low sodium intake, as sustained low sodium intake levels are unlikely to be achieved in the intervention group.

Can We Safely Reduce Salt Consumption To Low Levels

If we set aside the evidence and assume that low sodium intake does reduce cardiovascular risk , are there available interventions to reduce sodium intake, in individuals or communities, to lower levels? The answer also has implications for calls to conduct large definitive randomized controlled trials.

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Is It Salt Or Sodium

  • Sodium chloride is the chemical name for salt.1
  • Ninety percent of the sodium we consume is in the form of salt.1
  • The words salt and sodium are not exactly the same, yet these words are often used interchangeably. For example, the Nutrition Facts Panel on foods in the grocery store uses sodium, while the front of the package may say no salt added or unsalted.5

Community Interventions Can Help

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Even in the case of individuals who do consume too much table salt, however, the situation is not unsalvageable, the researchers say.

Mente notes that people can easily redress the balance and protect their heart health by making a few simple adjustments to their diets, such as adding more fruits, vegetables, and foods naturally rich in potassium.

We found all major cardiovascular problems, including death, decreased in communities and countries where there is an increased consumption of potassium which is found in foods such as fruits, vegetables, dairy foods, potatoes, and nuts and beans, says the study author.

Another one of the researches involved with the current study, Martin ODonnell, notes that most of the studies looking at the relationship between sodium intake and cardiovascular risk so far have focused on individual data, rather than information collected from larger cohorts.

This, he suggests, may have skewed the best practice guidelines into a direction that is both unrealistic and perhaps too cautious.

Public health strategies should be based on best evidence. Our findings demonstrate that community-level interventions to reduce sodium intake should target communities with high sodium consumption, and should be embedded within approaches to improve overall dietary quality.

There is no convincing evidence that people with moderate or average sodium intake need to reduce their sodium intake for prevention of heart disease and stroke, ODonnell adds.

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Low Salt Intake May Raise Risk Of Heart Attack Stroke And Death

A high salt intake has been linked to increased blood pressure and greater risk for heart problems. But according to new research, low salt intake may be just as harmful.

Published in The Lancet, the study found that low salt, or sodium, intake may raise the risk of heart attack, stroke, and death, compared with an average salt intake.

Lead author Andrew Mente, of the Michael G. DeGroote School of Medicine at McMaster University in Canada, and colleagues say their results indicate only people with high blood pressure who have a high salt intake should reduce their salt consumption.

Furthermore, the researchers suggest current recommendations for daily salt consumption may be set too low.

The Dietary Guidelines for Americans recommend that Americans consume less than 2,300 milligrams of sodium each day the equivalent to 1 teaspoon of salt.

However, a report from the Centers for Disease Control and Prevention earlier this year revealed that around 90 percent of Americans consume salt at levels above the recommended limit.

It is widely accepted that too much salt in the diet can lead to high blood pressure, increasing the risk for heart attack, stroke, and other cardiovascular diseases.

But does reducing salt intake to the levels recommended in current guidelines really reduce the risk of such outcomes? This is what Mente and colleagues set out to investigate.

Still Skeptical Take A Closer Look At The Science

Much of the research that questions sodium intake and health problems relies on flawed data, including inaccurate measurements of sodium intake and an overemphasis on studying sick people rather than the general population. Often, the studies with paradoxical findings are poorly designed to examine the relationship between sodium intake and the health outcome of interest. The American Heart Association published a Science Advisory in February 2014 that discussed the problems with many of the studies that question how sodium is related to heart disease.

If most Americans lowered their sodium consumption to less than 1,500 mg per day, whats the potential health impact?

We know wed save money and lives. One estimate suggested that if the U.S. population dropped its sodium intake to 1,500 mg/day, overall blood pressure could decrease by 25.6%, with an estimated $26.2 billion in health care savings. Another estimate projected that achieving this goal would reduce CVD deaths by anywhere from 500,000 to nearly 1.2 million over the next decade.

Written by American Heart Association editorial staff and reviewed by science and medicine advisers. See our editorial policies and staff.

Last Reviewed: Apr 16, 2018

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Does Cutting Back On Salt Help Improve Heart Failure

HealthDay Reporter

TUESDAY, April 5, 2022 — If you have heart failure, there’s good news and bad news on how much it would help you to cut back on salt.

New research finds that while it doesn’t prevent death or hospitalization among patients, it does appear to improve their quality of life.

Patients with heart failure have been told for years to reduce the salt in their diet as a way to help prolong life, but among more than 800 patients from six countries, reducing salt intake didn’t prevent deaths, visits to the emergency room or hospitalizations, the researchers found.

Still, “we do think that there is a small amount to be gained by reducing the amount of sodium in the diet,” said researcher Dr. Justin Ezekowitz, a professor in the division of cardiology at the University of Alberta in Edmonton, Canada.

The patients in the study were already eating a lot less salt than most Americans consume, although they had not achieved the optimal goal of the amount of salt recommended, he explained.

“The expected goal is not reducing clinical events necessarily, but it does improve quality of life, which might be very important for individual patients,” Ezekowitz said.

For the study, the research team followed heart failure patients from 26 medical centers in Australia, Canada, Colombia, Chile, Mexico and New Zealand. Half were randomly assigned to receive usual care, and the rest received nutritional counseling on how to further reduce their dietary salt intake.

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Heart Failure And Salt: The Great Debate

Why Salt does NOT Increase Risk of Heart Disease | Jason Fung

Let there be work, bread, water, and salt for all. Nelson Mandela

Salt: without it, food can seem tasteless. It is the reason sea water burns our eyes and skin. Some people enjoy salt water baths. Is it good for us? Is it not? Do we really know?

In modern medicine, we tend to have a generally negative feeling about sodium, the element found in salt. Excessive sodium intake is linked to water retention, and it is also a risk factor for high blood pressure. Both excessive sodium intake and high blood pressure are major risk factors for developing , and for causing complications in those with existing heart failure. Given that 6.5 million American adults have heart failure, restricting salt intake might profoundly reduce risk for this major medical scourge.

Indeed, we advise our patients with heart failure to restrict the amount of salt they consume per day. For years we have been telling them to stay away from salty fries and Chinese takeout, which may have up to 7,000 mg of sodium in a single meal. We consign patients hospitalized for heart failure to a bland low salt, heart healthy diet until discharge. But what do we base the low-salt recommendation on? Is this just anecdotal? Or do we have evidence that guides our recommendations?

In the spirit of open-mindedness, lets debate this question.

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Myth : All Salt Is Out To Kill You And You Shouldnt Eat Any Of It

Eating too much salt can contribute to high blood pressure, which is linked to conditions like heart failure and heart attack, kidney problems, fluid retention, stroke and osteoporosis. You might think this should mean you need to cut out salt completely, but salt is actually an important nutrient for the human body.

Your body uses salt to balance fluids in the blood and maintain healthy blood pressure, and it is also essential for nerve and muscle function. Its impossible to live a life without any salt , but this isnt a problem for most Australians the average Australian is consuming double the recommended amount of salt.

So, while a little salt in your diet is necessary, its important to keep the amount in check. The Australian Dietary Guidelines recommend adults eat no more than 5 grams of salt a day, which is less than one teaspoon. Most of us are consuming about 9 grams a day. To help you track how much salt youre eating, you can find out how much salt is in packaged foods by looking at the food label for the sodium level – salt is made up of sodium and chloride. Try to aim for items that have less than 120mg of sodium per 100 grams of the food. You should aim for a maximum of 2000mg of sodium a day.

Hypertension And Cardiovascular Disease

In 2018, the American Heart Association published an advisory stating that “if the U.S. population dropped its sodium intake to 1,500 mg/day, overall blood pressure could decrease by 25.6%, with an estimated $26.2 billion in health care savings. Another estimate projected that achieving this goal would reduce cardiovascular disease deaths by anywhere from 500,000 to nearly 1.2 million over the next decade.” There has been evidence from epidemiological studies, human and animal intervention experiments supporting the links between high rate of salt intake and hypertension. A Cochrane review and meta-analysis of clinical trials showed that reduced sodium intake reduces blood pressure in hypertensive and normotensive subjects. Since controlling hypertension is related to a reduced risk of cardiovascular disease, it is plausible that salt consumption is a risk factor for cardiovascular health. However, to properly study the effects of sodium intake levels on risk of development of cardiovascular disease, long-term studies of large groups using both dietary and biochemical measures are necessary.

Some researchers cast doubts on the link between lowering sodium intake and the health of a given population.

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The Verdict: Until We Have More Evidence Its A Draw

Take some of what we say with a grain of salt . There is not yet enough evidence for either side of the great salt debate to win. And our discussion should not lead patients to consume salt in excess until we know for sure. Indeed, in the absence of good clinical data, one must accept the need for good clinical judgment: avoiding excessive amounts of sodium is a healthy move for all of us, including those with heart failure.

Its also highly likely that some patients are more salt-sensitive than others. Thus, directing salt restriction to those most vulnerable might be better than a one-size-fits-all approach. Studies in this area are very much needed. Fortunately, clinical trials to address this question are ongoing, so stay tuned!

Follow Dr. Januzzi on Twitter @JJheart_doc and Dr. Ibrahim @IAmDrIbrahim

About the Authors

James Januzzi, MD, Contributor

Where Does All The Sodium Come From

Salt won

Table salt is a combination of two minerals about 40% sodium and 60% chloride.

Here are the approximate amounts of sodium in a given amount of salt:

  • 1/4 teaspoon salt = 575 mg sodium
  • 1/2 teaspoon salt = 1,150 mg sodium
  • 3/4 teaspoon salt = 1,725 mg sodium
  • 1 teaspoon salt = 2,300 mg sodium

More than 70% of the sodium we consume comes from packaged, prepared and restaurant foods. The rest of the sodium in the diet occurs naturally in food or is added when were cooking food or sitting down to eat . So even if you never use the salt shaker, youre probably getting too much sodium.

Because most of the sodium you eat is in your food before you buy it, it can be hard to limit how much youre getting. But you deserve to choose how much sodium you eat. An AHA survey found that about three-quarters of adults in the U.S. prefer less sodium in processed and restaurant foods.

Learn about the sources of sodium in the American diet and food supply. And watch out for the Salty Six the six common foods that add the most sodium to the diet.

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Tips For Cutting Salt From Your Diet

Most people think of salt as the stuff that comes out of a shaker. But that makes up a surprisingly small fraction of the sodium in an average diet. Most of the sodium we swallow comes from prepared and packaged foods.

Dr. Laffin offers these strategies for keeping sodium levels in the healthy range:

Reading labels and tweaking your diet might sound daunting. But like anything else, it gets easier with practice. Its a habit your heart will thank you for.

Losing Weight If Needed

Ask your doctor if youre within a moderate weight range. Being overweight or having obesity can put extra stress on the heart.

If youre comfortable, you can try working with a nutritionist or registered dietitian to figure out which foods you can eat that will help you maintain the weight thats right for you.

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Effect Of Salt On Blood Pressure

The human body has evolved to balance salt intake with need through means such as the reninangiotensin system. In humans, salt has important biological functions. Relevant to risk of cardiovascular disease, salt is highly involved with the maintenance of body fluid volume, including osmotic balance in the blood, extracellular and intracellular fluids, and resting membrane potential.

The well known effect of sodium on blood pressure can be explained by comparing blood to a solution with its salinity changed by ingested salt. Artery walls are analogous to a selectively permeable membrane, and they allow solutes, including sodium and chloride, to pass through , depending on osmosis.

Circulating water and solutes in the body maintain blood pressure in the blood, as well as other functions such as regulation of body temperature. When salt is ingested, it is dissolved in the blood as two separate ions Na+ and Cl. The water potential in blood will decrease due to the increase solutes, and blood osmotic pressure will increase. While the kidney reacts to excrete excess sodium and chloride in the body, water retention causes blood pressure to increase.

In agreement with studies regarding salt sensitivity, participants of African descent showed high reductions in blood pressure.

Too Much Salt And Your Heart Health

Ask the Expert: The Link Between Salt Intake and Heart Disease

Too much salt intake may eventually cause high blood pressure or hypertension which could increase your risk for heart disease. Hypertension can injure or overstretch the walls of your blood vessels, block blood flow and make it harder for the heart to pump blood through your body. It may also increase your risk for heart failure and a heart attack.

To protect your heart health, we recommend that you manage your sodium consumption and explore healthier ways to enjoy your food without adding extra salt.

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Risks Of High Salt Intake Only Found In People With Hypertension

The team analyzed data of more than 130,000 individuals spanning 49 countries.

They looked at the sodium intake of participants and how this related to the risk of heart disease and stroke among those with and without high blood pressure.

Compared with people who had an average sodium intake, the rates of heart attack, stroke, and death were higher among those who had a low sodium intake, regardless of whether participants had high blood pressure.

Interestingly, low salt intake in the study was defined as an intake of less than 3,000 milligrams a day, which is above current recommendations in the United States.

Furthermore, the researchers found that only individuals with high blood pressure appeared to be subject to the risks associated with high salt intake defined as more than 6,000 milligrams daily.

Mente says the teams findings are extremely important for individuals with high blood pressure.

While our data highlights the importance of reducing high salt intake in people with hypertension, it does not support reducing salt intake to low levels.

Our findings are important because they show that lowering sodium is best targeted at those with hypertension who also consume high sodium diets.

Andrew Mente

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