Friday, June 14, 2019

Another Medical Trope Exploded: People Can Consume (Much) More Salt Than The Health Scolds Allow

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In Banff, Alberta last year - celebrating Janice's birthday. We both enjoyed relatively salty platters, me with bison steak, gravy and french fries, Janice with roasted salmon, veggies and garlic bread.

The latest medical trope to fall was a biggie: the one that insisted adults limit daily sodium intake to no more than 2,300 mg a day - or a little over a teaspoonful of salt equivalent.  The limit was even more stringent for those "at risk of cardiovascular disease":  1,500 milligrams.  For years I've known I'd been exceeding this sodium chintzy limit - what with my love for sauerkraut and sandwiches laden with dill pickles- and Janice has too. Both of us are 'salty' connoisseurs who relish salt on our dishes - not scrimping on it. There's nothing worse that a tasteless, almost salt- free roasted chicken or fish dish.

Now, it appears we are both right to ignore the Salt scolds, at least according to Drs. Michael H. Alderman and David A. McCarron, writing in a recent WSJ piece ('Are You Getting Too Much Salt In Your Diet? Probably Not', June 3, p. A23).  Referring to the recommendations of the National Academy of Medicine, they write:

"Those recommendations ignore scientific developments and may be harmful to your health. In March we published an article in the Lancet summarizing six decaes of research on sodium intake in more than a million people world wide. We found the sodium 'sweet spot' - the intake range with the lowest risk of disease and the longest life expectancy- to be between 3,000 and 5,000 milligrams per day, considerably higher than the usual recommendations.  

Once daily sodium consumption falls below 3,200 milligrams - all cause mortality increases, and life expectancy decreases dramatically."

The full paper can be found in the link below, including a PDF download:

Urinary sodium excretion measures and health outcomes - The Lancet

They go on to explain the basis (ibid.):

"Adequate sodium is crucial for biological processes including nerve conduction, muscle contraction and sustaining the fluid balance necessary to assure blood flow and deliver nutrients and oxygen to every cell in the body.  As recently reviewed in The New England Journal of Medicine, human physiology has evolved a complex process mediated by the brain, to maintain sodium balance precisely. If we consume too little sodium our kidneys will go to extremes to conserve it. If we consume too much it is eliminated through our skin, intestines and kidneys. You're far likelier to die from failure to maintain this precise control than from the modest impact salt may have on your blood pressure."

The pair also has another cogent point, i.e that despite all the needling and salt shaming - and "despite vigorous efforts by government and advocacy groups  - average U.S. sodium intake has remained constant at 3,600 to 3,700 mg per day."  In other words, the rank and file of citizens are simply ignoring the salt nannies and putting the amounts of salt they want on eggs, fish, chicken etc. Hence, it appears no commandments from the health mavens, their advocacy extensions or government policy wonks can override our innate craving for salt - which may be biologically driven.

As the authors also note:

"Minimal decreases in serum sodium predict increased mortality in healthy people"

And just as eye-opening:

"Comparable increases in risk exist for the ill and the elderly.  Low serum sodium at hospital admission is associated with increased length of stay , in-hospital death and discharge to a care facility."

Clearly, they believe the FDA needs to remove existing sodium restrictions on food.  (Of course, common sense and one's personal health history also factors into salt consumption. So if one is genetically prone to malignant high blood pressure it's a good idea to stick with the minimum recommended.)

For ourselves, we don't plan to go "salt crazy", buying and eating 'Ruffles' chips, processed burritos and other salty fare every day, at every meal.  But we don't intend to become salt ascetics either, pretty well sticking to our current ca. 3,000 - 4,000 mg / day consumption.

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