This past weekend, the New York Times published an editorial on salt, and how we may not need to restrict it as much as we think. This line of thought is in stark contrast with the vehement warnings against American consumers eating too much sodium-laden food. Such conflicting information can be confusing and frustrating, particularly for people who need closely watch what they eat.
So Amy Campbell, M.S., R.D., L.D.N., C.D.E., an educator at Joslin, is weighing in and sorting through the some of the facts.
How is salt beneficial to your body? How can it be harmful?
Salt, or more specifically, sodium, is a mineral that we all need to regulate the balance of fluid in our bodies. It’s also needed for nerve conduction and muscle contraction. The kidneys help to control the amount of sodium in the body, but if they aren’t able to get rid of excess sodium very well (which can happen if the kidneys themselves aren’t working at full throttle), then sodium levels can build up in the blood. This excess sodium attracts water in an effort to keep things balanced, which means that the heart has to pump harder to keep blood moving throughout the body. The result? Higher blood pressure. And blood pressure that’s too high can increase the risk of heart disease, kidney disease and stroke.
Do you agree that some research stating that restricting salt is bad for your health is ignored while making recommendations?
It’s certainly possible. We’ve all been bombarded by messages from various health institutions and organizations, such as the American Heart Association, the Centers for Disease Control and the USDA about the dangers of excess sodium in the diet. On average, Americans consume about 3400 milligrams of sodium each, whereas the recommendations are no more than 2300 mg per day or 1500 mg for people 51 years of age or older, African Americans and those with high blood pressure, diabetes or chronic kidney disease. Rarely do we hear that too little sodium may lead to heart disease or increase the risk of death, for example.
If that research is ignored, do you think it is ignored for good reason?
The reality is that a slew of studies have linked a high salt intake to a host of maladies, such as stroke, thickening of blood vessel walls, endothelial dysfunction (which is a precursor to heart disease), a decrease in kidney function, osteoporosis, stomach cancer and even asthma. Also, of course, research has shown that cutting back on sodium intake does lower blood pressure in many people. Finally, the DASH (Dietary Approaches to Stop Hypertension) eating plan is a solid, balanced eating plan based on rigorous research, showing that eating more fruits and vegetables, lower fat dairy foods, lean protein sources and less sodium lower blood pressure, increases good (HDL) cholesterol and lower bad (LDL) cholesterol.
Do you think the benefits of lowering salt intake out-weigh the risks, particularly in patients with diabetes?
I think it’s too soon to say that. Last year, several studies were published in various journals, indicating that the benefits of a low sodium diet couldn’t be proven. One study, published in the Journal of the American Medical Association looked at 3700 healthy European men and women (rather small) aged 60 years or younger. The authors found that those who had a lower sodium intake over 8 years had a higher risk of heart attack and stroke. However, there were some flaws with the study, including how sodium excretion was measured and the fact that the subjects had normal blood pressure at the start of the study, and were white, younger and thinner than the typical American. Also, things like physical activity and total calorie intake weren’t considered. On the other hand, studies like these have raised awareness of sodium, in general, which is a good thing.
What can patients with diabetes take away from this editorial? Should they consider making changes to their diets?
It can be confusing for patients and healthcare providers alike when studies or editorials like these come out. It’s unlikely that changes in sodium recommendations will be made based on these few studies alone. But the take away is that it’s important to discuss issues such as sodium intake with your healthcare team to find out what’s best for YOU to do. Everyone’s different. And as far as making changes to one’s diet, it can only be a good thing if people start eating more fresh fruits and vegetables, cutting back on processed and fast foods, and preparing more healthful meals at home.