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Published: Wednesday, 5/15/2013 - Updated: 1 year ago

PUBLIC HEALTH

Report: No benefit to very low levels of salt consumption

NEW YORK TIMES
A study says there is no reason to limit sodium intake to less than 2,300 milligrams per day. A study says there is no reason to limit sodium intake to less than 2,300 milligrams per day.
ASSOCIATED PRESS Enlarge

WASHINGTON — In a report that undercuts years of public health warnings, a prestigious group convened by the government said there is no good reason based on health outcomes for many Americans to reduce their sodium consumption down to the very low levels recommended in national dietary guidelines.

Those levels, 1,500 milligrams of sodium a day, or a little more than half a teaspoon of salt, were supposed to prevent heart attacks and strokes in people at risk, including anyone older than 50, blacks, and people with high blood pressure, diabetes, or chronic kidney disease.

Some influential organizations, including the American Heart Association, have said everyone, not just those at risk, should aim for that very low sodium level.

The heart association reaffirmed that position even in light of the new report.

But the new expert committee, commissioned by the Institute of Medicine at the behest of the Centers for Disease Control and Prevention, said there was no rationale for anyone to aim for sodium levels lower than 2,300 milligrams a day.

The group examined new evidence that had emerged since the last such report was issued, in 2005.

“As you go below the 2,300 mark, there is an absence of data in terms of benefit and there begin to be suggestions in subgroup populations about potential harms,” said Dr. Brian Strom, chairman of the committee and a professor of public health at the University of Pennsylvania.

He explained that the possible harms included increased rates of heart attacks and an increased risk of death.

The committee was not asked to specify an optimal amount of sodium and did not make any recommendations about how much people should consume.

Dr. Strom said people should not eat too much salt, but he also said that the data on the health effects of sodium were too inconsistent for the committee to say what the upper limit of sodium consumption should be.

Until about 2006, almost all studies on salt and health outcomes relied on the well-known fact that blood pressure can drop slightly when people eat less salt.

From that, and from other studies linking blood pressure to risks of heart attacks and strokes, researchers created models showing how many lives could be saved if people ate less salt.

The U.S. dietary guidelines, based on the 2005 Institute of Medicine report, recommend that the general population aim for sodium levels of 1,500 to 2,300 milligrams a day because those levels will not raise blood pressure.

The average sodium consumption in the United States, and around the world, is about 3,700 milligrams a day, an amount that has not changed in decades.

But more recently, researchers began looking at the actual consequences of various levels of salt consumption, as found in rates of heart attacks, strokes, and death, not just blood pressure readings.

Some of what they found was troubling.

One study, published in 2011, followed 28,800 subjects with high blood pressure aged 55 and older for 4.7 years and analyzed their sodium consumption by urinalysis.

The researchers reported that the risks of heart attacks, strokes, congestive heart failure, and death from heart disease increased significantly for those consuming more than 7,000 milligrams of sodium a day and for those consuming less than 3,000 milligrams of sodium a day.

There are physiological consequences of consuming little sodium, said Dr. Michael Alderman, a dietary sodium expert at Albert Einstein College of Medicine who was not a member of the committee.

As sodium levels plunge, triglyceride levels increase, insulin resistance increases, and the activity of the sympathetic nervous system increases.

Each of these factors can increase the risk of heart disease.

“Those are all bad things,” Dr. Alderman said. “A health effect can’t be predicted by looking at one physiological consequence. There has to be a net effect.”

Medical and public health experts responded to the new assessment of the evidence with elation or concern, depending on where they stand in the debate.

“What they have done is earth-shattering,” Dr. Alderman said. “They have changed the paradigm of this issue. Until now it was all about blood pressure. Now they say it is more complicated.”

Dr. Elliott Antman, a spokesman for the American Heart Association and a professor of medicine at Brigham and Women’s Hospital, said the association remained concerned about the large amount of sodium in processed foods, which makes it almost impossible for most Americans to cut back.



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