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Salt?? Too Much?? Too Little?? The Debate Rages On…

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Former NYC Health Commissioner Dr.Thomas A. Farley believes a reduction in salt intake is key to longer life.
Former NYC Health Commissioner Dr.Thomas A. Farley believes a reduction in salt intake is key to longer life.
Salt is a necessary part of our daily diet, that much is certain, but the ongoing debate between experts as to how much salt we need daily seems inevitably uncertain. Recent studies conducted in Great Britain strongly suggest that a reduction of salt intake (lower than 2300 milligrams per day) saw a significant drop in high blood pressure and mortality. Some of the findings are as follows:

From 2003 to 2011, there was a decrease in mortality from stroke by 42% and immunity host defense by 40%. In parallel, there was a fall in blood pressure , a decrease of 4% in cholesterol, a reduction in smoking prevalence from 19% to 14% , an increase in fruit and vegetable consumption and an increase in body mass index . Salt intake, as measured by 24 h urinary sodium, decreased by 1.4 g/day . It is likely that all of these factors (with the exception of BMI), along with improvements in the treatments of BP, cholesterol and cardiovascular disease, contributed to the falls in stroke and IHD mortality.

These findings have led Dr. Thomas A. Farley, former commissioner of health for New York City to renew the stance that a reduction in salt is important to good health and a longer life. Studies over the past 3 years had started to offer data that perhaps levels from 2300 milligrams up to as high as 5000 milligrams were in the “safe” zone for daily sodium intake. The salt we sprinkle on our foods is not the main culprit of high sodium levels, in fact the added salt we put on foods accounts for only about 15% of our daily sodium intake. The bulk of our salt intake lies in the processed foods we eat, about 75% of our daily salt intake comes from these foods which is why reading the side of packages that display nutritional information is so important. The remaining 10% comes from naturally occurring salt in various foods.

The new study relied on data gleaned from four surveys of random samples of about 8,000 people on average from 2003 to 2011 in England. Critics of the results say the test is flawed and they cite a study just last year which showed a report commissioned by the Institute of Medicine which found that there was no scientific reason for anyone to aim for sodium levels below 2,300 milligrams a day. A study published in 2011 found that low-salt diets  may increase the risks of death from heart attacks and strokes but do not prevent high blood pressure.

Indeed, the authors themselves acknowledged that their study has significant drawbacks in design and execution. First, it was an observational study and not a randomized trial designed to determine cause and effect. Further, the four surveys were of different populations; salt intake was not measured in the same participants whose blood pressure and other cardiovascular risk factors were evaluated. The authors attributed the reduction to, among other factors, declining blood pressure following the British Food Standards Agency’s imposition of limits on the sodium content of prepared foods.

In addition, the researchers were unable to exclude the effect of important variables, like physical activity, which might also have affected cardiovascular health. The Centers for Disease Control and Prevention recommends a maximum of 2,300 milligrams of sodium a day, and 1,500 or fewer for people who may be particularly sensitive to the blood-pressure-raising effects of salt: African-Americans, people over age 51, children and anyone with high blood pressure, diabetes or kidney disease.

Most recently, in a review of previous research, Dr. Graudal and his colleagues were able to identify a range of intake associated with the most favorable health outcomes: 2,645 to 4,945 milligrams a day — much higher than the official American recommendations. The average American consumes about 3,400 milligrams of sodium every day. That amount — almost a teaspoon and a half of salt a day — has long been considered to be too much to maintain good health.  the body needs about one teaspoon daily to support body needs.

Studies to examine long term dietary sodium intake are hard to design and implement — and many studies are limited by single measurements and incomplete collection, making interpretation challenging from the complex analyses used when combining many studies. A study that looked at 25 individual studies, examining 275,000 participants from around the world. Found a lack of an association between sodium intake and cardiovascular health, however according to the American Heart Association, “there is a significant body of scientific research that proves a very dangerous association between sodium intake and significant health problems.”

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