By Dr. Teresa Liccardi
Eating less salt may actually worsen one’s health, according to Gary Taubes in Salt Reconsidered, a New York Times article on June 3. This may be a dangerous statement without clarification, leading many to think any discretion with regard to salt intake is unnecessary.
The true controversy is whether any statement about the amount of salt in our diets should be public policy or simply a recommendation by qualified medical caregivers based on personal health conditions.
High blood pressure, also known as hypertension, is defined as a blood pressure above 140/90. Hypertension is a major risk factor for cardiovascular disease, stroke, and kidney disease. According to the Centers for Disease Control, 68 million Americans – that’s one in three adults – have high blood pressure. Of this group, only half have it under control. Another 30 percent of the U.S. population has pre-hypertension (blood pressure more than 130/80 and less than 140/90). The U.S. spent more than $95 billion in 2010 on medical services, and lost productivity due to hypertension.
Such statistics make it imperative that we use all available means to encourage preventative lifestyle changes for hypertensive and pre-hypertensive individuals.
A low-salt diet is advocated as an important lifestyle modification that can help reduce high blood pressure. The average American diet contains 9 grams (or more) of salt. Seventy percent of our dietary salt consumption comes from processed foods. Our metabolisms cannot adequately handle the high sodium load of the American diet.
Research on the relationship between dietary salt intake and high blood pressure does not consistently make distinctions for age, methods used to quantify salt intake, or reliably distinguish individuals who are salt-sensitive. The data cited in the New York Times article questioning the detrimental effects of salt restriction have similar concerns.
Defending any position on dietary salt consumption utilizes studies that have less than perfect designs. Restrictions of a low-salt diet (below 1,500 mgs per day) in specific subsets of patients may be harmful.
Restricting salt intake to 2.4 grams appears to have a modest benefit in reducing hypertension. Given the magnitude of the socioeconomic burden of hypertension, the modest blood pressure reductions that can be achieved through dietary salt restriction – using a practical and achievable goal of 2.4 grams of sodium per day – are an important recommendation for healthy lifestyle modification. Modest salt restriction will greatly benefit Americans individually and collectively.
Avoiding extremes until more research is available is prudent, but taking personal responsibility for managing personal salt intake makes us “worth our salt,” as the ancient Romans would say.
Sodium (Na) and salt are used interchangeably. They are not the same. Sodium is an element. Salt is a compound. One type of salt is sodium chloride (NaCl) or common table salt. A dash of salt has been defined as 1/8 of a teaspoon, a pinch of salt is 1/16 of a teaspoon and a smidgen 1/32 of a teaspoon. One teaspoon of table salt equals 3 grams of sodium chloride. One gram of sodium chloride equals 400 milligrams of sodium. There are 1,000 milligrams in a gram. So a diet of 2.4 grams (2,400 milligrams) of sodium is equivalent to 6 grams of table salt. This is not to say we can safely consume 2 teaspoons of table salt daily.
Remember, the American diet has 70 percent of that 6 grams of sodium chloride in the processed foods we consume without adding extra salt.
Read labels. Count your grams of salt and understand what you are consuming. Do you need to modify your salt consumption? What are your risk factors for high blood pressure, heart disease, stroke and kidney disease?
Websites that can be of educational benefit include:
The Centers for Disease Control: www.cdc.gov/salt/
The American Heart Association: www.heart.org
Naturally for all individuals, personal dietary decisions regarding healthy lifestyle changes should be discussed with a healthcare professional qualified in the evaluation and treatment of hypertension and associated diseases.
Our health is part of our individual responsibilities. Dietary salt modification should be considered one important part of the picture leading to longevity. In conjunction with other lifestyle modifications, the additive effect can have a large long-term impact on reducing blood pressure, and reducing the risk of other chronic diseases.
Dr. Teresa Liccardi, who is board certified in internal medicine and nephrology, maintains a clinic for hypertension and chronic kidney disease at The Parker Family Health Center, a nonprofit organization for the uninsured located in Red Bank. She is working on a master’s degree in public health from Johns Hopkins University and was recently appointed president of the Rumson Commission of Health.