One of the great “truths” in cardiovascular medicine is that to prevent stroke and cardiovascular death you reduce your salt intake. But is it true? A new analysis of the existing literature from the Cochrane Library indicates this may not be the case (1). Analyzing a great number of published studies, researchers came to the conclusion that there is no strong evidence to support the idea that salt restriction reduces cardiovascular disease or all-cause mortality in people with either normal or increased blood pressure. Furthermore, they found that while reducing salt intake did decrease blood pressure, it also increased the risk of all-cause death in people with existing congestive heart failure.
If that wasn’t enough, an article in the May 4 issue of the Journal of the American Heart Association found that low salt increased the risk of death from heart attacks and stokes, while not reducing blood pressure (2). This study was done with middle-aged Europeans and followed them for nearly eight years. During this time, the less salt they consumed, the greater the number who died of heart disease.
Needless to say, the American Heart Association (the same people who recommend eating lots of omega-6 fats) was enraged, similar to the Wizard of Oz telling Dorothy to ignore the man behind the curtain.
So why might restriction of salt consumption cause increased heart attacks? The reason may be due to increased insulin resistance induced by salt restriction (3). Insulin resistance increases insulin levels, and if that is combined with increased consumption of omega-6 fatty acids (remember the American Heart Association), you now have a sure-fire prescription to produce more arachidonic acid. It’s the inflammatory eicosanoids derived from arachidionic acid that would cause inflammation in the arterial wall leading to a heart attack.
This is not to say that some people are not salt-sensitive (African-Americans are particularly so), but I believe the problem is more a matter of balance. You need some sodium, but you also need potassium to balance it. This is confirmed by a recent study from Harvard Medical School that demonstrates that the higher the sodium-to-potassium ratio in the blood, the greater the likelihood of cardiovascular mortality (4). The relationship for increased death was significantly greater for a high sodium-to-potassium level than simply the sodium level itself.
Getting sodium in your diet is easy (sprinkle salt on your food), but getting adequate levels of potassium means eating a lot of fruits and vegetables. So rather than restricting salt intake or taking drugs (i.e. diuretics) to reduce the levels of sodium in the body, think about eating more fruits and vegetables if your goal is to reduce the likelihood of a heart attack. Oh, yes, also ignore the advice of American Heart Association and take more omega-3 and less omega-6 fatty acids.
- Taylor, RS, Ashton KE, Moxham T, Hooper L and Ebrahim S. “Reduced dietary salt for the prevention of cardiovascular disease.” Cochrane Database of Systematic Reviews DOI: 10.1002/14651858.CD009217 (2011).
- Stolarz-Skrzypek K, Kuznetsova T, Thijs L, Tikhonoff V, Seidlerova J, Richart T, Jin Y, Olszanecka A, Malyutina S, Casiglia E, Filipovsky J, Kawecka-Jaszcz K, Nikitin Y, and Staessen JA. “Fatal and nonfatal outcomes, incidence of hypertension, and blood pressure changes in relation to urinary sodium excretion.” JAMA 305: 1777-1785 (2011).
- Alderman MH. “Evidence relating dietary sodium to cardiovascular disease.” J Am Coll Nutr 25: 256S-261S (2006).
- Yang Q, Liu T, Kuklina EV, Flanders WD, Hong Y, Gillespie C, Chang M-H, Gwinn M, Dowling N, Khoury MJ, and Hu FB. “Sodium and potassium intake and morality among US adults.” Arch Intern Med 171: 1183-1191 (2011).