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Salting at the table 12/07/22
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You CAN get used to less salt!
I've talked before about research that shows that those who gradually reduced the sodium level in their overall diet found that the same crackers tasted saltier after they'd become accustomed to a lower daily salt intake. Researchers in The Netherlands just published an interesting study in which they looked at people's responses to reduced sodium levels in bread.

Finding a direct link from sodium to heart disease
I like to tell my medical students that "medicine is not math." Remember that Transitive Property of Equality you might have learned about in Algebra? Where if A = B and B = C, then A always equals C?

Sodium and Stroke
The United States Department of Agriculture recommends that Americans limit their sodium intake to less than 2400 milligrams per day. The American Heart Association, however, recommends a limit of 1500 milligrams per day.

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Salting at the table

using a salt shaker to add salt to a pizza

Dietary research is fraught with pitfalls. Two common ones are: first, asking people what they usually eat is subject to individual memory, which can be unreliable. Second, there's what is known as "social desirability bias" - when people respond to surveys with what they think they should be doing (or eating or thinking or saying) rather than what they actually do. While there are ways to double check survey results to make sure they are as accurate as possible, there are some variables that are difficult to account for.

It's well established that higher levels of sodium intake are linked to higher blood pressures, and indeed, greater risk of heart disease in general. The problem with assessing sodium intake in most people is that while you can measure the sodium content in individual ingredients in a recipe, some people will still add salt from a salt shaker when they eat. How much do they add? Unless the researcher follows every subject throughout their daily lives and measures the amount of salt added at the table, it's nearly impossible to know.

With that in mind, a team of scientists at the schools of public health at Tulane University and Harvard University analyzed data gathered for the UK Biobank, a large-scale, long-term study that initially included over 210,000 men and women between the ages of 37 and 73 (JACC 2022;80(23):2157-2167). The participants responded to online dietary surveys asking them to report on their intake of over 200 different foods and drinks within the 24 hours before taking the survey.

They were also asked, "Do you add salt to your foods? (Do not include salt used in cooking.)" The participants chose from one of five responses that described a range from "never/rarely" to "always" and included "prefer not to answer."

The authors were most concerned with the development of cardiovascular disease, so they excluded those participants who had been diagnosed with heart disease, those whose dietary survey was incomplete or implausible, and those who chose not to answer the question about added salt. This left over 176,000 participants.

In addition to simply considering whether the participants added salt to their food, the authors calculated a modified DASH diet score for each participant that did not consider sodium intake. Scores could range from 7 to 35, with a higher score indicating greater adherence to a DASH diet.

The authors correlated data from the National Health Service and the national death index to find out which participants were diagnosed with cardiovascular disease in general, stroke, heart failure, or ischemic heart disease (all subtypes of cardiovascular disease).

Somewhat unsurprisingly, those who "never/rarely" added salt at the table were 25% less likely to develop any form of cardiovascular disease, 28% less likely to be diagnosed with ischemic heart disease, 8% less likely to experience stroke, and 39% less likely to develop heart failure than those who "always" added salt to their meals.

These effects were mitigated by a higher DASH diet score: those who "never/rarely" added salt and had a DASH score in the top third were 36% less likely to experience any cardiovascular events, 35% less likely to develop ischemic heart disease, and 54% less likely to develop heart failure.

What's interesting, however, is that even those who "always" added salt to their food could still decrease their risk of cardiovascular disease: those with a mid-level DASH score who always added salt were still 22% less likely to develop CVD than those with scores in the lowest third.

What this means for you

The point here is that reducing the amount of salt added at the table can have a significant impact on your health, even if you follow an otherwise healthy diet. We know that your salt taste buds get used to a certain level of salt: when you reduce your overall sodium intake things that used to not taste salty will start to taste more salty. Ask yourself: do you really to add more salt? Make sure you're tasting your food before adding salt to see if it's really necessary.

December 1, 2022