
Effect of longer-term modest salt reduction on blood pressure (2013) - YeGoblynQueenne
http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD004937.pub2/abstract
======
shijie
Salt might be a contributing factor, albeit small, but there's an increasing
tsunami of research pinning sugar, especially added sugar in the forms of
table sugar and high fructose corn syrup, as the primary cause of
hypertension, obesity, heart disease, and a huge host of other diseases.

This is a lengthy discussion between a health/fitness expert and Gary Taubes,
author of “The Case Against Sugar”:
[https://bengreenfieldfitness.com/podcast/nutrition-
podcasts/...](https://bengreenfieldfitness.com/podcast/nutrition-podcasts/the-
case-against-sugar-gary-taubes/)

After listening to that and reading some of the linked studies and articles,
it seems obvious to me that sugar is orders of magnitude the highest candidate
for heart-related disease and obesity. Just my conjecture though, happy to be
proven wrong. In the meantime, I'm cutting down heavily on refined sugar and
processed carbohydrates. I've never felt better. Same caloric intake, just
different sources.

~~~
aantix
Gary is a big proponent of the low carb/insulin hypothesis for weight loss.
And so far, with his Nutritional Science Initiative and their testing, it's
just not panning out..

[https://examine.com/nutrition/low-fat-vs-low-carb-for-
weight...](https://examine.com/nutrition/low-fat-vs-low-carb-for-weight-loss/)

[https://www.youtube.com/watch?v=MiUyjMjuLl0&t=674s](https://www.youtube.com/watch?v=MiUyjMjuLl0&t=674s)

I'm wondering if he's still worth listening to..

~~~
skosch
Weight loss is only one aspect of the nutrition story. That being said,
remember that just because Taubes is wrong on a bunch of things, doesn't make
sugar any healthier.

~~~
inyourtenement
Sugar can be unhealthy without being the Ultimate Evil, cause of all ills,
that Taubes makes it out to be.

------
dismal2
I’ll just leave this here [https://www.scientificamerican.com/article/its-
time-to-end-t...](https://www.scientificamerican.com/article/its-time-to-end-
the-war-on-salt/)

~~~
ShabbosGoy
Another relevant article: [https://mobile.nytimes.com/2017/05/08/health/salt-
health-eff...](https://mobile.nytimes.com/2017/05/08/health/salt-health-
effects.html)

Sodium is interesting in that low or high levels in the body are bad for you.
But it would appear that sodium promotes weight loss to a certain degree, the
undesirable side-effect being the burning of muscle tissue.

------
whistlerbrk
That's half a teaspoon a day. I cook every single day, so I'm very well aware
of how little that is. Id rather die a bit earlier then limit my added salt to
half a teaspoon.

Just don't eat processed food. Also restaurant food uses a ton of salt so
tread carefully.

~~~
tetraodonpuffer
it just takes time for your tastebuds to get used to lower salt, but
afterwards food tastes just as good. Some years back after eating probably
8,000-10,000mg of sodium a day for most of my life I had to permanently switch
to an extremely low sodium diet (<500mg/day) and taste has not been an issue
after the first few weeks of acclimatization, tastebuds are very adaptable and
interestingly nowadays some vegetables (potatoes for example) will taste
slightly salty to me on their own for example.

The major issue has been of course that eating out or eating pretty much any
packaged/premade food is impossible, due to everything having tons of
sodium/salt added. For some n=1 blood pressure was not the reason why I had to
get on this diet, but my bp went from 145/85 to 105/65 after not that long on
it, which really surprised me of course.

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gdubs
If I understand correctly, this is a meta analysis – meaning that they're
drawing conclusions based on pooling together existing research.

The very first study they linked was on something called the DASH diet, which
in addition to reduced sodium encourages people to stay away from processed
carbs and to favor whole grains.

Basically, I'd want to dig in to the linked studies and get a better sense of
how other factors besides sodium could be affecting the outcome. For instance,
fast food contains a lot of sodium. To get to lower sodium, you'd probably
have to cut down significantly on fast food. You'd drop the sodium, but you'd
also be changing a _lot_ of other variables.

Salt makes food taste good. If you're cooking at home, you're probably not
going to have to worry about salt unless you have a chronic condition of some
sort. It just doesn't compare to the amount of sodium crammed into processed
food. I'd rather focus on eating less processed foods, and season my home-
cooked meals so they're not terribly bland. The high-order bit is to eat less
processed foods.

------
whalesalad
I take 5-7g of salt daily in the form of manual supplementation. I eat a
ketogenic diet so it's necessary to combat the diuretic effect of low-carb
eating.

I feel like this study doesn't really do a good job isolating the actual
changes that might have led to the improvements. How was salt intake
determined? Was it controlled? Unless I am getting lost in the technical
writing it looks like the results were based purely on urine output tests, not
inputs.

~~~
oigursh
5-7g seems very high. What else do you eat?

~~~
whalesalad
Meat. Eggs. Cheese. Salad. Broccoli. Other veggies. Avocado. Nuts. Oils.
Coffee. That’s the gist of it.

~~~
kovach
That looks like a very healthy diet. What happens, or would happen, if you
reduce or stop your salt supplementation?

~~~
whalesalad
Headaches and flu-like symptoms. I take something called "lite salt" which is
intended to be a salt substitute for folks with health issues. It's
essentially a 50/50 blend of salt and potassium so it's perfect. I put a
teaspoon in some water with a zero-sugar flavor aid like mio, shake it up, and
boom I got some zero-sugar/low-carb gatorade.

------
toasterlovin
There are other problems with this analysis, but the main problem is this: it
does not indicate in any way that reducing salt intake will result in a
reduction of morbidity, and reducing morbidity is the only thing that actually
matters.

Blood pressure is important as a marker for a whole host of health issues, but
lowering blood pressure via reduced salt intake does not mean that you will
reduce the incidence of of health issues that are commonly associated with
high blood pressure. One simply does not follow from the other.

~~~
Steko
> it does not indicate in any way that reducing salt intake will result in a
> reduction of morbidity

It doesn't? I thought it said pretty clearly it will lower the incidence of
cardiovascular disease and predicted a reduction in strokes, heart attacks and
heart failure.

> Blood pressure is important as a marker for a whole host of health issues

False, blood pressure is far more than a marker. For example: _" The incidence
of stroke rises progressively with increasing blood pressure levels,
particularly systolic blood pressure in individuals >65 years. Treatment of
hypertension convincingly decreases the incidence of both ischemic and
hemorrhagic strokes."_

[https://en.wikipedia.org/wiki/Complications_of_hypertension](https://en.wikipedia.org/wiki/Complications_of_hypertension)

~~~
JoeAltmaier
Salt is responsible for 2 pts of BP benefit. Insignificant for most people.
And the depression from being on a low-salt tasteless diet could more than
offset for any gain.

------
scythe
Not really convinced by the last line:

>The current recommendations to reduce salt intake from 9-12 to 5-6 g/d will
have a major effect on BP, but are not ideal. A further reduction to 3 g/d
will have a greater effect and should become the long term target for
population salt intake.

First, this latter recommendation is not tested by the study; second, lower BP
is _not_ always optimal, as anyone who's ever experienced a fall resulting
from orthostatic hypotension can attest. It isn't obvious, but accidents are
among the top 10 causes of death in older people, and falls comprise more than
half:

[https://www.verywell.com/top-causes-of-death-among-adults-
ov...](https://www.verywell.com/top-causes-of-death-among-adults-
over-65-2967470)

------
narag
I see it is from 2013, could somebody explain why is it interesting five years
later? I don't say it isn't, just wondering.

 _current levels of approximately 9-12 grams per day_

That seems like a lot. I'm pretty sure I don't use so much, even if I like
salty food compared with people around me.

I do know that salt comes with a lot of prepared food, but most of it has been
considerably reduced. And I don't eat much prepared food anyway.

So if it's a real number, someone must be eating spoonfuls of salt to raise
the average :)

~~~
JumpCrisscross
> _I 'm pretty sure I don't use so much_

Two teaspoons of table salt are roughly 12 grams [1].

[1] [http://www.traditionaloven.com/culinary-
arts/cooking/table-s...](http://www.traditionaloven.com/culinary-
arts/cooking/table-salt/convert-tea-spoon-tsp-to-gram-g.html)

~~~
narag
That's correct. I've just actually put ten grams in my hand and it's as much
as I thought.

------
vixen99
"Therefore, 3 grams per day should become the long-term target for population
salt intake".

But why should this study be regarded as a definitive basis for public
recommendation ("should become") given numerous other studies which do not
come to this conclusion?

~~~
michaelkeenan
It's more trustworthy than one study because it's a systematic review of many
other studies. Reviews of good studies are the best form of evidence[1].

This review was conducted by Cochrane[2]. Cochrane reviews are widely regarded
as the best and most rigorous reviews.

[1]
[http://www.essentialevidenceplus.com/product/ebm_loe.cfm?sho...](http://www.essentialevidenceplus.com/product/ebm_loe.cfm?show=oxford)

[2]
[https://en.wikipedia.org/wiki/Cochrane_(organisation)](https://en.wikipedia.org/wiki/Cochrane_\(organisation\))

------
Symmetry
I seem to recall research saying that homeostasis kicks in on time horizons
longer than the ones used in this trial.

------
tedunangst
What is the expected change in outcome from a BP drop of 5mmhg?

------
seshagiric
Ayurveda is showing interesting benefits for hypertension
[http://www.medindia.net/patients/lifestyleandwellness/herbs-...](http://www.medindia.net/patients/lifestyleandwellness/herbs-
for-high-blood-pressure-arjuna.htm)

~~~
JumpCrisscross
> _Ayurveda is showing interesting benefits for hypertension_

You’re being downvoted for referencing an article making health claims with
zero citations. It should also be noted that Ayurvedic medicine is considered
a pseudoscience [1], slightly less useless than homeopathy or crystal healing.

[1]
[https://en.m.wikipedia.org/wiki/Ayurveda#Classification_and_...](https://en.m.wikipedia.org/wiki/Ayurveda#Classification_and_efficacy)

~~~
seshagiric
Fair comment about posting an article with zero citations. However Ayurveda is
not pseudoscience, rather a complementary health approach. This time more
credible source:
[https://nccih.nih.gov/health/ayurveda](https://nccih.nih.gov/health/ayurveda)

~~~
JumpCrisscross
Under “What the Science Says About the Effectiveness of Ayurvedic Medicine
Research” section of your own source [1], it says “most clinical trials of
Ayurvedic approaches have been small, had problems with research designs, or
lacked appropriate control groups, potentially affecting research results.”
The page doesn’t define “complementary medicine,” and presents loads of
warnings about the heavy metal and toxic contents of many Ayurvedic products.
Most notably, the “For Health Professionals” section is blank.

Ayurveda isn’t quite as bunk as homeopathy or crystal healing, where the
fundamental mechanisms are flaws. (Aspirin and penicillin came from natural
sources.) But any claims about its efficacy are pseudoscientific.

[1]
[https://nccih.nih.gov/health/ayurveda/introduction.htm#hed4](https://nccih.nih.gov/health/ayurveda/introduction.htm#hed4)

