12 ms·

Lowering sodium intake doesn’t help heart patients

251 points by johndcook 4y ago

mrfusion 4y ago
I have a theory that a large percentage of food cravings and idle snacking are due to being salt deficient and seeking out salty foods. Perhaps part of the obesity epidemic is due to the vilification of salt?
- jugg1es 4y ago
  Your theory can be anecdotally refuted by simply observing that people will eat more when food is well salted. French fries are an easy example. If you have two piles of fries - one salted, one not salted. Which do you think you'd eat more of?
  - drugstorecowboy 4y ago
    I'm not sure how that would refute GP, perhaps people prefer the salty fries due to salt deficiency...
  - krisroadruck 4y ago
    I mean your test can be juked both directions... perhaps you eat more of the salted pile because you are salt deficient and that pile provides the salt your body needs, while the none salted pile isn't solving the problem and thus is deemed unhelpful by your system? I'm not saying either are correct, I'm saying this hypothetical is a bad one.
  - jmkni 4y ago
    I don’t like the taste of salt and actively avoid things which taste salty, I guess I’m an outlier here lol
- jonnycoder 4y ago
  Your theory doesn't seem too far off. Perhaps it is not a deficiency but more of a craving associated with hormones like ghrelin. I find that salty processed foods such as Cheeze-Itz (flavored) are very addicting and not filling at all. My theory was always that anything with onion powder, salt and refined carbs is a craving that can't be satisfied easily.
zuminator 4y ago
Why does the title here omit the word "failure" from "heart failure patients"? This is a very narrow clinical result, and not evidence pro or con in the general sodium debate.
Shadonototra 4y ago
what about everything else? high sodium diet = - higher chance to develop kidney stones - increase in blood pressure - hurt the liver
- nabla9 4y ago
  Nothing. Study: States specific conditions and statistics. Hacker News reaction post: Interprets the title as maximalists statement. These studies are tiny information nuggets useful for researchers working in the field. Nobody should change their view based on studies posted here.
  - h2odragon 4y ago
    Wait'll the news gets a hold of it. The same study will probably generate "low salt diets cause heart attacks" and "skipping salt saves lives" news headlines.
  - giantg2 4y ago
    Most people here don't fit into the target group (ambulatory heart failure) being studied anyways.
- Mikeb85 4y ago
  And a no sodium diet = death. It's a mineral required for human life, it's only in our decadent modern society that too much has ever been an issue. Too much is bad but heavily restricting it isn't as good as people think.
  - qwytw 4y ago
    Before refrigeration salt was the most popular method of preserving food, so do we really consume that much more of it compared to people who lived in the past?
    - ceejayoz 4y ago
      Much of the diet would've still been grains, tubers, dried beans, etc.
mikeyouse 4y ago
We can shortcut a bunch of pedantic arguments by just reading their conclusion; > In ambulatory patients with heart failure, a dietary intervention to reduce sodium intake did not reduce clinical events. Ambulatory = walking around, e.g. not hospitalized. The patients were already diagnosed with chronic heart failure and were followed for a year to see if a low-sodium diet would prevent further cardiac events. There wasn't statistical evidence that the low-sodium diet did so. Tada!
- DoingIsLearning 4y ago
  But if they are outpatients is there any guarantee that they were even sticking to a low sodium diet in the first place?
  - Ensorceled 4y ago
    So you are saying they are lying in the title when they say "randomised, controlled trial"?
    - DoingIsLearning 4y ago
      You can still have an RCT with self-reported data. The issue being that self-reported is not always accurate.
  - mikeyouse 4y ago
    They followed the diets and measured intake -- the low sodium group was instructed to stay under 1,500mg/day -- they didn't quite get there but had substantially lower sodium intake as compared to the 'control'. The study group decreased median sodium intake by 27% compared to the 'control' group who decreased intake by 2%. There's always a issue of 'the human element' in studies like this where people lie and don't follow instructions but claim they did, but good study design and follow-through typically minimize those issues. > Between baseline and 12 months, the median sodium intake decreased from 2286 mg/day (IQR 1653–3005) to 1658 mg/day (1301–2189) in the low sodium group and from 2119 mg/day (1673–2804) to 2073 mg/day (1541–2900) in the usual care group.
rob_c 4y ago
Well given a lot of claims about sodium and heart failure seem hyped we shouldn't be surprised. Don't know of its my opinion of the field or the journal but i don't rate the lancet highly after digging into most higher profile papers.
- newbamboo 4y ago
  “Don't know of its my opinion of the field or the journal but i don't rate the lancet” Lol. It’s every field! Unless you live under a rock you’ve heard terms like p hacking, publication bias, publish or perish and in and on. All a manifestation of the glaring problems in higher education. If you uniquely don’t trust the lancet, you’re doing it wrong. Be skeptical of all research until it’s been replicated a bunch, ideally by your own research team.
Herodotus38 4y ago
This study looked at a stricter sodium goal than is typically advised (<1500 mg/day). Usually I counsel pts on less than 2000 mg a day which is what the control group targeted and seemed to achieve. This study is useful in that it shows being more restrictive isn’t necessary, but those with heart failure should still try to avoid excess salt. It is very easy to hit double the recommended intake with a typical American diet. The average American salt intake is about ~3400 mg/day from some studies. Edit: after reading some of the replies I think there’s confusion about who the target population is in this study: it’s people who already have heart failure. I could have added in my comments that I was also referring to ppl with heart failure.
- voyagerfoil 4y ago
  Agreed. The title of the post is misleading. A strict restriction of sodium versus usual care (a recommended low sodium diet) was tested. There was no benefit to a strict low sodium diet. As a cardiologist, it doesn't not change my advice regarding usual care -- recommending a low sodium diet in patient with heart failure.
- JoeAltmaier 4y ago
  Isn't that just clinging to the old advice without evidence? This study shows it has no effect. A lesser restriction would logically also have no effect. Let's give up on the old urban legend that salt has f-all to do with heart health.
  - Ensorceled 4y ago
    > A lesser restriction would logically also have no effect. How can you "logically" come to that conclusion?
  - taylodl 4y ago
    Salt raises blood pressure. That's just simple chemistry. High blood pressure causes all sorts of problems. That's medicine.
    - 4y ago
apollodorus 4y ago
xyzzy21 4y ago
Yep. This is NOT the first study generally disproving a link between sodium and CVD. Sodium is NOT the horrible evil it's portrayed as. What is actually problematic is, if anything, an imbalance with potassium and sometimes calcium and/or magnesium.
- pc86 4y ago
  > This is NOT the first study generally disproving a link between sodium and CVD. That's a weird way to phrase it because this study has nothing to do with cardiovascular disease generally. It's specifically about non-hospitalized patients already diagnosed with heart failure. This does nothing to disprove the very clear link between sodium intake above a certain level and heart disease in a previously healthy individual.
  - JumpCrisscross 4y ago
    > the very clear link between sodium intake above a certain level and heart disease in a previously healthy individual Is this actually well established? I’ve seen so many “war on salt” articles that I’d assumed it was still debated.
    - rabuse 4y ago
      No, it is not. It's difficult to correlate CVD to high sodium intake when the majority of people in the U.S. are overweight/obese, and is the largest factor in CVD.
  - newbamboo 4y ago
    “link between sodium intake above a certain level and heart disease in a previously healthy individual” I know this is common knowledge but could you provide any recent studies or citations for curious readers? Anything from the past 5 years? I could never understand how they factor in body weight and physical activity, which should change the recommended levels. Someone who sweats a lot because of intense exercise might need sodium above that limit. Or if you drank more water than average, etc…
- 4y ago
adrian_b 4y ago
I have read this study and it is much less meaningful than the title would suggest. They have compared a diet with a sodium intake close to the lower limit of the recommended intake, with a diet including an even lower sodium intake, slightly less than normally recommended. A daily sodium intake in a relatively wide range around the recommended daily intake (which is of about 4 to 6 grams of salt per day) is not expected to cause any differences, so the results of the study are not surprising. The recommendation to eat less salt is only for the people who eat mostly industrially-processed food, which always includes excessive quantities of salt and sugar, because they are among the cheapest ingredients, while enhancing the taste of the food. Such people typically eat 2 to 3 times more salt than recommended, and only for them it may be expected that lowering the sodium intake can reduce the risk of diseases. However, lowering the sodium intake is not easy for them, because they must begin to eat something different, since the excessive salt is not added by them to the food. Otherwise, lowering the salt intake much under 4 grams per day is a serious risk, especially for older women, and especially when they also take medication against high blood pressure. Hyponatremia, i.e. having a too low sodium content in the body, manifests initially with symptoms like muscular weakness, constipation, lack of appetite and problems with the equilibrium, which may result in falls. Such symptoms may be difficult to distinguish from just consequences of old age. If hyponatremia is not diagnosed in time, the consequences can be extremely severe, including the loss of life.
- btilly 4y ago
  You missed the biggest point. Not only was the difference in salt not much, but they would have to have reduced adverse events (eg repeat heart attacks) by over 20% to have had decent odds of detecting it with their actual sample size. So the real conclusion is that a modest reduction of salt from the recommended low levels likely does not drop the odds of a repeat heart attack by more than 20%. This is a very, very long ways from the headline that lowering sodium doesn't help heart patients. And yet, this crap passes as science???
  - oldgradstudent 4y ago
    > And yet, this crap passes as science??? Have you ever looked at the papers that support the hypothesis that lowering salt consumptions helps heart patients?
everybodyknows 4y ago
To the broader topic of health information going wrong, at the top of the Lancet page I see an ad for Hydroxychloroquine Sulfate. Anyone else? I'm in western US.
- antonvs 4y ago
  I see that, although it links directly to an 18 page pdf of prescribing information (which includes no mention of COVID.) Maybe satisfying some sort of legal notification requirement?
alexk307 4y ago
Is it possible that salt intake is just correlated to heart disease because the real foods causing heart disease (highly processed foods with refined vegetable oils, sugar, preservatives, etc.) are loaded with salt? Anecdotally, I put salt in everything I cook - sometimes to the point where others find it salty. My blood pressure has always been firmly in the healthy range (low 30s Male).
- stephen_g 4y ago
  As others have said, this study is comparing a very low salt diet to a recommended level of salt diet, and only in people who already have pre-existing cardiac issues. Apparently the average American has a diet that has 1.5 times the recommended level, so what this study is looking at isn’t anything like that, let alone an even higher-salt diet. So you can’t take the study as saying anything about preventing heart disease generally. The one conclusion you perhaps could extrapolate from it is to say that the recommended limit is probably pretty good since it doesn’t seem to help going lower.
  - bluGill 4y ago
    Even then, the study would only detect large charges in effect, if someone claims the lower salt is 10% better the study wouldn't refute that.
- snarf21 4y ago
  Yes, it is like a co-morbidity. These are factors that amplify each other. Salt is likely fine if you don't have kidney or liver issues. However, heavy salt on top of trans fats and high sugar and .. and .. and .. is likely hard on our body.
- chasebank 4y ago
  You're probably right. I don't have a source but I vaguely remember reading about how salt is no different than fat or cholesterol in terms of how it correlates to your body. Fat does not make you fat. Cholesterol doesn't raise your cholesterol. Salt doesn't raise your sodium levels. Excess calorie consumption combined with lots of fat (high in calories), will indeed, make you fat. Excess calorie consumption combined with lots of cholesterol, will raise cholesterol levels. Salt is no different. This is an interesting read about salt from a 2011 article. "Intersalt, a large study published in 1988, compared sodium intake with blood pressure in subjects from 52 international research centers and found no relationship between sodium intake and the prevalence of hypertension. In fact, the population that ate the most salt, about 14 grams a day, had a lower median blood pressure than the population that ate the least, about 7.2 grams a day." [1] https://www.scientificamerican.com/article/its-time-to-end-the-war-on-salt/ https://www.scientificamerican.com/article/its-time-to-end-t... EDIT: The above referenced article has been discussed here on HN a few times over the years for anyone who wants to read previous comments. [2] https://hn.algolia.com/?q=end+war+on+salt https://hn.algolia.com/?q=end+war+on+salt
loa_in_ 4y ago
I'm not an expert by any means, but I thought it is common sense that what really matters is to have equivalent sodium and chloride ion counts ( or their equivalents ), because in nature one would basically never deviate from this. In modern times we do, relatively a lot.
01100011 4y ago
It's good to remember that highly salted foods are associated with stomach cancer: https://www.frontiersin.org/articles/10.3389/fnut.2021.801228/full#:~:text=The%20findings%20of%20this%20study,processed%20meat%20intakes%20were%20not https://www.frontiersin.org/articles/10.3389/fnut.2021.80122.... This explains the higher incidence of stomach cancer in many E. Asian countries. Stomach cancer is the fourth most common cancer last time I checked.
- carlmr 4y ago
  But this is probably not the salt's fault, it's only that bacon and pickled food is salty.
smm11 4y ago
Salt isn't bad. Sugar is.
- wtetzner 4y ago
  And too much linoleic acid.
mech987 4y ago
I wonder if the commonly thought of causation relationship for sodium and health problems is inverted. Speculatively, i.e... your body has a greater need to use the sodium-potassium pump more when you're stressed, which makes you crave salt, and eat more sodium. The high stress is what causes bad health outcomes, the high sodium levels just happen to correlate with it.
throw8383833jj 4y ago
I think a lot of people don't realize that the impact of sodium and other "bad stuff for you" varies from person to person. Only 25% of the population is subject to high blood pressure as a result of high sodium intake. So, if you create an experiment that can subtly select for the 75% of the population doesn't experience high blood pressure, then you can show that sodium doesn't raise it. I don't if that's what's going on here but a lot interested parties will try to go this route in order to show that salt is harmless.
apolymath 4y ago
nradov 4y ago
The issues with sodium intake are caused more by high osmolality than by absolute quantity. We can't tell if a particular patient's sodium consumption is too high without also knowing their fluid intake. https://peterattiamd.com/rickjohnson2/ https://peterattiamd.com/rickjohnson2/ Genetics are also a huge factor.
randcraw 4y ago
I can't read the article, but it's my impression that high sodium isn't as much a threat to general health as increased BP is. I'd like to know what sodium reduction did for BP, and how much the two groups then differed. If the goal for patients is not reduction of BP, then the presumption of this study is that sodium is affecting the heart and vessels in more complex ways than pressure alone, and such patients might suffer in a diverse multitude of complex ways that are much harder to attribute directly to the level of sodium. The authors' conclusion seems to be only that the correlation between sodium intake and death in heart patients is not simple and linear.
nycbenf 4y ago
Seems like a lot of people are missing the fact that is study of people with heart failure not a study of otherwise healthy people. The study is decreasing sodium intake even further from the current guideline for patients with heart failure. The effect of sodium intake is very different for people who need to maintain very tight tolerances to survive. And a ton of effort is spent keeping people with heart failure out of the hospital. I have heart failure and have an implant that measures electrical conductivity of heart tissue and will warn if I am approaching fluid overload due to too much sodium.
8f2ab37a-ed6c 4y ago
It's frustrating that on one hand you want to hit a decent amount of sodium per day for the optimal operation of one's body, while at the same time if you go over 2500mg of sodium per day, you increase the likelihood of building kidney stones.. there's no way to win, from what I can tell. Is there a trick here or is that just the way the human body is built, and that's that?
- PuppyTailWags 4y ago
  Lots of water?
  - 8f2ab37a-ed6c 4y ago
    I think that helps? I haven't run into studies showing the ideal water-to-sodium intake ratio, but that could be pretty useful.
    - PuppyTailWags 4y ago
      My understanding is that the human body is so complicated and so individual that very few things can be systemized like that unfortunately. Maybe if there are biomarkers to indicate specific people should have specific ratios??? I don't know.
1-6 4y ago
Womp womp womp
andy_ppp 4y ago
I'm going to make a bet the sodium intake is correlated with calorie consumption which is why these studies all find it so difficult to figure out why salt sometimes seems to cause similar issues to high calorie diets. Let's be honest here, if you eat a bowl of food with no salt on it you will get bored and find the food hard to finish.

251 points by johndcook 4y ago

I have a theory that a large percentage of food cravings and idle snacking are due to being salt deficient and seeking out salty foods. Perhaps part of the obesity epidemic is due to the vilification of salt?

jugg1es 4y ago
Your theory can be anecdotally refuted by simply observing that people will eat more when food is well salted. French fries are an easy example. If you have two piles of fries - one salted, one not salted. Which do you think you'd eat more of?
- drugstorecowboy 4y ago
  I'm not sure how that would refute GP, perhaps people prefer the salty fries due to salt deficiency...
- krisroadruck 4y ago
  I mean your test can be juked both directions... perhaps you eat more of the salted pile because you are salt deficient and that pile provides the salt your body needs, while the none salted pile isn't solving the problem and thus is deemed unhelpful by your system? I'm not saying either are correct, I'm saying this hypothetical is a bad one.
- jmkni 4y ago
  I don’t like the taste of salt and actively avoid things which taste salty, I guess I’m an outlier here lol
jonnycoder 4y ago
Your theory doesn't seem too far off. Perhaps it is not a deficiency but more of a craving associated with hormones like ghrelin. I find that salty processed foods such as Cheeze-Itz (flavored) are very addicting and not filling at all. My theory was always that anything with onion powder, salt and refined carbs is a craving that can't be satisfied easily.

zuminator 4y ago

Why does the title here omit the word "failure" from "heart failure patients"? This is a very narrow clinical result, and not evidence pro or con in the general sodium debate.

Shadonototra 4y ago

what about everything else? high sodium diet = - higher chance to develop kidney stones - increase in blood pressure - hurt the liver

nabla9 4y ago
Nothing. Study: States specific conditions and statistics. Hacker News reaction post: Interprets the title as maximalists statement. These studies are tiny information nuggets useful for researchers working in the field. Nobody should change their view based on studies posted here.
- h2odragon 4y ago
  Wait'll the news gets a hold of it. The same study will probably generate "low salt diets cause heart attacks" and "skipping salt saves lives" news headlines.
- giantg2 4y ago
  Most people here don't fit into the target group (ambulatory heart failure) being studied anyways.
Mikeb85 4y ago
And a no sodium diet = death. It's a mineral required for human life, it's only in our decadent modern society that too much has ever been an issue. Too much is bad but heavily restricting it isn't as good as people think.
- qwytw 4y ago
  Before refrigeration salt was the most popular method of preserving food, so do we really consume that much more of it compared to people who lived in the past?
  - ceejayoz 4y ago
    Much of the diet would've still been grains, tubers, dried beans, etc.

mikeyouse 4y ago

We can shortcut a bunch of pedantic arguments by just reading their conclusion; > In ambulatory patients with heart failure, a dietary intervention to reduce sodium intake did not reduce clinical events. Ambulatory = walking around, e.g. not hospitalized. The patients were already diagnosed with chronic heart failure and were followed for a year to see if a low-sodium diet would prevent further cardiac events. There wasn't statistical evidence that the low-sodium diet did so. Tada!

DoingIsLearning 4y ago
But if they are outpatients is there any guarantee that they were even sticking to a low sodium diet in the first place?
- Ensorceled 4y ago
  So you are saying they are lying in the title when they say "randomised, controlled trial"?
  - DoingIsLearning 4y ago
    You can still have an RCT with self-reported data. The issue being that self-reported is not always accurate.
- mikeyouse 4y ago
  They followed the diets and measured intake -- the low sodium group was instructed to stay under 1,500mg/day -- they didn't quite get there but had substantially lower sodium intake as compared to the 'control'. The study group decreased median sodium intake by 27% compared to the 'control' group who decreased intake by 2%. There's always a issue of 'the human element' in studies like this where people lie and don't follow instructions but claim they did, but good study design and follow-through typically minimize those issues. > Between baseline and 12 months, the median sodium intake decreased from 2286 mg/day (IQR 1653–3005) to 1658 mg/day (1301–2189) in the low sodium group and from 2119 mg/day (1673–2804) to 2073 mg/day (1541–2900) in the usual care group.

rob_c 4y ago

Well given a lot of claims about sodium and heart failure seem hyped we shouldn't be surprised. Don't know of its my opinion of the field or the journal but i don't rate the lancet highly after digging into most higher profile papers.

newbamboo 4y ago
“Don't know of its my opinion of the field or the journal but i don't rate the lancet” Lol. It’s every field! Unless you live under a rock you’ve heard terms like p hacking, publication bias, publish or perish and in and on. All a manifestation of the glaring problems in higher education. If you uniquely don’t trust the lancet, you’re doing it wrong. Be skeptical of all research until it’s been replicated a bunch, ideally by your own research team.

Herodotus38 4y ago

This study looked at a stricter sodium goal than is typically advised (<1500 mg/day). Usually I counsel pts on less than 2000 mg a day which is what the control group targeted and seemed to achieve. This study is useful in that it shows being more restrictive isn’t necessary, but those with heart failure should still try to avoid excess salt. It is very easy to hit double the recommended intake with a typical American diet. The average American salt intake is about ~3400 mg/day from some studies. Edit: after reading some of the replies I think there’s confusion about who the target population is in this study: it’s people who already have heart failure. I could have added in my comments that I was also referring to ppl with heart failure.

voyagerfoil 4y ago
Agreed. The title of the post is misleading. A strict restriction of sodium versus usual care (a recommended low sodium diet) was tested. There was no benefit to a strict low sodium diet. As a cardiologist, it doesn't not change my advice regarding usual care -- recommending a low sodium diet in patient with heart failure.
JoeAltmaier 4y ago
Isn't that just clinging to the old advice without evidence? This study shows it has no effect. A lesser restriction would logically also have no effect. Let's give up on the old urban legend that salt has f-all to do with heart health.
- Ensorceled 4y ago
  > A lesser restriction would logically also have no effect. How can you "logically" come to that conclusion?
- taylodl 4y ago
  Salt raises blood pressure. That's just simple chemistry. High blood pressure causes all sorts of problems. That's medicine.
  - 4y ago

apollodorus 4y ago

xyzzy21 4y ago

Yep. This is NOT the first study generally disproving a link between sodium and CVD. Sodium is NOT the horrible evil it's portrayed as. What is actually problematic is, if anything, an imbalance with potassium and sometimes calcium and/or magnesium.

pc86 4y ago
> This is NOT the first study generally disproving a link between sodium and CVD. That's a weird way to phrase it because this study has nothing to do with cardiovascular disease generally. It's specifically about non-hospitalized patients already diagnosed with heart failure. This does nothing to disprove the very clear link between sodium intake above a certain level and heart disease in a previously healthy individual.
- JumpCrisscross 4y ago
  > the very clear link between sodium intake above a certain level and heart disease in a previously healthy individual Is this actually well established? I’ve seen so many “war on salt” articles that I’d assumed it was still debated.
  - rabuse 4y ago
    No, it is not. It's difficult to correlate CVD to high sodium intake when the majority of people in the U.S. are overweight/obese, and is the largest factor in CVD.
- newbamboo 4y ago
  “link between sodium intake above a certain level and heart disease in a previously healthy individual” I know this is common knowledge but could you provide any recent studies or citations for curious readers? Anything from the past 5 years? I could never understand how they factor in body weight and physical activity, which should change the recommended levels. Someone who sweats a lot because of intense exercise might need sodium above that limit. Or if you drank more water than average, etc…
4y ago

adrian_b 4y ago

I have read this study and it is much less meaningful than the title would suggest. They have compared a diet with a sodium intake close to the lower limit of the recommended intake, with a diet including an even lower sodium intake, slightly less than normally recommended. A daily sodium intake in a relatively wide range around the recommended daily intake (which is of about 4 to 6 grams of salt per day) is not expected to cause any differences, so the results of the study are not surprising. The recommendation to eat less salt is only for the people who eat mostly industrially-processed food, which always includes excessive quantities of salt and sugar, because they are among the cheapest ingredients, while enhancing the taste of the food. Such people typically eat 2 to 3 times more salt than recommended, and only for them it may be expected that lowering the sodium intake can reduce the risk of diseases. However, lowering the sodium intake is not easy for them, because they must begin to eat something different, since the excessive salt is not added by them to the food. Otherwise, lowering the salt intake much under 4 grams per day is a serious risk, especially for older women, and especially when they also take medication against high blood pressure. Hyponatremia, i.e. having a too low sodium content in the body, manifests initially with symptoms like muscular weakness, constipation, lack of appetite and problems with the equilibrium, which may result in falls. Such symptoms may be difficult to distinguish from just consequences of old age. If hyponatremia is not diagnosed in time, the consequences can be extremely severe, including the loss of life.

btilly 4y ago
You missed the biggest point. Not only was the difference in salt not much, but they would have to have reduced adverse events (eg repeat heart attacks) by over 20% to have had decent odds of detecting it with their actual sample size. So the real conclusion is that a modest reduction of salt from the recommended low levels likely does not drop the odds of a repeat heart attack by more than 20%. This is a very, very long ways from the headline that lowering sodium doesn't help heart patients. And yet, this crap passes as science???
- oldgradstudent 4y ago
  > And yet, this crap passes as science??? Have you ever looked at the papers that support the hypothesis that lowering salt consumptions helps heart patients?

everybodyknows 4y ago

To the broader topic of health information going wrong, at the top of the Lancet page I see an ad for Hydroxychloroquine Sulfate. Anyone else? I'm in western US.

antonvs 4y ago
I see that, although it links directly to an 18 page pdf of prescribing information (which includes no mention of COVID.) Maybe satisfying some sort of legal notification requirement?

alexk307 4y ago

Is it possible that salt intake is just correlated to heart disease because the real foods causing heart disease (highly processed foods with refined vegetable oils, sugar, preservatives, etc.) are loaded with salt? Anecdotally, I put salt in everything I cook - sometimes to the point where others find it salty. My blood pressure has always been firmly in the healthy range (low 30s Male).

stephen_g 4y ago
As others have said, this study is comparing a very low salt diet to a recommended level of salt diet, and only in people who already have pre-existing cardiac issues. Apparently the average American has a diet that has 1.5 times the recommended level, so what this study is looking at isn’t anything like that, let alone an even higher-salt diet. So you can’t take the study as saying anything about preventing heart disease generally. The one conclusion you perhaps could extrapolate from it is to say that the recommended limit is probably pretty good since it doesn’t seem to help going lower.
- bluGill 4y ago
  Even then, the study would only detect large charges in effect, if someone claims the lower salt is 10% better the study wouldn't refute that.
snarf21 4y ago
Yes, it is like a co-morbidity. These are factors that amplify each other. Salt is likely fine if you don't have kidney or liver issues. However, heavy salt on top of trans fats and high sugar and .. and .. and .. is likely hard on our body.
chasebank 4y ago
You're probably right. I don't have a source but I vaguely remember reading about how salt is no different than fat or cholesterol in terms of how it correlates to your body. Fat does not make you fat. Cholesterol doesn't raise your cholesterol. Salt doesn't raise your sodium levels. Excess calorie consumption combined with lots of fat (high in calories), will indeed, make you fat. Excess calorie consumption combined with lots of cholesterol, will raise cholesterol levels. Salt is no different. This is an interesting read about salt from a 2011 article. "Intersalt, a large study published in 1988, compared sodium intake with blood pressure in subjects from 52 international research centers and found no relationship between sodium intake and the prevalence of hypertension. In fact, the population that ate the most salt, about 14 grams a day, had a lower median blood pressure than the population that ate the least, about 7.2 grams a day." [1] https://www.scientificamerican.com/article/its-time-to-end-the-war-on-salt/ https://www.scientificamerican.com/article/its-time-to-end-t... EDIT: The above referenced article has been discussed here on HN a few times over the years for anyone who wants to read previous comments. [2] https://hn.algolia.com/?q=end+war+on+salt https://hn.algolia.com/?q=end+war+on+salt

loa_in_ 4y ago

I'm not an expert by any means, but I thought it is common sense that what really matters is to have equivalent sodium and chloride ion counts ( or their equivalents ), because in nature one would basically never deviate from this. In modern times we do, relatively a lot.

01100011 4y ago

It's good to remember that highly salted foods are associated with stomach cancer: https://www.frontiersin.org/articles/10.3389/fnut.2021.801228/full#:~:text=The%20findings%20of%20this%20study,processed%20meat%20intakes%20were%20not https://www.frontiersin.org/articles/10.3389/fnut.2021.80122.... This explains the higher incidence of stomach cancer in many E. Asian countries. Stomach cancer is the fourth most common cancer last time I checked.

carlmr 4y ago
But this is probably not the salt's fault, it's only that bacon and pickled food is salty.

smm11 4y ago

Salt isn't bad. Sugar is.

wtetzner 4y ago
And too much linoleic acid.

mech987 4y ago

I wonder if the commonly thought of causation relationship for sodium and health problems is inverted. Speculatively, i.e... your body has a greater need to use the sodium-potassium pump more when you're stressed, which makes you crave salt, and eat more sodium. The high stress is what causes bad health outcomes, the high sodium levels just happen to correlate with it.

throw8383833jj 4y ago

I think a lot of people don't realize that the impact of sodium and other "bad stuff for you" varies from person to person. Only 25% of the population is subject to high blood pressure as a result of high sodium intake. So, if you create an experiment that can subtly select for the 75% of the population doesn't experience high blood pressure, then you can show that sodium doesn't raise it. I don't if that's what's going on here but a lot interested parties will try to go this route in order to show that salt is harmless.

apolymath 4y ago

nradov 4y ago

The issues with sodium intake are caused more by high osmolality than by absolute quantity. We can't tell if a particular patient's sodium consumption is too high without also knowing their fluid intake. https://peterattiamd.com/rickjohnson2/ https://peterattiamd.com/rickjohnson2/ Genetics are also a huge factor.

randcraw 4y ago

I can't read the article, but it's my impression that high sodium isn't as much a threat to general health as increased BP is. I'd like to know what sodium reduction did for BP, and how much the two groups then differed. If the goal for patients is not reduction of BP, then the presumption of this study is that sodium is affecting the heart and vessels in more complex ways than pressure alone, and such patients might suffer in a diverse multitude of complex ways that are much harder to attribute directly to the level of sodium. The authors' conclusion seems to be only that the correlation between sodium intake and death in heart patients is not simple and linear.

nycbenf 4y ago

Seems like a lot of people are missing the fact that is study of people with heart failure not a study of otherwise healthy people. The study is decreasing sodium intake even further from the current guideline for patients with heart failure. The effect of sodium intake is very different for people who need to maintain very tight tolerances to survive. And a ton of effort is spent keeping people with heart failure out of the hospital. I have heart failure and have an implant that measures electrical conductivity of heart tissue and will warn if I am approaching fluid overload due to too much sodium.

8f2ab37a-ed6c 4y ago

It's frustrating that on one hand you want to hit a decent amount of sodium per day for the optimal operation of one's body, while at the same time if you go over 2500mg of sodium per day, you increase the likelihood of building kidney stones.. there's no way to win, from what I can tell. Is there a trick here or is that just the way the human body is built, and that's that?

PuppyTailWags 4y ago
Lots of water?
- 8f2ab37a-ed6c 4y ago
  I think that helps? I haven't run into studies showing the ideal water-to-sodium intake ratio, but that could be pretty useful.
  - PuppyTailWags 4y ago
    My understanding is that the human body is so complicated and so individual that very few things can be systemized like that unfortunately. Maybe if there are biomarkers to indicate specific people should have specific ratios??? I don't know.

1-6 4y ago

Womp womp womp

andy_ppp 4y ago

I'm going to make a bet the sodium intake is correlated with calorie consumption which is why these studies all find it so difficult to figure out why salt sometimes seems to cause similar issues to high calorie diets. Let's be honest here, if you eat a bowl of food with no salt on it you will get bored and find the food hard to finish.