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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

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 5y 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 5y 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 5y ago
  > A lesser restriction would logically also have no effect. How can you "logically" come to that conclusion?
- taylodl 5y ago
  Salt raises blood pressure. That's just simple chemistry. High blood pressure causes all sorts of problems. That's medicine.
  - bluGill 5y ago
    > Salt raises blood pressure Which is why your body has means to get rid of salt. > That's just simple chemistry sure, but biology is what we are talking about here, and biology is more complex.
  - electrondood 5y ago
    The ratio of sodium to potassium is what matters for blood pressure, not sodium intake.
  - JoeAltmaier 5y ago
    Eating a lot of salt raises it a point or two for an hour or so. Let's get our 'simple chemistry' right.
  - ek750 5y ago
    I feel that this sort of simplification is common to our mis-understanding of health and nutrition. I also heard similar myths like: Calories in = Calories out, you are what you eat (meaning if you eat high fat you'll gain fat), etc. Can you explain why you think salt raises blood pressure?
    - mikeyouse 5y ago
      It's a very well understood effect -- as your body absorbs salt, it also retains more water to maintain osmotic pressure. This additional fluid in your circulatory system necessarily causes your blood pressure to increase. That's the very simple chemistry behind salt increasing blood pressure. The biology is more complex and the effect isn't necessarily long lasting or linear, but there is indeed a direct relationship between sodium intake -> blood pressure.
      - JoeAltmaier 5y ago
        It would seem to make sense, until biology gets in the way. Mammals have several exquisite mechanisms for regulating sodium. Unless you're very sick, they work fine. So there is no 'direct' relationship at all.
- mannykannot 5y ago
  It seems the control group was following the current advice while the experimental group went beyond it, which would mean this study has nothing to say about the efficacy of the former.
capitainenemo 5y ago
I don't know much about this subject, but this information has been on the wikipedia page for years. https://en.wikipedia.org/wiki/Health_effects_of_salt#Dietary_recommendations https://en.wikipedia.org/wiki/Health_effects_of_salt#Dietary... As of 2009 the average sodium consumption in 33 countries was in the range of 2,700 to 4,900 mg/day. This ranged across many cultures, and together with animal studies, this suggests that sodium intake is tightly controlled by feedback loops in the body. This makes recommendations to reduce sodium consumption below 2,700 mg/day potentially futile.[39] Upon review, an expert committee that was commissioned by the Institute of Medicine and the Centers for Disease Control and Prevention reported that there was no health outcome-based rationale for reducing daily sodium intake levels below 2,300 milligrams, as had been recommended by previous dietary guidelines; the report did not have a recommendation for an upper limit of daily sodium intake.[27][40] There's also this: https://en.wikipedia.org/wiki/Health_effects_of_salt#Dietary_reduction https://en.wikipedia.org/wiki/Health_effects_of_salt#Dietary... Studies found that excessively low sodium intake, below about three grams (3,000 mg) of salt per day, is associated with increased mortality and higher risk for cardiovascular disease.[6][7] But.. maybe it depends on the population. I know that if you're outside in the heat, insufficient salt is far more dangerous.
rhinoceraptor 5y ago
If the goal is lowering blood pressure, why would you put people on an insane low salt diet instead of a low carb diet?
- Herodotus38 5y ago
  The measured goal in the study was to reduce heart failure exacerbations, which included ER visits and admissions to the hospital, not blood pressure per se.
- carlmr 5y ago
  Low carb diets can be really unhealthy for your heart. Sure if you do low carb with mostly salad you're probably fine. But many people start eating red meat, bacon and other things that cause heart disease.

voyagerfoil 5y 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 5y 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 5y ago
> A lesser restriction would logically also have no effect. How can you "logically" come to that conclusion?
taylodl 5y ago
Salt raises blood pressure. That's just simple chemistry. High blood pressure causes all sorts of problems. That's medicine.
- bluGill 5y ago
  > Salt raises blood pressure Which is why your body has means to get rid of salt. > That's just simple chemistry sure, but biology is what we are talking about here, and biology is more complex.
- electrondood 5y ago
  The ratio of sodium to potassium is what matters for blood pressure, not sodium intake.
- JoeAltmaier 5y ago
  Eating a lot of salt raises it a point or two for an hour or so. Let's get our 'simple chemistry' right.
- ek750 5y ago
  I feel that this sort of simplification is common to our mis-understanding of health and nutrition. I also heard similar myths like: Calories in = Calories out, you are what you eat (meaning if you eat high fat you'll gain fat), etc. Can you explain why you think salt raises blood pressure?
  - mikeyouse 5y ago
    It's a very well understood effect -- as your body absorbs salt, it also retains more water to maintain osmotic pressure. This additional fluid in your circulatory system necessarily causes your blood pressure to increase. That's the very simple chemistry behind salt increasing blood pressure. The biology is more complex and the effect isn't necessarily long lasting or linear, but there is indeed a direct relationship between sodium intake -> blood pressure.
    - JoeAltmaier 5y ago
      It would seem to make sense, until biology gets in the way. Mammals have several exquisite mechanisms for regulating sodium. Unless you're very sick, they work fine. So there is no 'direct' relationship at all.
mannykannot 5y ago
It seems the control group was following the current advice while the experimental group went beyond it, which would mean this study has nothing to say about the efficacy of the former.

capitainenemo 5y ago

I don't know much about this subject, but this information has been on the wikipedia page for years. https://en.wikipedia.org/wiki/Health_effects_of_salt#Dietary_recommendations https://en.wikipedia.org/wiki/Health_effects_of_salt#Dietary... As of 2009 the average sodium consumption in 33 countries was in the range of 2,700 to 4,900 mg/day. This ranged across many cultures, and together with animal studies, this suggests that sodium intake is tightly controlled by feedback loops in the body. This makes recommendations to reduce sodium consumption below 2,700 mg/day potentially futile.[39] Upon review, an expert committee that was commissioned by the Institute of Medicine and the Centers for Disease Control and Prevention reported that there was no health outcome-based rationale for reducing daily sodium intake levels below 2,300 milligrams, as had been recommended by previous dietary guidelines; the report did not have a recommendation for an upper limit of daily sodium intake.[27][40] There's also this: https://en.wikipedia.org/wiki/Health_effects_of_salt#Dietary_reduction https://en.wikipedia.org/wiki/Health_effects_of_salt#Dietary... Studies found that excessively low sodium intake, below about three grams (3,000 mg) of salt per day, is associated with increased mortality and higher risk for cardiovascular disease.[6][7] But.. maybe it depends on the population. I know that if you're outside in the heat, insufficient salt is far more dangerous.

rhinoceraptor 5y ago

If the goal is lowering blood pressure, why would you put people on an insane low salt diet instead of a low carb diet?

Herodotus38 5y ago
The measured goal in the study was to reduce heart failure exacerbations, which included ER visits and admissions to the hospital, not blood pressure per se.
carlmr 5y ago
Low carb diets can be really unhealthy for your heart. Sure if you do low carb with mostly salad you're probably fine. But many people start eating red meat, bacon and other things that cause heart disease.