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March 03, 2009

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Miriam Lippel Blum

Great response, Anna. The high sodium levels in so many foods are terrible. People could live healthily with so much less...and still have food that tastes good.

Simon Prince


Amen. I put up a post the other day:

http://nsneph.blogspot.com/2009/02/new-dipstick-to-monitor-sodium-intake.html

This may be a helpful way for patients (who urinate) to monitor their sodium intake.

Don

Have you seen the ads for all natural sea salt?? I actually had a natural food "expert" try to tell me sea salt was much lower in sodium than conventional table salt and much better for you. Well, it does lack iodine and anti caking agents but I'm guessing they failed high school chemistry.

You should go visit www.msgfacts.com sometime for an interesting slant on another harmless food additive.

Miriam Lippel Blum

As long as we're talking about "harmless" food additives, I'd like to bring up the question of pesticides and the like. There are a lot of pesticide residues in our fruits and vegetables. The FDA will say that the levels they allow are safe for normal adults. However, noone has done any studies as to the impact of these chemicals on people who have little or no renal function. WE likely can't eliminate them as well. I personally try to eat organic produce when I can to minimize my exposure and wash everything really well.

Joel Topf

Sodium restriction is just not a very effective therapy. In controlled trials reducing sodium intake by 33% (from 150 mmol to 100 mmol/day) resulted in a decrease in BP of 1.7/0.9. (http://xrl.in/1p24)

Honestly, I'm not going to spend any of my time in the clinic promoting dramatic dietary changes that have such small effects on BP.

When I give dietary advice I'd rather spend my time on phos restriction. If I want to help them with their BP I focus on the DASH diet which is not a sodium restricted diet but a sodium neutral diet.

I agree with you that dialysis patients are different and sodium restriction is essential for blood pressure control. But I don't think that NYC is restricting sodium for the sake of the dialysis patients there.

Anna Bennett

Dr. Topf, your point is well taken, and appreciated. If the Salt Institute had used your rationale in their letter, rather than simply accusing the NYC Health Commissioner of being "foolhardy" (implying that there was danger in a lowering salt in the diet), I might not have called them out... yeah, right, who am I kidding? I am biased. I see the world through the CKD5 lens. When I ride the NYC subway in the morning, I look at people and in my eyes they are one of two types, potential donor or potential dialysis patient.

I agree that the effect of a reduced salt diet so far has had very little study and those studies do raise question. BUT even the DASH diet is sodium neutral (the NYC war is against excessive salt intake). What about the second DASH-Sodium study? They advocate lowering sodium intake.

My point (and I believe the Health Commissioner's point), is that there is too much dietary sodium in processed foods, and people are not aware of it. This is hidden sodium, where education could counteract perceived non-compliance.

Which brings me to another facet of my argument - is this a case of non-compliance or poor education? So often, I see people labeled as non-compliant but the truth is, in our overstressed health care environment there is very little patient education. We here in cyberspace are in a fishbowl. We have a wealth of information at our fingertips - it is our choice to be compliant, as we have the necessary tools and education to make informed choices.

The NYC Health Commissioner is concerned for the 8+ million inhabitants of NYC many who do not have access to education, or access to good medical care. Our emergency rooms are being used as free clinics. In between cardiac arrests and gunshot wounds, our doctors are filling BP prescriptions and writing scrips for a sore throat or a "Please excuse XXX form work, as s/he has been seen for a medical condition" note.

Sadly, public health education has become a moot point. NYC can barely pay its teachers, policemen and firemen. In this economic climate's hierarchy of need, public health education is a luxury that few municipalities can afford. I still think that little effect is better than no effect at all. NYC should have issued a War on Sloth, it would have been fun to watch the reactions. But as it stands, I still applaud the effort of the War on Salt.

Ajlouny

How some fast food restaurants get away with poisoning society with their outrageously high fat, calorie, and sodium content is beyond me. There should be a cap on the amount of these three artery damaging ingredients. Our society's health is suffering.

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