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March 26, 2009

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Don

Our taste buds are addicted to salt and winning the battle will be hard. The salt-free taste of victory will be sweet! - Thanks Anna

Richard L. Hanneman

Anna,

Here's the Salt Institute's take:

1. CDC is certainly right that a miniscule number of Americans consume what they consider the "correct" amount of salt. For the past century, Americans have consumed salt in the 2,300 mg to 4,600 mg/day Na average -- average in the world, by the way.

2. CDC is right that salt is related to blood pressure and that if the population could reduce its salt intake to a 1,500 mg/day Na level, population blood pressure would likely decline by several mmHg systolic.

3. CDC is silent as to the health outcome of this intervention. Small wonder since the available evidence -- until late last year, all observational studies -- shows no health improvement on low salt diets. How can that be? When a person reduces salt, multiple things happen in the body. Blood pressure may change (about one-third of the population would reduce blood pressure and about one-quarter would actually INCREASE blood pressure). More importantly -- and totally ignored by CDC -- is that low-salt diets trigger other changes. Insulin resistence increases on low-salt diets (a risk factor for diabetes and metabolic syndrome), sympathetic nervous system activity increases and low-salt diets stimulate the activity of the renin-angiotensin system and production of aldosterone. These are powerful risk factors for heart attacks. Thus, the theory that low-salt diets would produce cardiovascular benefits has been tested in these -- observational -- studies. Now, two articles have been published reporting the first-ever RANDOMIZED CONTROLLED TRIAL of low-salt diets. The study group was a high-risk group of congestive heart failure patients. Doctors have been recommending as a first intervention for heart failure patients that they be put on low-salt diets. Theoretically, that's the right answer, clinicians have agreed, for the past 50 years. But it was never tested. It has been now. And the verdict is strong and consistent: those on low-salt diets died more quickly and more often and were re-admitted to hospitals for further treatment more frequently. CDC forgot to mention that.

4. CDC also stated with alarm that the current salt intake level is causing great public harm. Readers should compare the gloom and doom of the CDC's release against the CDC data at http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5728a6.htm?s_cid=mm5728a6_e. I always believe the data before I believe theoretical projections of impacts.

5. Finally, CDC calls for reduction in Americans' salt intake as if their recommendation had some chance of success. It doesn't. Research shows that every animal species -- humans included -- consumes salt in a predictable range, if salt is available. Eminent Swedish doctor Bjorn Folkow calls the 2,300 mg to 4,600 mg/day Na intake range the "hygienic safety range." It is also the natural range of population intakes. We now the mechanism is found in the human brain. Salt appetite is hard-wired. It's not a matter of conscious choice, of behavior, even of taste. The body senses how much salt each of us needs and instructs the body to consume additional food until that intake is achieved.

All the medical journal studies supporting the above summary can be found on our website at http://www.saltinstitute.org/Articles-references/References-on-salt-issues.

Thanks for the invitation to contribute to this discussion. We are most anxious that we decide this issue on hard data.

Dick Hanneman
Salt Institute

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