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28/03/2006

Cutting salt could cut your life

            - 37% increased risk of death from heart disease says new study

Leading health expert, Dr Hillel Cohen, and colleagues from the Albert Einstein College of Medicine in New York, including Dr Michael Alderman, president of the International Society of Hypertension, have just completed one of the largest follow-up studies into the effects of salt intake on the risk of heart attack and stroke. The results, published in the American Journal of Medicine, will be unveiled by Dr Cohen at a medical convention in San Francisco which runs from 1st – 5th April.

Some 13 years after the nutritional habits of over 7,000 US citizens were recorded for the National Health and Nutrition Examination Surveys, there have been 1,343 deaths, including 541from cardiovascular disease. Peoplewho reported eating less salt than is recommended by US or UK government guidelines were 37 per centmore likely to die from cardiovascular causesthan those who ate more. It raises major questions over the safety of the current UK policy to encourage population-wide salt reduction.

Researchers say that the findings fall short of proving that restricting sodium is bad for your health. But they say the proof that lower salt diets protect against death from heart and artery disease has also not emerged. Dr Cohen echoes a string of experts (see notes to editor) in questioning blanket salt restriction advice given by both the UK and US governments.  “It is increasingly evident that one size doesn’t fit all when it comes to diet,” he says. “This was an observational study, and not a clinical trial, so we can’t really conclude from our findings that low-sodium intakes are harmful. But our study certainly doesn’t support the idea of a universal prescription for lower salt intake.

Under US government nutrition guidelines, adults should limit their daily sodium intake to 2.3 grammes, which is equivalent to under 6 grammes of salt, and roughly the same as the UK guideline. But this study shows that, even after adjusting for total calorie intake, age, and smoking status, people who had less than the recommended daily salt intake were significantly more likely to have died from cardiovascular causes than people who ate more salt.

Although the link between a lower salt diet and a higher risk of death was not seen among non-whites, obese persons, and those under the age of 55 when enrolled in the study, no single sub-group appeared to benefit from eating a diet that was lower in sodium. Cohentheorises that low-sodium diets raise the kidney's levels of renin, a protein involved with increasing blood pressure when sodium levels are low.

ends

Notes to editor

1. The Salt Manufacturers' Association is the trade association representing UK manufacturers of salt, including domestic salt, catering salt, water-softening salt, industrial salt and de-icing salt.
2. A string of experts across the world have questioned the UK government’s blanket advice, including:

• Immediate past president of the European Hypertension Society, Professor Tony Heagerty
• Nutrition expert, Dr David McCarron, whose research suggests that mineral deficiency, rather than salt consumption, is one of the most important influences upon high blood pressure
• Professor Ron Maughan, sports scientist, Loughborough University. Researched sweating tendencies of footballers at premierclubs and found that some could lose upto 20g of sodium in a day's training.
• Leading British physiologist, Professor Bill Keatinge, has found that, in unacclimatized elderly subjects, the risk of heart attack or stroke is increased by salt depletion during a heatwave. He suggests that they should be strongly advised not to reduce their salt intake in summer or when holidaying in warmer climates.
• Professor Ingo Fusgen, University of Witten-Herdecke in Germany. Studies show that up to 10 per cent of older people suffer from sodium deficiency.
• Professor Deiderick Grobbee, cardiovascular specialist from the Netherlands and author of the Rotterdam. Tested 8,000 people in their 50s+ and found that as long as their salt intake wasno more than 16g a day, there was an insignificant effect on blood pressure.
• Six Canadian medical groups rejected a recommendation for universal salt restriction, instead making lifestyle recommendations for reducing blood pressure such as exercising, eating a balanced diet, and stress management.