How about eating lots of vegies and going low-fat? According to the Dietary Approaches to Stop Hypertension study (see "A Clinical Trial... " in the bibliography), you can get dramatic reductions without worrying much about sodium.
However, before we get too carried away, let's remember that this is one study, conducted in an elaborate manner. Meals, for example, were prepared for the subjects.
A follow-up study
will compare three levels of sodium intake to the high-vegie, low-fat
DASH diet, Whelton says. He cautions that while the DASH improvement does
seem impressive, the study has not been repeated yet.
A second idea is to broaden the focus from sodium to other minerals, primarily potassium. "Everything we are learning about potassium shows that it's the converse of sodium," says Whelton. "It seems to protect blood vessels in animals, and epidemiology shows that a higher intake is associated with a better cardiovascular outcome," meaning fewer heart attacks and strokes.
The evidence in people with normal blood pressure "does not support the current recommendation for a universal dietary sodium restriction," says Logan. But practically speaking, one size may need to fit everybody. If roughly one-third of the population must eat a low-sodium diet to be healthy, and if upwards of 75 percent of sodium is coming from processed foods, then the choices for improving public health are:
We promised we'd not be able to sort out the salt. If, as the skeptics contend, the salt bogeyman has been overblown, it's time to back off and issue fewer, and more circumspect recommendations. "This may be a thing in human life where we don't know what to do," says Alderman. "I don't think there's any need or basis for saying that one size of sodium intake will fit the entire U.S. population."
But Rocella and the other anti-salt campaigners observe that while only a minority of the population needs to cut salt, they can't do that given the preponderance of salt in processed foods.
Manufacturers, he says, must start cutting down on sodium in their products, even though only a minority will benefit. Air bags and seat belts offer a comparable public-health benefit: "On the way home from work today, some people will have an accident. We can't predict who...but we ask people as a public-health interest to wear a seat belt anyway."
As we said, when it comes to salt and health, you pays your money and you takes your choice. If you have a medical reason to reduce your blood pressure, it makes a lot of sense to find out whether reducing your salt intake will help. If you have no medical reason to worry about blood pressure, you at least understand why so many people are calling for lower salt in processed foods.
And whether or not you have hypertension, you have a better understanding why, in the world of epidemiology, 2 plus 2 can equal 5.
What's shakin' in the saline science bibliography?
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