Reducing Salt Intake Might Harm
Heart Failure Patients, Study Claims
February 08, 2016
Story at-a-glance
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Heart failure patients following a low-sodium diet were
85 percent more likely to die or require hospitalization
for heart disease compared to those who didn’t restrict
their salt intake.
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Among those restricting their sodium intake, 42 percent
died or were hospitalized for heart problems during the
study, compared to 26 percent of those with no salt
restrictions
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Restricting salt may backfire by causing a reduction in
fluid that triggers hormones to try to retain body
fluids, accelerating heart failure
By Dr. Mercola
Close to 6 million Americans have heart failure while more than
870,000 cases are diagnosed each year. If you have heart failure, it
means your heart isn’t pumping as well as it should be and, as a
result, your body is probably not getting enough oxygen. In other
words, you have a weak heart.
Once-simple activities, like walking or carrying groceries, may
become difficult, and you may also experience fatigue, shortness of
breath, fluid build-up and coughing.1
Because heart failure is associated with fluid build-up, a
low-salt diet is typically recommended. Excess sodium may cause your
body to retain water and, so the conventional thinking goes, may
worsen the fluid build-up associated with heart failure.
This dietary dogma is touted as fact, but in reality you may want
to think twice about slashing your salt intake if you have heart
failure, as new research has linked it with an increased risk of
death.
Cutting Down Salt Intake Might Worsen Health of Heart Failure
Patients
Researchers from Rush University Medical Center in Chicago
followed more than 800 heart failure patients for an average of
three years. Both their health status and salt intake were analyzed.2
It turned out that those following a low-sodium diet were 85
percent more likely to die or require hospitalization for heart
disease compared to those who didn’t restrict their salt intake.3
Among those restricting their sodium intake, 42 percent died or
were hospitalized for heart problems during the study, compared to
26 percent of those with no salt restrictions.
The researchers concluded, “In symptomatic patients with chronic
HF [heart failure], sodium restriction may have a detrimental impact
on outcome.”4
It’s possible that restricting salt could backfire by altering a
person’s fluid volumes. Lead researcher Dr. Rami Doukky told Medical
Xpress:5
“The idea is sodium restriction leads to a contraction of
the fluid volume in the body, and that turns on certain hormones
which try to retain fluids in the body and may potentially
accelerate the heart failure process."
Heart Benefits of Salt Restriction Increasingly Questioned
The heart benefits of restricting salt intake have been
questioned for some time. In 2011, a systematic review of data
involving 6,500 people also found evidence was lacking to recommend
salt restriction.6
Among people with high blood pressure or normal blood pressure,
salt restriction was not significantly associated with overall
mortality or cardiovascular mortality. Among those with congestive
heart failure, meanwhile, salt restriction was associated with
increased mortality risk.
An update to the review, published in 2014, also found “there is
insufficient power to confirm clinically important effects of
dietary advice and salt substitution on cardiovascular mortality”
among people with high blood pressure or normal blood pressure.7
Yet another meta-analysis found that people with heart failure
who limited their sodium intake had a 160 percent higher risk of
death than those who did not.8
Some studies have shown a modest benefit to salt restriction
among some people with high blood pressure, but the
evidence does not extend to the rest of the population. So what’s
really going on?
For starters, there’s a huge difference between natural salt and
the processed salt added to processed foods and salt shakers in most
homes and restaurants. The former is essential for good health,
whereas the latter is best avoided altogether.
Sally Fallon Morell, president of the Weston A. Price Foundation,
stated:9
"A study from 1991 indicates that people need about one
and one-half teaspoons of salt per day.
Anything less triggers a cascade of hormones to
recuperate sodium from the waste stream, hormones that make
people vulnerable to heart disease and kidney problems. This is
proven biochemistry.”
Too Little Salt May be Dangerous
The U.S. Food and Drug Administration (FDA) and the Food Safety
Inspection Service (FSIS) recommend limiting your daily sodium
intake to less than 2,300 milligrams (mg).
They advise a further reduction to 1,500 mg (just over one-half
teaspoon) for people who are age 51 and older, African-American, or
who have hypertension, diabetes or chronic kidney disease (this
encompasses about half of the U.S. population).
However, there are very real risks from eating too little salt,
and population-wide recommendations to restrict salt intake to very
low levels could in fact increase rates of a wide range of
diseases.
For instance, in one study a low-salt diet led to an increase in
insulin resistance, which is a risk factor for type 2 diabetes — and
the change occurred in just seven days.10
Research published in JAMA also found that consuming less than
3,000 mg of sodium per day may increase your risk of dying from
heart disease.11
A low-sodium diet is even linked to increases in LDL cholesterol
and triglycerides,12
and an increased risk of death for diabetics (another population
that’s often advised to restrict their sodium intake).13
There’s also hyponatremia, in which your body has too little
sodium, causing fluid levels to rise and your cells to swell.
Hyponatremia is most common in older adults and athletes (whose
sodium levels may become depleted by excessive sweating and drinking
too much water).
This swelling can cause a number of health problems, from mild to
severe. At its worst, hyponatremia can be life threatening, leading
to brain swelling, coma and death.
But mild to moderate hyponatremia has more subtle effects that
you or your health care provider may not even connect with a
sodium-deficiency problem, including:
Nausea, vomiting, and changes in appetite |
Headache |
Confusion |
Hallucinations |
Loss of energy |
Fatigue |
Urinary incontinence |
Nervousness, restlessness and irritability, and other mood
changes |
Muscle weakness, spasms or cramps |
Seizures |
Unconsciousness |
Coma |
Your Sodium:Potassium Ratio
Another factor that can have a significant impact on whether salt
will harm or help your health is the ratio between the salt and
potassium in your diet.
Your body needs
potassium to maintain proper pH levels in your body fluids, and
it also plays an integral role in regulating your blood pressure.
It’s possible that potassium deficiency may be more responsible for
hypertension (which is a risk factor for heart disease) than excess
sodium.
Imbalance in your sodium:potassium ratio can lead to
hypertension, and the easiest way to achieve this imbalance is by
consuming a diet of processed foods, which are notoriously low in
potassium while high in sodium.
Processed foods are also loaded with
fructose, which is clearly associated with increased
hypertension risk, as well as virtually all chronic diseases. This
may also explain why high-sodium diets appear to affect some people
but not others.
According to a 2011 federal study into sodium and potassium
intake, those at greatest risk of cardiovascular disease were those
who got a combination of too much sodium along with too
little potassium.14
According to Dr. Elena Kuklina, one of the lead authors of the
study, potassium may neutralize the heart-damaging effects of salt.
Tellingly, those who ate a lot of salt and very little potassium
were more than twice as likely to die from a heart attack as those
who ate about equal amounts of both nutrients.
While potassium is found in many foods commonly consumed in the
U.S. – including fruits, vegetables, dairy products, salmon,
sardines, and nuts – only 2 percent of U.S. adults get the
recommended daily amount of 4,700 mg.15
The easiest way to achieve an imbalance in your
sodium-to-potassium ratio is by consuming a diet of processed foods,
which are notoriously low in potassium while high in processed salt.
According to the FDA, 77 percent of Americans sodium intake comes
from processed and restaurant foods; when you reduce processed foods
in your diet, you’ll automatically reduce your intake of processed
salt as well.
How to Improve Your Sodium-Potassium Ratio
If you eat a lot of
processed foods and not many vegetables, there’s a good chance
your sodium-to-potassium ratio is unbalanced. If you’re not sure,
try a free app like My Fitness Pal, which allows you to enter the
foods you eat and then calculates the ratio automatically.
It's generally recommended that you consume five times more
potassium than sodium, but most Americans get two times more sodium
than potassium. If your ratio is out of balance:
- Ditch all processed foods, which are very high in processed
salt and low in potassium and other essential nutrients
- Eat a diet of whole, unprocessed foods, ideally organically
and locally grown to ensure optimal nutrient content. This type
of diet will naturally provide much larger amounts of potassium
in relation to sodium
- When using added salt, use a natural salt. I believe
Himalayan salt may be ideal, as it contains lower sodium and
higher potassium levels compared to other salts16
It can be difficult to get enough potassium from diet, but the
best way to do so is to increase the amount of vegetables you
consume. Green vegetable
juicing is an excellent way to ensure you’re getting enough
nutrients for optimal health, including about 300 to 400 mg of
potassium per cup. Some additional rich sources of potassium are:
- Lima beans (955 mg/cup)
- Winter squash (896 mg/cup)
- Cooked spinach (839 mg/cup)
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Avocado (500 mg per medium)
Other potassium-rich fruits and vegetables include:
- Fruits:
papayas, prunes, cantaloupe, and bananas. (But be careful of
bananas as they are high in sugar and have half the potassium of
an equivalent amount of green vegetables. It is a myth that you
are getting loads of potassium from bananas; the potassium is
twice as high in green vegetables)
- Vegetables: broccoli, Brussels sprouts,
avocados,
asparagus, pumpkin, Swiss chard, and beet greens
Top Tips to Prevent Heart Failure and Other Heart Problems
There are many strategies that can protect your heart no matter
what your age. Please don't wait until you experience
heart attack symptoms or heart failure to take action because by
then it may be too late. Do so now in order to prevent any
long-lasting damage:
- Eat unprocessed saturated animal fats, and ignore the media,
as you will benefit from these fats. Many may also benefit from
increasing the healthy fat in their diet to 50 to 85 percent of
daily calories.
- Avoid sugars, including processed fructose and grains if you
are insulin and leptin resistant. It doesn't matter if they are
conventional or organic, as a high-sugar, high-grain diet
promotes insulin and leptin resistance, which is a primary
driver of heart disease.
- Minimize your intake of salt from processed foods and
instead use natural Himalayan salt to flavor your real
food.
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Exercise regularly. People who engage in at least 150
minutes of moderate exercise, or 75 minutes of vigorous exercise
a week, had a 33 percent lower risk of heart failure than
inactive people.17
Use a combination of
high-intensity interval training, strength training,
stretching, and core work.
- Avoid excess sitting; aim for three hours a day or less of
sitting and try to take 10,000 steps a day (in addition to your
exercise program).
- Regularly
walk barefoot to ground with the earth. When you do, free
electrons are transferred from the earth into your body; this
grounding effect is one of the most potent antioxidants we know
of and helps alleviate inflammation throughout your body.
- Manage your stress daily. One of my favorite tools for
stress management is the
Emotional Freedom Technique (EFT).
© Copyright 1997-2016 Dr. Joseph Mercola. All Rights Reserved.
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