April 21, 2007
Salt Increases Heart Disease Risk

A team at Harvard Medical School have the proof for what you already thought you knew: Yes, eating too much salt really is bad for your heart and cardiovascular system.

Boston, MA- Researchers at Brigham and Women's Hospital (BWH), in an extended follow-up of a randomized trial, found that reducing sodium intake among men and women lowered subsequent risk of cardiovascular disease by 25 percent more than 10 years after the trial ended.

BWH researcher, Nancy Cook, ScD, in a study to be published in the British Medical Journal, expanded upon the most recent findings from the analysis of the Trials of Hypertension Prevention (TOHP)- in which participants, ages 30 to 54 years with high normal blood pressure took part in a sodium intervention during which participants were taught to identify, select and prepare low-salt foods. The study demonstrated that by reducing dietary salt intake, an individual could lower the risk of developing cardiovascular disease 10 to 15 years post-trial. Specifically, participants who were randomized to a sodium lifestyle intervention during the study period experienced a 25 percent decreased risk of cardiovascular disease up to 15 years later. Total mortality was also reduced by 20%, a finding that was consistent, although not statistically significant. This study marks the only randomized sodium intervention that has been followed for later long-term cardiovascular disease risk.

It is not like you didn't already know this. But think of it as a reminder.

Heart disease and cancer are the two biggest killers. Heart disease is far easier to avoid than cancer. Don't smoke. Avoid saturated fats and trans fats. Eat lots of vegetables. Do not use table salt and avoid highly salted prepared foods. Try using vinegar and spices in place of salt. Works for me. Get exercise. How much? More than you are getting now in all likelihood (you long distance runners excepted).

Cancer is the tougher one. Just about all the things you should do for your heart will also reduce your cancer risk (and stop eating carcinogen-laden charbroiled foods - which are bad for your heart anyway). But with a great diet and lifestyle the cancer risk won't go down near as much as the heart disease risk. We really need cures for cancer. Given my diet and weight and blood lipids I do not worry about dying from heart disease. But cancer is something that strikes me as a big dice roll where the odds get higher every year. I'm always a few mutations away from a fatal case of cancer. The sooner it becomes curable the better.

Share |      Randall Parker, 2007 April 21 11:08 AM  Aging Diet Studies

Jake said at April 21, 2007 12:48 PM:

Taking an ace inhibitor will bring your blood pressure more effectively than salt restriction. Plus people are more apt to stick with the pill. Cost is less than $10 a month.

Randall Parker said at April 21, 2007 1:42 PM:


But not everyone who would benefit from salt restriction already has high blood pressure.

If you do not have high blood pressure then eat less salt.

If your cholesterol isn't high enough to justify statins you still should follow a diet that improves your blood lipids.

purenoiz said at April 21, 2007 4:37 PM:

I take it that neither of you has any experience with these drugs. If you did you would realize what a load the pharmaceutical industry is passing off as treatment these days.

MAJOR SIDE EFFECTS — The side effects that do occur are primarily related directly or indirectly to reduced angiotensin II formation. These include hypotension, acute renal failure, hyperkalemia, and problems during pregnancy [5,6]. There are other complications — cough, angioneurotic edema, and anaphylactoid reactions — that are thought to be related to increased kinins since ACE is also a kininase (see below). This is an important distinction clinically because the side effects related to reduced angiotensin II, but not those related to kinins, are also seen with the angiotensin II receptor blockers. (See "Angiotensin II receptor blockers in the treatment of hypertension").

Hypotension — Weakness, dizziness, or syncope may result from an excessive reduction in blood pressure. First dose hypotension, which can be marked in hypovolemic patients with high baseline renin levels, can be minimized by not beginning therapy if the patient is volume depleted and by discontinuing prior diuretic therapy for three to five days. Hypotension can also occur after the initiation of therapy in patients with congestive heart failure [5]. The risk can be minimized by beginning with a very low dose, such as 2.5 mg BID of enalapril. (See "Treatment of hypertension in heart failure").

Statins while not having the severest of side effects, they do profoundly effect the day to day quality of peoples lives. This is manly due to the inhibition of HMG-CoA reductase, which also effects CoQ-10. CoQ10 or Ubiquinol is necessary for the energy levels found inside our cells. I have worked with over a thousand people on statin medications who suffer from myalgia aka muscle pain. Once they start a regimen of CoQ10 they do have typically see a quick turn around in energy, pain etc.

Now how could somebody turn around a nutritionally induced disease such as hypertension? Changing the ratio of K:NA would be a great place to start. Increased consumption of Potassium rich foods with decreased consumption of sodium. Celery seed does a good job as well, oh not to forget those pesky Omega-3's. Hmm, how is is it that things completely essential to human life, that are completely lacking in american's diet, actually benefit or reverse disease states?

Randall Parker said at April 21, 2007 4:54 PM:


Note that I did not advocate drug use in the original post. Yes, some people have problems severe enough to warrant medicine for blood pressure or cholesterol. But for the vast majority I say make like an ape man: Ape Man Diet Lowers Cholesterol And Inflammation Marker. Note the size of cholesterol decline by diet can equal the size from statin usage. Though if you have a genetically caused hypercholesterolemia you might need both drugs and diet.

As for the side effects of statins: Some people (e.g. Steve Sailer) report worse memory to use use of statins. Others suffer muscle problems. Yes, I've read that statins decrease the supply of Coenzyme Q10. I've also read that switching between Crestor, Lipitor, and other statins sometimes lowers the side effects. But try diet first by all means.

As for high blood pressure: If you can't get it down with diet (and not all can) then the drugs seem a good bet. High blood pressure appears to accelerate cognitive decline. So weigh drug side effects against the costs of the disorders that lead to diseases.

purenoiz said at April 22, 2007 4:12 PM:

I am definitely glad to hear that you support diet first. I also remember a food fanatic friend of mine who was studying Latin telling me that Diet was latin for a days work. Dictionary.com says [Origin: 1175–1225; (n.) ME diete I am definitely glad to hear that you support diet first. I also remember a food fanatic friend of mine who was studying Latin telling me that Diet was latin for a days work. Dictionary.com says [Origin: 1175–1225; (n.) ME diete

Blood pressure can have multiple factors needed to lower it. exercise does help. comprehensive diet changes can help, ,not always, but can, the greater a change one makes to their diet the better the result.

Then again we all gotta die, is a stroke the worst way to go? It can be quick, or just be very damaging. I would rather go out quick than suffer like Alzheimer's patients.

maybe I am a bit excessive, I did a 100 mile bike ride today, and I am looking at how I can replace a lot of the electrolytes I lost with out having to pop pills. with out excessive caloric intake.

Rich said at April 24, 2007 3:24 PM:

Like so many newsreports lately, they do not seem to accurately describe the research they are reporting on.

I submit this evidence.


The first group was from the 18-month Trial of Hypertension Prevention I (TOHP I). Its 744 subjects were 30-54 years old at the start of that study, overweight with BMIs of about 27, and had blood pressures of about 125/84. Half had been put on sodium-reduced diets and lowered the sodium in their diet by about 1,011 mg a day — nearly half! The extreme sodium reduction lowered their blood pressures by a mere 1.71/0.8 mmHg. The control group continued with their usual diets after being given guidelines for “healthy eating.”

The second group was from the 4-year TOHP II with 2,382 adults of the same ages, but these men and women were mostly “obese” with BMIs of about 31 and blood pressures of about 127/86. These participants were divided into sodium-reduced diets (similar to the other study), a control group, a weight loss intervention group, and a weight loss with sodium-reduction group. The sodium reduction groups had reduced their sodium intake by about 758 mg a day and reduced their blood pressure by 1.2/0.7 mmHg.

These researchers found that 5-10 years later, those who’d undergone intense education and efforts to reduce their sodium intake had maintained their fear of sodium. Nearly half said they usually or always used low-sodium foods and read labels, and more than a quarter kept track of their daily sodium intake. There were 124 self-reported cases of heart disease and 25 heart disease-related deaths (0.8% of participants). Of those deaths, 10 were in the intervention groups and 15 in the control groups — a difference of only 5 people. So all of these dramatic conclusions are being based on 5 people.

The researchers did a computer statistical analysis to come up with odds ratios for the association between mortality and sodium reduction (factoring for the clinic, age, race, sex and weight loss intervention) and found a 19% lower odds ratio for mortality associated with sodium reduction.

The most glaring problem you’ve probably already noticed is that not only is this an untenable odds ratio — a number so low it could just as easily be a minute error in their computer model or an unreproduceable fluke— but that it’s an association, which does not mean causation. Yet, virtually every media report is eagerly jumping to conclude that lowering salt will add years to your life and save lives or that eating salt kills.

Another notable flaw in the logic here is that countless other contributing factors could be (and likely were) much more significant than sodium in explaining those correlations, yet the researchers failed to include them in their computer model. For example, it appears they didn’t account for socioeconomic status, stress, alcohol consumption, exercise or smoking! So to conclude it was the sodium is a huge stretch of the evidence.

Since this study was splitting hairs, another detail from TOHP II that won’t make the news is that 2 more people died who had been put on the weight loss intervention than had been in the control or the sodium reduction groups. Although their causes of death are unknown, this study doesn’t support claims that weight loss is all together health promoting.

The bottom line is that this study didn’t provide any credible evidence or answer any questions. There were numerous flaws and glaring missing information. It doesn’t offer evidence that population-wide recommendations for the general public to reduce sodium are beneficial or that the current levels of sodium we eat are harming us.


Maybe it's just me, but I don't think the media spin is supported by the study cited.

The media wants you to use less salt, that's clear enough.

The question is, why?


Bob Badour said at April 26, 2007 4:59 AM:

I have noticed that Randall's coverage of diet issues is biased heavily toward the recent almost cultish 'low fat' 'low sodium' mantra prevalent among the medical community over the past three decades or so. I often find it un-empirical.

Statistically insignificant is just that: insignificant. Which is to say, meaningless. Why even bother mentioning meaningless results? They don't mean anything.

Rob said at April 26, 2007 2:33 PM:

Well, everyone is different, but I found that lowering my salt intake helped me a lot. My blood pressure was high, even with a pretty good dose of two different drugs. I read somewhere on the internet that it was sodium/potasium balance that effected blood pressure the most. According to this theory, you up your potasium intake and lower your sodium intake and your blood pressure goes down.

So, I started avoiding salt - not fanatically, just common sense stuff: lots of vegitables and fruits (with a preference towards high-potasium ones like bananas), meats and starches cooked without extra salt. My blood pressure dropped from 170/100 to about 145/85 in about three weeks (I kept taking the drugs, you don't want to stop them once you start). This is anecdotal, of course, but whatever works, you know?

It's a healthier way to eat anyway. Mostly, I just had to give up most kinds of junk foods, which wasn't all that hard, at least for me.

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