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Shake on the Salt?

What's this I hear about a low-salt diet being bad for the heart? Is it true?

Answer (Published 8/4/2008)

We'll see. A study from Albert Einstein College of Medicine in New York found that people who eat the least salt have the highest rates of death from heart disease. This surprising finding emerged from a review of data gathered from a federal health survey of a representative sample of adults. A total of 8,700 Americans over the age of 30 participated. None were on a special low-salt diet when they enrolled between 1988 and 1994. However, they did disclose the amount of salt they habitually consumed. In 2000, the researchers looked at death records of the survey population to see how the volunteers had fared over time: they found that the 25 percent who claimed they ate the least salt were 80 percent more likely to die of cardiac disease. They also had a risk of death from any cause that was 24 percent higher than the participants who stated they ate the most salt. This remained true after adjusting for such heart disease risk factors as smoking, high blood pressure and diabetes.

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No one is suggesting that on the basis of these findings we start using more salt to protect our hearts – but the researchers did question whether there is any reason for doctors to recommend that healthy people cut back on salt. Study author Hillel W. Cohen, associate professor of epidemiology and population health, said that the findings suggest that, for the general adult population, "higher sodium is very unlikely to be independently associated with higher risk of death" from heart disease or other causes. Keep in mind that this wasn't the type of study designed to determine cause and effect – that is, while it shows an association, it doesn't tell us whether low-salt diets were responsible for the higher risk of death from cardiovascular disease, and it certainly doesn't demonstrate that consuming lots of salt would be protective. There could be another explanation, although the researchers said that they tried to account for other possibilities.

Bear in mind that the sodium in salt seems to affect blood pressure only among "salt-sensitive" people. If you have high blood pressure, you may be able to bring it under control by losing weight, exercising regularly, practicing relaxation techniques and following my other recommendations for lowering blood pressure before resorting to medication.

Andrew Weil, M.D.

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