Study: "Disappointly weak" link between salt and high blood pressure

For decades table salt has been on a healthy heart’s most wanted list. Believing it’s responsible for skyrocketing blood pressure, Americans have banned salt from tables and stripped it from recipes. 

But new research says salt just might deserve a bit of a reprieve.  

The link between salt and blood pressure is thought to date back to the 1940s when Duke University researcher Walter Kempner, M.D., became famous for using salt restriction as a means to treat people with high blood pressure. During the next few decades, studies confirmed Kempner’s theory that reducing salt could help reduce hypertension.

A Controversy is Born

Despite history, a brand new review of several studies from the past few decades related to blood pressure and salt intake suggests Kempner wasn’t right—that salt might not have as much of an effect on blood pressure and heart health as suspected.

The team leading the review published in the December 2012 Health Affairs pored over dozens of studies, some dating back to 1967, and said they were unable to find a link between salt intake and a risk for high blood pressure.

The Columbia University Mailman School of Public Health team of scientists that conducted the review said the link to salt intake and high blood pressure, heart disease, and stroke is “disappointingly weak." 

The merit of salt’s ability to cause high blood pressure has been questioned before. In 2011, the Cochrane Review published two studies that showed little or no relationship with death and salt reduction. That review was widely criticized.

Not So Fast, Put Down the Salt Shaker

While the debate about salt’s impact on blood pressure pulses on, few doubt salt’s role in the body.

“Salt is a mineral that a body needs to stay hydrated. When we consume salt, water usually follows so it’s nature’s way of ensuring hydration,” says Katherine Patton, a registered dietitian at Cleveland Clinic specializing in prevention and management of cardiovascular disease.

But eat too much salt and your body is likely to become over-hydrated. “When you have too much fluid in your body, your kidneys have to work harder than normal to expel the extra,” says Patton. The extra water also increases blood volume in the body and that requires your heart to work harder to move all that blood around, thus your pressure goes up.

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High Blood Pressure a Still Huge Problem

Of all those on blood pressure medication in the U.S., 50 percent are not at their goal blood pressure, according to a recent study published by the American Heart Association (AHA). Experts theorize that some patients may not be taking their medication consistently or filling prescriptions at all because they underestimate the medicine’s ability to rein in their blood pressure.

Side effects like achiness and muscle cramps top the list of reasons women stop taking diuretic medications. Cost of the prescription is also a factor.

Eliot A. Brinton, M.D., director of Atherometabolic Research at the Utah Foundation for Biomedical Research and a founding board member of the National Lipid Association, says roughly one third of adults don’t tell their doctor that they’re stopping their blood pressure medicine. “It is important to take all heart-related medications as prescribed to help reduce the number of cardiovascular deaths. And if there’s a monetary or medical reason they’re uncomfortable with the medicine, instead of stopping it on their own, they need to talk to their doctor,” he says.

Get the Facts About High Blood Pressure

The Current Guidelines for Salt

Patton says these are the current dietary guidelines for salt intake:

  • Anyone under age 51 with no history of high blood pressure, kidney disease or diabetes, can have up to 2,300 mg of sodium a day
  • Anyone age 51 and older, or anyone with a history of high blood pressure, kidney disease or diabetes should limit salt intake to 1,500 mg

“Additionally, any African American adult regardless of health history should limit their salt to 1,500 mg a day,” says Patton.

Letting Salt (Slightly) Off the Hook

Patton says there is scientific evidence that salt is linked to high blood pressure but also says salt might not be a villain for every heart in America.

“If you’re under age 51, are not African American and don’t have a history or high blood pressure, kidney disease, or diabetes, then this new review could be a bit of good news. It might let salt off the hook a little,” she says.

She stresses the importance of everyone trying to be aware of their salt intake, but if you fall into the ‘safe’ category, you might not have to scrutinize every grain. “Be aware of the risk of overindulging because sodium is abundant in foods,” says Patton.

The AHA supports the thinking that Americans should aim to improve their whole or overall diet to maintain healthy blood pressure and overall heart health. In addition to sticking to the guidelines for salt intake, The AHA recommends individuals consume:

  • A variety of fruits, vegetables, and grain products, especially whole grains
  • Fat-free and low-fat dairy products, legumes, poultry, and lean meats
  • Fish, preferably oily fish like salmon, herring or trout, at least twice a week

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