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World Salt Awareness Week has goal of reducing strokes

Robin Wulffson MD's picture
salt, sodium, potassium, hypertension, high blood pressure, stroke

War is a controversial topic. However, the latest war launched by a branch of our government should not spark controversy; instead, it should promote health awareness. The Centers for Disease Control and Prevention (CDC) has announced that March 26 through April 1 is World Salt Awareness Week. The CDC notes that strong evidence exists that too much sodium intake increases blood pressure.

The agency notes that approximately nine out of 10 Americans aged two years and older consume too much sodium. Most of the sodium is contained in packaged, processed, store-bought, and restaurant food. The resultant increased blood pressure is the most significant modifiable risk factor for stroke. An individual with normal blood pressure has half the risk of having a stroke in their lifetime compared to someone with high blood pressure.

The CDC notes that stroke is the fourth leading cause of death in the United States. Almost 800,000 individuals suffer a stroke each year. Contrary to popular belief, most of them survive; however, they are often burdened with major health consequences. Almost 50% of stroke victims are left permanently disabled with paralysis, speech difficulties, memory loss and emotional problems. Stroke survivors also face staggering medical expenses. In 2010, stroke cost the nation an estimated $54 billion in healthcare services, medications, and missed days of work.

Dietary sodium is measured in milligrams (mg). Table salt is 40% sodium; 1 teaspoon of table salt contains 2,300 mg of sodium. Although the current guidelines call for a limit of 2,300 milligrams per day, the average American’s actual sodium consumption is 3,300 milligrams per day. Furthermore, that amount does not include salt added at the table. If an individual is African American, 51 years of age or older, have high blood pressure, diabetes, or chronic kidney disease, he or she should further reduce sodium to 1,500 milligrams per day.

Sodium is also added to various food products. Some of these added forms are monosodium glutamate, sodium nitrite, sodium saccharin, baking soda (sodium bicarbonate), and sodium benzoate. These are ingredients in condiments and seasonings such as Worcestershire sauce, soy sauce, onion salt, garlic salt, and bouillon cubes.

According to a recent CDC Vital Signs report, 44% of the sodium consumed by the average American comes from only 10 types of foods:

  • Breads and rolls
  • Cold cuts and cured meats
  • Pizza
  • Poultry
  • Soups
  • Sandwiches
  • Cheese
  • Pasta dishes
  • Meat dishes
  • Snacks

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The CDC notes the following guidelines to reduce dietary sodium:

  • Read Nutrition Facts labels when shopping to find the lowest sodium options of your favorite foods.
  • Eat more fruits and vegetables, either fresh, frozen (without sauce), or canned (with no salt added).
  • Limit processed foods high in sodium.
  • When dining out, request no salt be added to your meal.

Many young healthy individuals express little concern regarding their sodium intake; however, these are the individuals who can benefit most from keeping their sodium intake in the normal range. According to recent studies, healthy individuals with normal blood pressure should avoid a sodium-saturated diet. You might ask, “What is a sodium-saturated diet? Answer: it is a diet high in sodium relative to potassium. Both commonly come as salts of chlorine: sodium chloride (NaCl) and potassium (KCl). Both are present in bodily fluids.

An Institute of Medicine study IOM study, published last year, reviewed data from more than 12,000 American adults; it was looking for risk factors for death from heart disease. The investigators found that while a diet high in sodium increases ones risk, of more importance is the ratio of sodium to potassium in one’s diet: sodium increases heart disease risk while potassium lowers it. According to the IOM study, “No one is immune to the adverse health effects of excessive sodium intake.”

When individuals whose meals contained less sodium than potassium were compared with those whose diets had a high sodium-to-potassium ratio, the latter were nearly 50% more likely to die from any cause and more than twice as likely to die from ischemic heart disease during a follow-up period (average: 14.8 years).

A high sodium diet increases blood pressure and increases the risk of chronic hypertension; sodium reduces the elasticity of the arteries and blocks nitric oxide, which relaxes arteries. A chronically-elevated blood pressure increased the risk of cardiovascular disease: heart attacks and strokes. Conversely, potassium activates nitric oxide, which relaxes the arteries and lowers the risk of hypertension.

Another study, which was published earlier this year in the Archives of Internal Medicine by the CDC, also evaluated the sodium-potassium ratio in one’s diet. “We controlled for all the major cardiovascular risk factors and still found an association between the sodium-potassium ratio and deaths from heart disease,” noted Dr. Elena V. Kuklina, a nutritional epidemiologist at the CDC and an author of the study. She added, “With age, the risk of high blood pressure increases. The lifetime risk in this country is 90%. If you live long enough, you’re at risk.”

Another source of sodium is in water softeners, which exchange hard minerals with sodium. Many are not aware that water softeners can be charged with potassium chloride rather than sodium chloride. The potassium salts are more expensive; however, the health benefit makes them worth the extra cost. Also of note, potassium-softened water is healthy for your house plants, which shrivel and die if watered with sodium-softened water.

Reference: CDC