Hold the salt and save a life!
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Salt, made up of sodium and chloride ions, has been used for centuries as a food preservative and flavoring agent. Only with the advent of refrigeration has the importance of salt as a food preservative diminished. Unfortunately, over-consumption of salt has been known to create hypertension or high blood pressure. The consequences of high blood pressure include the development of heart attacks, strokes, and heart failure. A recent study in the New England Journal of Medicine examined what the effects would be if Americans decreased their salt consumption just moderately. The model developed concluded that the number of new cases of coronary heart disease which can lead to heart attack were reduced by 60,000 to 120,000 cases per year and that stroke was reduced by 32,000 to 66,000 cases per year. It was estimated that the number of deaths would be reduced by 44,000 to 92,000 per year. The authors reasoned that the benefits of population wide reduction in salt intake would be equivalent to reductions in tobacco use, obesity and cholesterol levels. It is estimated that the average man in the United States consumes 10.4 g of salt per day and that the average woman 7.8 g per day. Even if we could just get it down to the range of 5.8 g per day these tremendous benefits would follow. Part of the problem is that 75 to 80% of the salt in the United States diet comes from processed foods. A number of countries around the world have already reduced population-wide salt intake by both regulation and by labeling content in processed food. The authors point out in the article that everyone would benefit by these changes whether they had hypertension or not. This would hold for both black and white Americans, young and old Americans, and male and female as well. Blacks who have a greater sensitivity to salt intake and hypertension would benefit most. For example non-black men and women would have approximately 10% decrease in the incidence of coronary heart disease while on average for black men and women it would be closer to 15%. The number for decreases in deaths would also follow similar percentages. As mentioned above, these changes would be similar to those occuring from smoking cessation, weight loss, pharmacologic treatment of hypertension and statin therapy for cholesterol lowering in the primary prevention of coronary artery disease. If this model projection is true then the consequences of dietary restriction of sodium intake are phenomenal. There are situations of course where the body loses salt to a significant degree and needs replacement. For example, workers who labor in the hot sun all day can lose significant amounts of salt from the body and may need to have replacement therapy. For those workers if we restrict the amount of sodium in processed foods it might be necessary at times, with their doctors' input, to supplement their diet with salt tablets. However these kinds of situations are generally not a problem for most Americans. I strongly recommend that the government whether local federal or both begin to enforce restrictions on salt in processed foods and begin a campaign of educating the public on salt reductions in their diet. NEJM 2010;362:590-9 K. Bibbons-Domingo et.al..
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