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Guidelines for Salt consumption

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tks

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Supposedly our 'enemies are salt, sugar (especially refined sugar), caffeine , and fat (saturated especially though coconut and others are fine within reason). As we grow older, we are asked to watch the amount we consume of the above substances.

At one time, fat regardless of designation became the target (in the USA and later world wide) and the food industry began to offer food rich in sugar and corn syrup etc which turned out to be far more dangerous (in the current thinking). This was replaced by diet and artificial sweeteners that brought its own set of problems.

The so called food pyramid taught for generation (with carbohydrates being at the bottom of the pyramid and hence should be consumed the most) was reversed completely. The carbohydrates especially from refined flours etc were declared to be the bigger enemy due to the insulin response of our body. Today one is asked to consume 'good fat' such as those items rich in Omega 3 fat

At some point salt was also identified to be the enemy of maintaining good health.

These recommendations have been going all over the place often controlled by billion dollar food lobby that operates world wide these days.

The doctors generally parrot whatever that is taught and just pass the recommendations on. On such matters one really cannot trust a doctor because most by their training lack analytical skills in my experience. There are of course exceptions.

In the next post, I want to share a latest news that perhaps restrictions on use of salt need not be severe.
 
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OP
tks

tks

0
International Experts Call Salt Guidelines Far Too Restrictive

Source
http://cardiobrief.org/2017/02/14/international-experts-call-salt-guidelines-far-too-restrictive/
===========================================================

A broad group of international experts are recommending a far more modest and less draconian approach to sodium restriction than current U.S. and international guidelines.

In a new paper, published online in the European Heart Journal, they also focused on the broad gaps of knowledge in the field and drew attention to the paucity of high-quality evidence and research. Again, this approach represents a rebuke of current guidelines, which authoritatively assert the benefits of dramatic reductions in salt consumption.

Worldwide, sodium intake is estimated to average about 3.95 g/day, though there are wide geographical and cultural variations. Most guidelines recommend that sodium consumption be reduced to levels below 2.3 g/day, though the American Heart Association goes further and recommends reductions to 1.5 g/day or lower.

By contrast, the authors of the new paper recommended that sodium be reduced to under 5 g/day, since “there is consistent evidence that high sodium intake (> 5 g/day) is associated with increased CV risk.” However, they freely acknowledged that there is no good randomized, controlled trial evidence to support this target. And they explicitly rejected the lower target of other guidelines, explaining that “there is an ongoing scientific debate about the optimal lower level of sodium intake for CVD prevention.”

The new paper also emphasized the potential dangers of lowering sodium too much, as in the WHO and AHA guidelines. “Sodium,” the authors wrote, “is an essential nutrient. This implies that there must be a ‘U’-shaped relationship between dietary sodium intake and cardiovascular events, but there is no consensus of where the minimum risks lies.”

An Internal Rebellion

The paper in some respects reflected an internal rebellion within the international hypertension, nutrition and public health establishment against the extreme recommendations promulgated by the AHA, WHO, and other organizations. For this reason, and in order to prevent a public rupture within the expert community, the paper was labelled as a “technical report” from the “joint working group of the World Heart Federation, the European Society of Hypertension and the European Public Health Association.” Ostensibly, the paper was about sodium in low- and middle-income countries, but the vast majority of the paper applied to high-income countries as well.

Because it is labelled as a “technical report,” several of the authors explained to me, it did not require endorsements or approval from the hundreds of individual organizations represented by the working group. Endorsements from many of the groups would be nearly impossible to obtain, given that many have already endorsed one form or another of the extreme sodium restrictions.

The full title of the paper is “The technical report on sodium intake and cardiovascular disease in low- and middle-income countries by the joint working group of the World Heart Federation, the European Society of Hypertension and the European Public Health Association.” Among the authors of the report are well-known hypertension experts like Giuseppe Mancia, Suzanne Oparil, and Paul Whelton.

“We all agree that populations that consume large amounts of salt have more deaths and cardiovascular events than populations using lesser amounts,” said co-author, Michael Weber (SUNY Downstate College of Medicine). “But anything more subtle than that is problematic.” The AHA recommendation “is not strongly evidence-based.”

In sharp contrast to the guidelines, the “technical” paper called attention to the many limitations in the field that make firm, detailed guidelines difficult to establish. The paper noted that it is extremely difficult to reliably measure sodium intake in both individuals and in large populations and it is even more difficult to perform large, long-term randomized controlled trials with cardiovascular endpoints.

“While guidelines may recommend an intake of sodium < 2.3 g/day, this target is relatively meaningless to both clinician and patient, as it is not supported by an available objective measurement,” they wrote.

Weber said that “the impetus was the lack of credible evidence in the sodium domain. Most published studies are weak, mainly because of the major difficulty of measuring salt intake in individuals…. virtually every study is questionable or even flawed.”

Even if lower levels were proven to be beneficial, the experts pointed out that there is no evidence that it would be possible to achieve these low levels in an entire population. “Despite recommendations for population-wide low sodium intake, it has not been shown that sustained low sodium intake is feasible in free living individuals,” they wrote.

The Low Sodium Empire Strikes Back

Hard core defenders of strict sodium guidelines were not convinced by the new paper. Sidney Smith, a member of the committee writing the new ACC/AHA hypertension guideline, said that “there is no new evidence in the paper to support a change from the 2013 recommendations in the ACC/AHA guidelines for the USA (derived from the systematic evidence reviews at NHLBI).”

Rose Marie Robertson, chief science and medical officer of the American Heart Association, tried to minimize the difference between the working group report and the AHA position. “We’re in agreement with them about most of the content.” She pointed out that the working group report is “consistent” with the AHA position in that it does not question the relationship between lowering sodium and lowering blood pressure, and that both groups agree that lowering blood pressure is an important priority.

Because it’s extremely difficult to perform the large trials that would “connect the dots”— showing that lowering sodium leads to lower blood pressure that then leads to fewer cardiovascular events — Robertson said it would be “irresponsible to not try to improve the current situation.” She said the AHA position makes “biological sense” and that “people want to know what to eat now.”

I asked Robertson whether she was concerned that the low-sodium recommendation might have unintended consequences, along the lines of the negative effect of the AHA’s earlier recommendations against dietary cholesterol and saturated fat. She said that the AHA and other experts have learned this lesson and are monitoring health statistics and trends. We are “watching these things like a hawk,” she said.

Call For Research

At first glance the working group paper’s call for more research to inform guidelines may appear unimportant, because the vast majority of published scientific papers reach similar conclusions. But this call becomes far more than a cliché in this context. It is increasingly becoming clear that firm, authoritative guidelines may serve to hinder important research.

Mancia, the lead author of the working group paper, discussed “the potentially negative impact guidelines may have on future research if they issue strong recommendations in areas in which evidence is weak. This discourages potential sponsoring institutions and investigators to engage in further studies, not to mention the risk to have a project rejected by Ethical Committees that may regard the research not needed because the answer is already in the guidelines.”

The working group paper “is really a plea for more rigorous methodology in clinical research studies,” added Weber. “Once we get credible evidence we can move on to supportable guidelines and recommendations. But this is probably several years away.”
 

renuka

Well-known member
There is some confusion about what constitutes hypertension..140 systolic or higher and 90 diastolic or higher is the WHO guidelines...Salt intake is also recommended < 5g per day

http://www.searo.who.int/entity/non...non_communicable_diseases_hypertension_fs.pdf


There is no actual confusion at all.

Medical science is a very evolving field where we are dealing with the human body and not machines..so a refined analytical ability is a hallmark of being a doctor to start with..its common sense that there is no one size fit all in the medical field for any disease.

Setting the Blood pressure target of 140/90 mmHg is rather old school cos effects of hypertension on body is not merely a number.

Now this is where one starts to analyze.

Ok..here goes..Hypertension is a complex situation and one must be vigiliant as to detect target organ changes like microvascular changes in Renal(Kidney) system,Cardiovascular and not to mention Retinal vascular system.

Treating a patient with hypertension is not just check the BP..make him/her swallow the meds and case closed.

Nope! Not at all.

No sane doc does that.

One needs to monitor patient for micro -proteinuria(protein in the urine) and also eGFR(estimated Glomerular Filtration Rate)..normal accepted as >60mL/min/1.73m square.

These changes are important to predict changes in the body..sometimes these changes are also seen in those whose BP might not actually even reach 140/90.

Baseline BP is also important.

For eg if a persons BP used to be 100/60mmHg and suddenly goes up to 135/85mmg..

Is it normal? Yes or No?

135/85 is less than 140/90 the so called cut off point..so do we actually tell the patient "hey..you are fine..no BP"


WRONG!

Investigate the patient as why it went up from 100/60 to 135/85.

This is just the tip of the ice berg what I wrote.

One needs to analyze each patient differently..humans are not a bunch of crash test dummies that are identical.

Even identical twins can react differently to medication.

So its ANALYZE ..ANALYZE..ANALYZE.

Remember we deal with human bodies..no two of anything is alike in this world.

For that matter even... no two machines are alike!LOL
 
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renuka

Well-known member
Whatever a non medico chooses to believe about medical science is fine as long its a personal opinion but if one intends to go into detail it would be totally responsible to put a disclaimer that a person on a salt restricted diet should NOT make changes without consultation with a bona fide doctor...instead of writing that one cant trust a doc fully becos of their so called lack of analytical capability.

This much social responsibility we should have so that we do not mislead people into abandoning their medical advise that could cost their lives...more so if we are not a medical professional.

After all never forget what Lord Krishna said.

Its always better to follow one's own Dharma though faulty than to perform anothers Dharma perfectly.
 
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tbs

0
There is no actual confusion at all.

Medical science is a very evolving field where we are dealing with the human body and not machines..so a refined analytical ability is a hallmark of being a doctor to start with..its common sense that there is no one size fit all in the medical field for any disease.

Setting the Blood pressure target of 140/90 mmHg is rather old school cos effects of hypertension on body is not merely a number.

Now this is where one starts to analyze.

Ok..here goes..Hypertension is a complex situation and one must be vigiliant as to detect target organ changes like microvascular changes in Renal(Kidney) system,Cardiovascular and not to mention Retinal vascular system.

Treating a patient with hypertension is not just check the BP..make him/her swallow the meds and case closed.

Nope! Not at all.

No sane doc does that.

One needs to monitor patient for micro -proteinuria(protein in the urine) and also eGFR(estimated Glomerular Filtration Rate)..normal accepted as >60mL/min/1.73m square.

These changes are important to predict changes in the body..sometimes these changes are also seen in those whose BP might not actually even reach 140/90.

Baseline BP is also important.

For eg if a persons BP used to be 100/60mmHg and suddenly goes up to 135/85mmg..

Is it normal? Yes or No?

135/85 is less than 140/90 the so called cut off point..so do we actually tell the patient "hey..you are fine..no BP"


WRONG!

Investigate the patient as why it went up from 100/60 to 135/85.

This is just the tip of the ice berg what I wrote.

One needs to analyze each patient differently..humans are not a bunch of crash test dummies that are identical.

Even identical twins can react differently to medication.

So its ANALYZE ..ANALYZE..ANALYZE.

Remember we deal with human bodies..no two of anything is alike in this world.

For that matter even... no two machines are alike!LOL
hi

may be two hormones are same..lol
 

renuka

Well-known member
doc, the problem lies in identifying the sane ones !!! By the time one reaches a conclusion, a truckload of pills would have been digested...

The problem is also sometimes the patients.
Risks are too high these days for a law suit...so some docs play defensive medicine to safe guard their practice.

Sometimes patients too demand medication for everything and anything.

I have noticed my patients from India who work here seem to love gulping medicine!LOL

They always ask for the famous "Tonic" to give them strength and also to increase appetite..they seem to just love to eat!

Then the famous insisting on an antibiotic when it might not be warranted.

Sometimes the patients themselves from out here insists for non warranted investigations believing what they read on the internet.

You would have people asking for MRI brain for nothing at all!LOL

An episode of diarrhea and they would be asking for Colonoscopy.

Dealing with humans isnt easy.

So to get a good doctor first one must be a good patient..otherwise too bad!LOL
 

tbs

0
The problem is also sometimes the patients.
Risks are too high these days for a law suit...so some docs play defensive medicine to safe guard their practice.

Sometimes patients too demand medication for everything and anything.

I have noticed my patients from India who work here seem to love gulping medicine!LOL

They always ask for the famous "Tonic" to give them strength and also to increase appetite..they seem to just love to eat!

Then the famous insisting on an antibiotic when it might not be warranted.

Sometimes the patients themselves from out here insists for non warranted investigations believing what they read on the internet.

You would have people asking for MRI brain for nothing at all!LOL

An episode of diarrhea and they would be asking for Colonoscopy.

Dealing with humans isnt easy.

So to get a good doctor first one must be a good patient..otherwise too bad!LOL
hi

you may get good patients from tamilbrahmins forum....here all are good and genuine patients..lol
 

prasad1

Active member
Whatever a non medico chooses to believe about medical science is fine as long its a personal opinion but if one intends to go into detail it would be totally responsible to put a disclaimer that a person on a salt restricted diet should NOT make changes without consultation with a bona fide doctor...instead of writing that one cant trust a doc fully becos of their so called lack of analytical capability.

This much social responsibility we should have so that we do not mislead people into abandoning their medical advise that could cost their lives...more so if we are not a medical professional.

After all never forget what Lord Krishna said.



Its always better to follow one's own Dharma though faulty than to perform anothers Dharma perfectly.

Very true.
 

prasad1

Active member
Sodium is one of those things that everyone “knows” is unhealthy… kind of like saturated fat.
The government has been warning us about it for decades and has spent a massive amount of resources warning us about the “dangers” of it.
The reason they do so, is that sodium is believed to increase blood pressure, a common risk factor for heart disease and stroke.
These are the two most common sources of death in middle- and high income countries (1).
The major health organizations recommend that we cut back on sodium:

  • United States Department of Agriculture (USDA): 2300 mg.
  • American Heart Association (AHA): 1500 mg (2).
  • Academy of Nutrition and Dietetics (AND): 1500 to 2300 mg.
  • American Diabetes Association (ADA): 1500 to 2300 mg.
So… there is definitely a consensus among these organizations that we should aim for less than 1500 mg of sodium per day, and definitely not more than 2300 mg.
Keep in mind that salt contains both sodium and chloride. Only 40% of the weight of salt consists of sodium, so you can actually eat 2.5 times more salt than sodium.
1500 mg of sodium amounts to 0.75 teaspoons or 3.75 grams of salt per day, while 2300 mg amounts to one teaspoon or 6 grams of salt per day.
Most people today are eating much more than that. The average intake of sodium is about 3400 mg, most of it coming from processed foods.
If these health organizations have their way, all of us need to make drastic changes in our food choices, start reading labels and start to actively restrict the amount of sodium in our diets.
I have to say, I’m skeptical… these health organizations do have a track record of getting things wrong in the past, such as the misguided low-fat dietary guidelines.
So is sodium really that bad? Do the studies show that reducing sodium intake actually leads to improved health?
And more importantly… if there are benefits to sodium restriction, are they important enough to be worth the obvious reduction in pleasure we will derive from our (now tasteless, salt-free) foods?


What sodium does in the body is to bind water and maintain intracellular and extracellular fluids in the right balance.
It is also an electrically charged molecule, and along with potassium helps maintain electrical gradients across cell membranes, which is critical for nerve transmission, muscular contraction, and various other functions.
The body can NOT function without sodium. Period.
The more sodium we have in our bloodstream, the more water it binds. For this reason, sodium is thought to increase blood pressure (which it does, but only mildly).
If blood pressure is elevated, the heart has to work harder to push the blood throughout the body and there is increased strain on the arteries and various organs.
High blood pressure (hypertension) is a major risk factor for many serious diseases, like heart disease, stroke and kidney failure.

[FONT=&quot]If your doctor has recommended that you limit sodium for whatever reason, then by all means continue to do so.[/FONT]
[FONT=&quot]However, for people who are generally healthy and want to stay healthy, there doesn’t seem to be any reason to be even remotely concerned about moderate intakes of sodium.[/FONT]
[FONT=&quot]Studies actually show that the effects of sodium may follow a J-shaped curve. Too little and too much are both harmful, the sweet spot is somewhere in between (21).[/FONT]
[FONT=&quot]Also be aware that if you’re on a low-carb diet, your sodium requirement may go up.[/FONT]
[FONT=&quot]It is probably best to consume unrefined varieties of salt, such as sea salt and Himalayan pink salt. They also contain various trace nutrients that may be important.[/FONT]
[FONT=&quot]Given that most people get most of their sodium from processed foods and that studies on sodium restriction don’t show any benefit, then I’d like to propose this radical approach to optimizing your sodium intake.[/FONT]
[FONT=&quot]No obsessive counting of milligrams required:[/FONT]

  • Eat real food.
  • Add salt whenever appropriate to make your food taste good.
  • That’s it.

https://authoritynutrition.com/how-much-sodium-per-day/


 
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prasad1

Active member
Your body needs some sodium to function properly because it:

  • Helps maintain the right balance of fluids in your body
  • Helps transmit nerve impulses
  • Influences the contraction and relaxation of muscles
Your kidneys naturally balance the amount of sodium stored in your body for optimal health. When your body sodium is low, your kidneys essentially hold on to the sodium. When body sodium is high, your kidneys excrete the excess in urine.

But if for some reason your kidneys can't eliminate enough sodium, the sodium starts to build up in your blood. Because sodium attracts and holds water, your blood volume increases, which makes your heart work harder and increases pressure in your arteries. Such diseases as congestive heart failure, cirrhosis and chronic kidney disease can make it hard for your kidneys to keep sodium levels balanced.
Some people's bodies are more sensitive to the effects of sodium than are others. If you're sodium sensitive, you retain sodium more easily, leading to fluid retention and increased blood pressure. If this becomes chronic, it can lead to heart disease, stroke, kidney disease and congestive heart failure.

http://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/in-depth/sodium/art-20045479


Please have faith in your doctor's advice. If you do not faith in one doctor find a different one till you are satisfied, and then follow that doctor's advice.

It is dangerous to self-medicate, treat salt, sugar, fat and others as medicine.
 
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