Dr Davis:

PREVENTION v PREVENTION!
A curious thing but I wonder if you mid-westerners really need to be giving up iodized salt at all if you are taking care of your potassium and magnesium?
When you get time, please let us know your patient findings on mineral status.
"Lite" salt contains a % of potassium which may be  iodized. Of course one's ability to take potassium maybe compromised by some medications.

Mike V

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UK ARTICLE
Is salt REALLY so bad for your blood pressure?
By Jerome Burne
30th March 2009

It's been demonised for years. But suddenly experts are asking whether we're missing the bigger picture about salt...

We're all eating too much salt and it's going to give us high blood pressure - that's the message we've heard for years, but now new research suggests salt is being wrongly demonised.
A recent study suggests that by concentrating on the effects of salt we could be missing the bigger picture. That's because salt doesn't affect blood pressure on its own; it does so with another mineral we get in our diet - potassium.
Blood pressure is constantly being raised and lowered - salt is involved in raising pressure by tightening arteries, while potassium is part of the relaxation system. So making sure you have enough potassium is vital.
Salty snack: Research has found that eating more salt does not necessarily raise the risk of heart disease
This was highlighted in the study from Loyola University in Chicago. Researchers measured the amount of salt in the urine, an accurate way of measuring how much had been consumed, and found no significant difference in the risk of heart disease whether patients had been eating a lot or a little. What did reduce the risk, however, was the ratio of salt to its balancing mineral potassium.
The new study 'is a quantum leap in the quality of the data', says lead author Dr Paul Whelton, an epidemiologist and president of the university's health division. That's because it followed nearly 3,000 patients for between ten and 15 years.
Whelton now believes many of us need to significantly increase our potassium intake to help our arteries.
'To lower blood pressure and dampen the effects of salt, adults should consume 4.7grams of potassium per day,' he says.
The British recommended daily dose of potassium is only 3.5g. Foods high in potassium include potatoes, sweet potatoes, yoghurt, tuna, lima beans and bananas.
'To lower blood pressure and dampen the effects of salt, adults should consume 4.7grams of potassium per day'
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As for salt, Dr Whelton and colleagues from America's Institute of Medicine say we should stick to less than 6g (a teaspoon) a day, which is the same as the existing UK guidelines.
But his study is not the only one to raise questions about conventional approaches to this problem.
A review of the evidence published in the British Medical Journal (BMJ) seven years ago found that while cutting back on salt might help those taking medication for high blood pressure, the research showed no clear benefits for everyone doing it.

Even more extraordinarily, in 2005, researchers at the Albert Einstein College of Medicine in New York published the results of a 13-year study that had followed 7,000 men and women - this showed that people who consumed less than 6g of salt a day actually had a ********'raised' risk of heart disease.*********

The author of that study, Dr Hillel Cohen, says this was only an observation, and more work is needed to establish why this trend was found. 'But it does suggest a set limit of salt for everyone doesn't work,' he adds.

Effective or not, cutting back on salt makes up only a small part of the regime recommended for anyone with raised blood pressure, which is also known as hypertension.
The first step is usually a version of the Dash (Dietary Approaches to Stop Hypertension) diet that recommends fruits, vegetables, and low-fat dairy foods, and which has been shown to be effective in bringing blood pressure down. But this can be hard to follow if you've been eating less healthily for years.
  Eating a healthy amount of potassium in your diet can offset the impact salt has on raising blood pressure
Dr Peter Berkin is a GP in Milton Keynes who favours treating chronic disorders with diet where possible.
'Doctors always recommend weight loss and improving your diet but they rarely have the time or facilities to help patients to make and stick with the changes,' he says.
The result is that after six weeks or so, most patients are prescribed drugs to lower their blood pressure.
An estimated ten million people in the UK have high blood pressure, and in England alone millions of prescriptions are written for drugs to treat them every year. But are drugs the best way to treat the problem?

What patients are often not told is the numbers of people who have to be treated with a drug in order for just one person to benefit.
In the case of elderly patients with mild hypertension, of every 76 patients who take the drug, one will avoid a stroke, according to Michael Oliver, professor emeritus of cardiology at the University of Edinburgh, writing in the BMJ.
Professor Oliver was also concerned about the side-effects of these drugs that benefit so few. 'Reduction of mild hypertension can lead to vertigo, particularly in elderly people,' he wrote.

The drugs have a range of other effects. Diuretics, which make you go to the loo more often, reducing the volume of water in the blood and in turn lowering blood pressure, can cause gout.

Calcium channel blockers, which relax the arteries, can bring on headaches, while ACE inhibitors, which work by stopping the blood vessels from narrowing, often cause a nasty cough.

More seriously, several of these drugs are now linked, ironically, with a raised risk of heart disease.
One study of 1,860 men followed over 17 years found that ^^^^^^those treated with diuretics were 23 per cent more likely to have a heart attack********* than those who weren't.
Another widely used class of drug is the beta-blocker. These work by blocking a natural substance that causes the arteries to narrow and the heart to beat faster, enabling the arteries to widen again.
However, using these actually raises heart problems, according to a review by doctors at St Luke's Roosevelt Hospital in New York. They found that patients given beta-blockers had more heart attacks and more strokes.
'A study found that people who consumed less than 6g of salt a day had a *****raised risk of heart disease'******
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The reason could be that most of the studies involved a widely used beta-blocker, atenolol. Worryingly, even though the problems with atenolol have been known for years, 14 million prescriptions for it were written in England and Wales in 2007.

'Atenolol should not be given to anybody,' says Dr John Cockcroft of the Wales Heart Institute in Cardiff. 'Nobody disagrees atenolol is guilty, yet we are still using it.'
Drugs certainly bring dangerously high blood pressure down, and for those with high blood pressure they are a lifesaver. But do people with only slightly elevated blood pressure really need them? Research shows that 167 patients need to take the drugs for a single person to benefit.
A number of GPs believe that more could be done to help people simply with diet and lifestyle.

'Around 33 per cent of people aged 25 to 55 have borderline hypertension,' says Dr Adam Carey, a nutrition expert who runs a corporate health programme helping employees to get fit, as well as advising the Welsh rugby union team on nutrition.

'We can get that down to 9 per cent without using drugs, but by giving them a structured programme of diet and exercise.
'The key is to cut out refined carbohydrates such as white flour and sugar. These foods push up your blood sugar level, and the body stores the extra sugar as fat.
  
Foods high in potassium include potatoes, sweet potatoes, yoghurt, tuna, lima beans and bananas
'Eating carbohydrates that haven't been refined, such as brown rice and wholegrains, smoothes out the sudden spikes and troughs of blood sugar that come with sweets and pastries.'

The American study showed, raising your potassium is important. But there is another pair of minerals involved in controlling blood pressure in the same way as the sodium in salt and potassium do - calcium and magnesium.

While calcium tightens the blood vessels, magnesium relaxes them. The recommended daily allowance for magnesium is 300 to 400mg and it is found, together with potassium, in green leafy vegetables, nuts and seeds. One of the effects of diuretics can be to flush magnesium and potassium out of the body.

Relaxation techniques such as meditation can help, too. Anxiety pushes up your blood pressure by raising levels of hormones such as adrenaline and cortisol.

Dr. Davis, can you suggest a good omega-3 capsule? I know you have previously mentioned that one can use any omega-3 we get at Costco. I used Naturemade (or Nature's own, I do not remember the name right now) omega-3 capsules. HOWEVER, they have started smelling fishy these last few days! Obviously the oil in them has gone rancid! The capsules are not supposed to expire till 2011, so its really bothering me that they turned bad so soon. I store them in my pantry which is cool and dark, so the capsules were not exposed to harsh sunlight.

Dr.Davis

This is very informative.
What is the best base level of Iodine daily to promote thyroid health?

Thanks for you great blog!

Aaron

So iodine aside, I'm curious as to your take about the whole salt issue. Taubes touches on it in Good Calories, Bad Calories, and essentially looks to insulin --not salt-- as the villain in blood pressure problems. NHANES III seems to help things along in that direction as well: http://www.ncbi.nlm.nih.gov/pubmed/18465175

I would grant that high salt intake might be a problem for a certain percentage of sensitive individuals, but I kind of doubt that percentage is all that high. I also wonder if sodium sensitivity in some people has more to do with other factors, such as magnesium deficiency (since magnesium regulates sodium) than with sodium actually being malicious in and of itself. *shrugs*

Some say that the chemically processed, straight sodium chloride is what causes the problems, and that a good full-spectrum sea salt is the way to go, as it contains all the original trace minerals to balance things out. I use Redmond RealSalt (I love the taste). I've known three people now who have gotten on the RealSalt (in large quantities) only to have their blood pressure go down. With no other changes. I don't really understand it, but it's interesting, and helps to further my skepticism about the supposedly universal salt/BP connection.

Loved this entry (a fellow paleo) -- thank you for your blog. I added my own libertarian take on it.

Eat two Egglands Best eggs a day and you'll get your daily allowance of iodine.

Or, just a pinch of dry sea kelp in your tea will do the same.

Or, just a single daily serving of seafood (any of the wild finfishes, roe [fish eggs], crustaceans, or mollusks) should do the trick too.

Unfortunately, sea salt (unless it's been purposely iodized) has only a small, insignificant trace amount of iodine.

Iodine seems to upregulate the sensitivity of steroid receptors. There is anecdotal evidence that in the case of diabetes the amount of injected insulin (which is a steroid hormone) has to be drastically reduced to avoid severe side effects like hypoglycaemia ( http://www.healthy-eating-politics.com/diabetes-iodine.html ).
Since vitamin d is actually a steroid hormone, too, could it be that the recommended range of sufficiency (60-80 ng/dl) has to be adjusted for someone who is on iodine supplementation and therefore likely has increased steroid receptor sensitivity?
Any thoughts?

Mike V--

Admittedly, "avoid salt" is a generalization.

There are genetic types who gain little by minimizing salt. Then there are people at the other end of the spectrum who gain visibly and dramatically with salt restriction, e.g., drops in systolic BP 30+ mmHg, weight (water) reductions of many lbs, even changes in blood electrolytes.

Salt is one of those things that is handled in dramatically different ways among different humans.

David, I believe there's also increased stomach cancer risk with salt...

It's easy to avoid salt imbalances if one avoids processed foods, as processed foods contain lots of sodium, very little potassium and magnesium.

Eating real foods one prepares at home may be salted with sea salt with little worry of taking in too much salt.  I tend to think that the association of disease with salt is a marker for malnutrition and poor nutrition from a crappy SAD diet, too high in carbs, too low in protein and natural fats, and deficient in multiple micronutrients.  

Taubes wrote a great article in Science a few years back on the soft (political) science behind the salt restriction advice.  That's eventually what moved him to investigate the fat/cholesterol hypothesis, because the most influential salt restriction theorist was such a "bad" scientist and bragged so much about his influence that Taubes' skepticism went on high alert.

Kismet,

I won't argue that point, but I would question it, just because I think more information would be helpful. A lot of the studies on salt and stomach cancer that I've seen are observational in nature. Observational studies are useful as far as they go, but they're not good at proving causality. In other words, perhaps it's true that people who get stomach cancer eat a lot of salt. But is the salt actually causing the cancer? People who eat a lot of salt also eat a lot of nitrates-- in fact the two often go together. So which is it that causes the cancer? Salt or nitrates? We can't tell from the observational studies, because there are still too many variables to narrow down the relationship.

Maybe lots of salt does cause stomach cancer. I honestly don't know what to think. But I do think that caution is needed when evaluating observational studies for the purpose of establishing causality, especially when they are so often contradictory (see another study on salt and stomach cancer here that shows an opposite conclusion from the mainstream: http://cebp.aacrjournals.org/cgi/reprint/1/7/607.pdf)

David

Dr. Davis:

What do you think of the ideas of those who advocate drastically increasing iodine intake to Japanese levels?

Examples:

http://www.optimox.com/pics/Iodine/opt_Research_I.shtml

Radio inteviews Dr. Stan, Dr. Blaylock, Dr. Flechas:

http://curezone.com/ig/f.asp?f=1723

Lack of iodized salt may not be as big an issue as lack of iodine in store bought baked goods. We absorb only 10% of the iodine in salt but 90% of the iodine in baked goods. Bakeries used to condition doughs with iodine but now use bromine which competes with iodine. We are now under-Iodiniated and over-Brominated.

Braesikalla, insulin is not a steriod hormone, it is a peptide.

I've seen localised clusters of goiters in Europe but hadn't realised you had such a large zone of iodine depletion.

Here (UK) we have localised areas of other mineral shortages, animal farmers have to put out salt licks or add magnesium, manganese etc. to the feed, and some arable and vegetable farmers need to mineralise their soil. There are large areas deficient in selenium (and I believe in some parts of China it is at near toxic levels) your local farmer may be someone to ask about your local conditions.

They told me to eat less salt and my BP kept going up, plus I started getting leg cramps. I ate less carbs and it came back down, they didn't tell me that one! I believe the population of salt sensitive hypertensives is quite low, yet they tell the rest of us to avoid it as well.

Strangely when I was chomping sodium bicarbonate (acid reflux) I started getting leg cramps again, that time adding magnesium sorted them (and my electrolytes came back spot on) the interrelationship can be complex.

Who avoids salt?  That seems ridiculous.  Especially if you exercise, you need even more salt.

High salt levels can build up in your body and chlorine (chloride from the sodium chloride aka table salt) can displace the nessesary iodine in your body especially from thyroid. This can cause health problems including goiters. Iodine can be relaced by consuming it in small amounts. One very effective way is by adding small amounts of Lugol's solution of iodine in your drinking water. A couple of drops per liter is enough. Pure iodine itself will not dissolve in water therefore you must have some type of iodine solution in order to properly intake it.
You can easily make your own Lugol's Iodine. Here is the formula: (adjust it to your desired amount by multiplying or dividing the factors)
10 grams of potassium iodide
5 grams of pure iodine (crystals, prills, or flakes)
85 mL of distilled water or drinkable (spring) water
Mix the potassium iodide with the water first then add and stir the iodine until all is dissolves. This usually takes some time but can be speed up by heating the water a little.
You can purchase iodine and potassium iodide at www.ushalogen.com

It might be better to think of the buy-local movement in terms of, "It's silly to buy foods from elsewhere that we're perfectly capable of growing here," while still importing foods that contain nutrients that are deficient locally.  That's the whole point of trade, after all:  acquiring things you wouldn't have otherwise.

Expecting foods grown in the ground to provide us with iodine when we've got perfectly good seafood in the oceans that give us the same thing is kind of silly.  Rather on the order of using tofu or seitan as meat substitutes when there are perfectly good cows and chickens running around out there.

An alternative, too, is to completely avoid goitrogenic foods if you live far from the sea.  It's believed that this is why cruciferous vegetables taste bitter to some people but not others:  the genes responsible seem to have evolved in people who lived far inland.  They needed to maximize thyroid function, so a mutation that allowed them to detect foods that were most likely to mess with thyroid function came in very handy.  No reason we can't make conscious choices in that direction now--it's not like we can't live without any of the foods in question.

Dealing with environmental pollution and avoiding chemical stressors is important too, as you know.  But every little bit that we ourselves can control right now, counts for something.

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