I have read this study and it is much less meaningful than the title would suggest.<p>They have compared a diet with a sodium intake close to the lower limit of the recommended intake, with a diet including an even lower sodium intake, slightly less than normally recommended.<p>A daily sodium intake in a relatively wide range around the recommended daily intake (which is of about 4 to 6 grams of salt per day) is not expected to cause any differences, so the results of the study are not surprising.<p>The recommendation to eat less salt is only for the people who eat mostly industrially-processed food, which always includes excessive quantities of salt and sugar, because they are among the cheapest ingredients, while enhancing the taste of the food.<p>Such people typically eat 2 to 3 times more salt than recommended, and only for them it may be expected that lowering the sodium intake can reduce the risk of diseases. However, lowering the sodium intake is not easy for them, because they must begin to eat something different, since the excessive salt is not added by them to the food.<p>Otherwise, lowering the salt intake much under 4 grams per day is a serious risk, especially for older women, and especially when they also take medication against high blood pressure.<p>Hyponatremia, i.e. having a too low sodium content in the body, manifests initially with symptoms like muscular weakness, constipation, lack of appetite and problems with the equilibrium, which may result in falls.<p>Such symptoms may be difficult to distinguish from just consequences of old age. If hyponatremia is not diagnosed in time, the consequences can be extremely severe, including the loss of life.
This study looked at a stricter sodium goal than is typically advised (<1500 mg/day). Usually I counsel pts on less than 2000 mg a day which is what the control group targeted and seemed to achieve. This study is useful in that it shows being more restrictive isn’t necessary, but those with heart failure should still try to avoid excess salt. It is very easy to hit double the recommended intake with a typical American diet. The average American salt intake is about ~3400 mg/day from some studies.<p>Edit: after reading some of the replies I think there’s confusion about who the target population is in this study: it’s people who already have heart failure. I could have added in my comments that I was also referring to ppl with heart failure.
We can shortcut a bunch of pedantic arguments by just reading their conclusion;<p>> <i>In ambulatory patients with heart failure, a dietary intervention to reduce sodium intake did not reduce clinical events.</i><p>Ambulatory = walking around, e.g. not hospitalized. The patients were already diagnosed with chronic heart failure and were followed for a year to see if a low-sodium diet would prevent further cardiac events. There wasn't statistical evidence that the low-sodium diet did so. Tada!
Is it possible that salt intake is just correlated to heart disease because the real foods causing heart disease (highly processed foods with refined vegetable oils, sugar, preservatives, etc.) are loaded with salt?<p>Anecdotally, I put salt in everything I cook - sometimes to the point where others find it salty. My blood pressure has always been firmly in the healthy range (low 30s Male).
I wonder if the commonly thought of causation relationship for sodium and health problems is inverted.<p>Speculatively, i.e... your body has a greater need to use the sodium-potassium pump more when you're stressed, which makes you crave salt, and eat more sodium. The high stress is what causes bad health outcomes, the high sodium levels just happen to correlate with it.
Seems like a lot of people are missing the fact that is study of people with heart failure not a study of otherwise healthy people.<p>The study is decreasing sodium intake even further from the current guideline for patients with heart failure.<p>The effect of sodium intake is very different for people who need to maintain very tight tolerances to survive. And a ton of effort is spent keeping people with heart failure out of the hospital.<p>I have heart failure and have an implant that measures electrical conductivity of heart tissue and will warn if I am approaching fluid overload due to too much sodium.
The issues with sodium intake are caused more by high osmolality than by absolute quantity. We can't tell if a particular patient's sodium consumption is too high without also knowing their fluid intake.<p><a href="https://peterattiamd.com/rickjohnson2/" rel="nofollow">https://peterattiamd.com/rickjohnson2/</a><p>Genetics are also a huge factor.
It's good to remember that highly salted foods are associated with stomach cancer:<p><a href="https://www.frontiersin.org/articles/10.3389/fnut.2021.801228/full#:~:text=The%20findings%20of%20this%20study,processed%20meat%20intakes%20were%20not" rel="nofollow">https://www.frontiersin.org/articles/10.3389/fnut.2021.80122...</a>.<p>This explains the higher incidence of stomach cancer in many E. Asian countries. Stomach cancer is the fourth most common cancer last time I checked.
I think a lot of people don't realize that the impact of sodium and other "bad stuff for you" varies from person to person. Only 25% of the population is subject to high blood pressure as a result of high sodium intake.<p>So, if you create an experiment that can subtly select for the 75% of the population doesn't experience high blood pressure, then you can show that sodium doesn't raise it. I don't if that's what's going on here but a lot interested parties will try to go this route in order to show that salt is harmless.
I have a theory that a large percentage of food cravings and idle snacking are due to being salt deficient and seeking out salty foods.<p>Perhaps part of the obesity epidemic is due to the vilification of salt?
I'm not an expert by any means, but I thought it is common sense that what really matters is to have equivalent sodium and chloride ion counts ( or their equivalents ), because in nature one would basically never deviate from this. In modern times we do, relatively a lot.
I can't read the article, but it's my impression that high sodium isn't as much a threat to general health as increased BP is. I'd like to know what sodium reduction did for BP, and how much the two groups then differed.<p>If the goal for patients is not reduction of BP, then the presumption of this study is that sodium is affecting the heart and vessels in more complex ways than pressure alone, and such patients might suffer in a diverse multitude of complex ways that are much harder to attribute directly to the level of sodium.<p>The authors' conclusion seems to be only that the correlation between sodium intake and death in heart patients is not simple and linear.
Yep. This is NOT the first study generally disproving a link between sodium and CVD.<p>Sodium is NOT the horrible evil it's portrayed as.<p>What is actually problematic is, if anything, an imbalance with potassium and sometimes calcium and/or magnesium.
It's frustrating that on one hand you want to hit a decent amount of sodium per day for the optimal operation of one's body, while at the same time if you go over 2500mg of sodium per day, you increase the likelihood of building kidney stones.. there's no way to win, from what I can tell. Is there a trick here or is that just the way the human body is built, and that's that?
I'm going to make a bet the sodium intake is correlated with calorie consumption which is why these studies all find it so difficult to figure out why salt sometimes seems to cause similar issues to high calorie diets.<p>Let's be honest here, if you eat a bowl of food with no salt on it you will get bored and find the food hard to finish.
Well given a lot of claims about sodium and heart failure seem hyped we shouldn't be surprised.<p>Don't know of its my opinion of the field or the journal but i don't rate the lancet highly after digging into most higher profile papers.
Why does the title here omit the word "failure" from "heart failure patients"?<p>This is a very narrow clinical result, and not evidence pro or con in the general sodium debate.
To the broader topic of health information going wrong, at the top of the Lancet page I see an ad for Hydroxychloroquine Sulfate. Anyone else? I'm in western US.