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Reducing Salt Intake Might Harm Heart Failure Patients, Study Claims

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Reprinted with the kind permission of Dr. Mercola.
By Dr. Mercola
Close to 6 million Americans have heart failure while more than 870,000 cases are diagnosed each year. If you have heart failure, it means your heart isn’t pumping as well as it should be and, as a result, your body is probably not getting enough oxygen. In other words, you have a weak heart.
Once-simple activities, like walking or carrying groceries, may become difficult, and you may also experience fatigue, shortness of breath, fluid build-up and coughing.1

Because heart failure is associated with fluid build-up, a low-salt diet is typically recommended. Excess sodium may cause your body to retain water and, so the conventional thinking goes, may worsen the fluid build-up associated with heart failure.
This dietary dogma is touted as fact, but in reality you may want to think twice about slashing your salt intake if you have heart failure, as new research has linked it with an increased risk of death.
Cutting Down Salt Intake Might Worsen Health of Heart Failure Patients
Researchers from Rush University Medical Center in Chicago followed more than 800 heart failure patients for an average of three years. Both their health status and salt intake were analyzed.2
It turned out that those following a low-sodium diet were 85 percent more likely to die or require hospitalization for heart disease compared to those who didn’t restrict their salt intake.3
Among those restricting their sodium intake, 42 percent died or were hospitalized for heart problems during the study, compared to 26 percent of those with no salt restrictions
The researchers concluded, “In symptomatic patients with chronic HF [heart failure], sodium restriction may have a detrimental impact on outcome.”It’s possible that restricting salt could backfire by altering a person’s fluid volumes. Lead researcher Dr. Rami Doukky told Medical Xpress:5
“The idea is sodium restriction leads to a contraction of the fluid volume in the body, and that turns on certain hormones which try to retain fluids in the body and may potentially accelerate the heart failure process."
Heart Benefits of Salt Restriction Increasingly Questioned
The heart benefits of restricting salt intake have been questioned for some time. In 2011, a systematic review of data involving 6,500 people also found evidence was lacking to recommend salt restriction.6
Among people with high blood pressure or normal blood pressure, salt restriction was not significantly associated with overall mortality or cardiovascular mortality. Among those with congestive heart failure, meanwhile, salt restriction was associated with increased mortality risk.
An update to the review, published in 2014, also found “there is insufficient power to confirm clinically important effects of dietary advice and salt substitution on cardiovascular mortality” among people with high blood pressure or normal blood pressure.7
Yet another meta-analysis found that people with heart failure who limited their sodium intake had a 160 percent higher risk of death than those who did not.8
Some studies have shown a modest benefit to salt restriction among somepeople with high blood pressure, but the evidence does not extend to the rest of the population. So what’s really going on?
For starters, there’s a huge difference between natural salt and the processed salt added to processed foods and salt shakers in most homes and restaurants. The former is essential for good health, whereas the latter is best avoided altogether.
Sally Fallon Morell, president of the Weston A. Price Foundation, stated:9
"A study from 1991 indicates that people need about one and one-half teaspoons of salt per day.
Anything less triggers a cascade of hormones to recuperate sodium from the waste stream, hormones that make people vulnerable to heart disease and kidney problems. This is proven biochemistry.”
Too Little Salt May be Dangerous
The U.S. Food and Drug Administration (FDA) and the Food Safety Inspection Service (FSIS) recommend limiting your daily sodium intake to less than 2,300 milligrams (mg).
They advise a further reduction to 1,500 mg (just over one-half teaspoon) for people who are age 51 and older, African-American, or who have hypertension, diabetes or chronic kidney disease (this encompasses about half of the U.S. population).
However, there are very real risks from eating too little salt, and population-wide recommendations to restrict salt intake to very low levels could in fact increase rates of a wide range of diseases. 
For instance, in one study a low-salt diet led to an increase in insulin resistance, which is a risk factor for type 2 diabetes — and the change occurred in just seven days.10

Research published in JAMA also found that consuming less than 3,000 mg of sodium per day may increase your risk of dying from heart disease.11
A low-sodium diet is even linked to increases in LDL cholesterol and triglycerides,12 and an increased risk of death for diabetics (another population that’s often advised to restrict their sodium intake).13 
There’s also hyponatremia, in which your body has too little sodium, causing fluid levels to rise and your cells to swell. Hyponatremia is most common in older adults and athletes (whose sodium levels may become depleted by excessive sweating and drinking too much water).
This swelling can cause a number of health problems, from mild to severe. At its worst, hyponatremia can be life threatening, leading to brain swelling, coma and death.
But mild to moderate hyponatremia has more subtle effects that you or your health care provider may not even connect with a sodium-deficiency problem, including:

Nausea, vomiting, and changes in appetite
Headache Confusion Hallucinations
Loss of energy Fatigue Urinary incontinence
Nervousness, restlessness and irritability, and other mood changes

Muscle weakness, spasms or cramps
Seizures Unconsciousness Coma

Your Sodium:Potassium Ratio
Another factor that can have a significant impact on whether salt will harm or help your health is the ratio between the salt and potassium in your diet.

Your body needs potassium to maintain proper pH levels in your body fluids, and it also plays an integral role in regulating your blood pressure. It’s possible that potassium deficiency may be more responsible for hypertension (which is a risk factor for heart disease) than excess sodium.
Imbalance in your sodium:potassium ratio can lead to hypertension, and the easiest way to achieve this imbalance is by consuming a diet of processed foods, which are notoriously low in potassium while high in sodium.
Processed foods are also loaded with fructose, which is clearly associated with increased hypertension risk, as well as virtually all chronic diseases. This may also explain why high-sodium diets appear to affect some people but not others.

According to a 2011 federal study into sodium and potassium intake, those at greatest risk of cardiovascular disease were those who got a combination of too much sodium along with too little potassium.14
According to Dr. Elena Kuklina, one of the lead authors of the study, potassium may neutralize the heart-damaging effects of salt. Tellingly, those who ate a lot of salt and very little potassium were more than twice as likely to die from a heart attack as those who ate about equal amounts of both nutrients.
While potassium is found in many foods commonly consumed in the U.S. – including fruits, vegetables, dairy products, salmon, sardines, and nuts – only 2 percent of U.S. adults get the recommended daily amount of 4,700 mg.15 The easiest way to achieve an imbalance in your sodium-to-potassium ratio is by consuming a diet of processed foods, which are notoriously low in potassium while high in processed salt. 
According to the FDA, 77 percent of Americans sodium intake comes from processed and restaurant foods; when you reduce processed foods in your diet, you’ll automatically reduce your intake of processed salt as well.
How to Improve Your Sodium-Potassium Ratio
If you eat a lot of processed foods and not many vegetables, there’s a good chance your sodium-to-potassium ratio is unbalanced. If you’re not sure, try a free app like My Fitness Pal, which allows you to enter the foods you eat and then calculates the ratio automatically.
It's generally recommended that you consume five times more potassium than sodium, but most Americans get two times more sodium than potassium. If your ratio is out of balance:

  • Ditch all processed foods, which are very high in processed salt and low in potassium and other essential nutrients

  • Eat a diet of whole, unprocessed foods, ideally organically and locally grown to ensure optimal nutrient content. This type of diet will naturally provide much larger amounts of potassium in relation to sodium

  • When using added salt, use a natural salt. I believe Himalayan salt may be ideal, as it contains lower sodium and higher potassium levels compared to other salts16

It can be difficult to get enough potassium from diet, but the best way to do so is to increase the amount of vegetables you consume. Green vegetable juicing is an excellent way to ensure you’re getting enough nutrients for optimal health, including about 300 to 400 mg of potassium per cup. Some additional rich sources of potassium are:

  • Lima beans (955 mg/cup)

  • Winter squash (896 mg/cup)

  • Cooked spinach (839 mg/cup)

  • Avocado (500 mg per medium)

 Other potassium-rich fruits and vegetables include:

  • Fruits: papayas, prunes, cantaloupe, and bananas. (But be careful of bananas as they are high in sugar and have half the potassium of an equivalent amount of green vegetables. It is a myth that you are getting loads of potassium from bananas; the potassium is twice as high in green vegetables)

  • Vegetables: broccoli, Brussels sprouts, avocados, asparagus, pumpkin, Swiss chard, and beet greens

 Top Tips to Prevent Heart Failure and Other Heart Problems
There are many strategies that can protect your heart no matter what your age. Please don't wait until you experience heart attack symptoms or heart failure to take action because by then it may be too late. Do so now in order to prevent any long-lasting damage:
Eat unprocessed saturated animal fats, and ignore the media, as you will benefit from these fats. Many may also benefit from increasing the healthy fat in their diet to 50 to 85 percent of daily calories.
Avoid sugars, including processed fructose and grains if you are insulin and leptin resistant. It doesn't matter if they are conventional or organic, as a high-sugar, high-grain diet promotes insulin and leptin resistance, which is a primary driver of heart disease.
Minimize your intake of salt from processed foods and instead use natural Himalayan salt to flavor your real food.
Exercise regularly. People who engage in at least 150 minutes of moderate exercise, or 75 minutes of vigorous exercise a week, had a 33 percent lower risk of heart failure than inactive people.17 Use a combination of high-intensity interval training, strength training, stretching, and core work.
Avoid excess sitting; aim for three hours a day or less of sitting and try to take 10,000 steps a day (in addition to your exercise program).
Regularly walk barefoot to ground with the earth. When you do, free electrons are transferred from the earth into your body; this grounding effect is one of the most potent antioxidants we know of and helps alleviate inflammation throughout your body.
Manage your stress daily. One of my favorite tools for stress management is the Emotional Freedom Technique (EFT).

Sources and References
JACC Heart Failure January 2016
Authority Nutrition January 2016
Medical Xpress December 28, 2015
1 American Heart Association, About Heart Failure
2, 4 JACC Heart Failure January 2016
3, 5 Medical Xpress December 28, 2015
6 Cochrane Database Syst Rev. 2011 Jul 6;(7):CD009217.
7 Cochrane Database Syst Rev. 2014 Dec 18;12:CD009217.
8 Am J Hypertens. 2011 Aug;24(8):843-53.
9 Weston A. Price Foundation Commentary to FDA January 22, 2012
10 Metabolism – Clinical and Experimental November 1, 2010
11 JAMA. 2011 Nov 23;306(20):2229-38.
12 Cochrane Database Syst Rev. 2003;(1):CD004022.
13 Diabetes Care. 2011 Apr;34(4):861-6.
14 Arch Intern Med. 2011;171(13):1183-1191
15 Medicine Net September 4, 2014
16 U.S. FDA, Sodium in Your Diet
17 Science Daily November 21, 2015

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