Not only does the weight of the evidence suggest that there is no risk in aggressive salt reduction, Mozaffarian said. “You don’t have any plausible biology to explain why you’d get an uptick in risk with low sodium intake.”
There’s another reason for skepticism. The PURE study assessed sodium consumption based on a single urine sample collected each morning. Antman called that a “very unreliable method” for measuring salt intake.
“The gold standard is 24-hour urine collection, and they didn’t use it. And even then your sodium intake may vary a lot from day to day,” he told Reuters Health.
“The bottom line is, the American Heart Association position has not changed in response to the PURE paper,” said Antman, a cardiovascular expert at Brigham and Women’s Hospital in Boston. The association recommends less that 1.5 grams of sodium daily.
Nonetheless, Dr. Suzanne Oparil of the University of Alabama at Birmingham contends in a Journal editorial that, “Both high and low levels of sodium excretion may be associated with an increased risk of death and cardiovascular-disease outcomes and (the tests suggest) that increasing the urinary potassium excretion counterbalances the adverse effect of high sodium excretion.”
That idea should be confirmed in a large study, she said, but “in the absence of such a trial, the results argue against reduction of dietary sodium as an isolated public health recommendation.”
“The big picture is that high sodium is bad and should be reversed, and there’s just some controversy over how low you should go,” said Mozaffarian, adding that doctors and patients should be pushing for a strong national policy to reduce the sodium content of processed food.
“Whether it should be 2 grams or 1.5 grams or 2.5 grams per day, that’s all theory.” he said. “Right now it’s close to 4 grams per day. Let’s get it down below 3, and then we can argue how low it should go. But right now it’s clearly way too high.” (Reuters)[eap_ad_3]
