The People's Perspective on Medicine

Show 1160: How Good Is the Evidence for Cutting Salt?

Cutting salt from our diets has been dogma for many years. Yet there is not very much evidence to support the extreme efforts some people make.
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How Good Is the Evidence for Cutting Salt?

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For decades, public health experts have been admonishing Americans to cut the salt in our diets. In fact, the American Heart Association recommends that we limit ourselves to 2,300 mg of sodium daily. That’s about one teaspoon. Ideally, the AHA says, we would get less than 1,500 mg of this crucial mineral every day. 

Should You Be Cutting Salt?

Why is salt such a problem? People who consume large quantities of salt tend to have high blood pressure. When they reduce their sodium intake, their blood pressure often drops. But what about people who get ordinary amounts of salt in their food? Should they be struggling to cut back?

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Dr. Aaron Carroll is very conscious of the medical evidence for such recommendations. Surprisingly, what he says about salt restriction is that there isn’t very much scientific data to support it. Because it has been dogma all these years, it sounds like heresy to suggest that cutting back on salt might not make very much difference for most people and could even be harmful for a few. Have health care providers embraced other recommendations despite a paucity of evidence? Call in your questions or observations: 888-472-3366 between 7 and 8 am EDT on Saturday, April 13, 2019.

Side Effects of Gabapentinoids:

Doctors have recently started prescribing one group of medicines far more frequently than they once did. The gabapentinoids (gabapentin and pregabalin, aka Neurontin and Lyrica) were originally introduced as anticonvulsants. However, doctors now prescribe them widely for serious pain conditions on the assumption that they are safer than opioids. What evidence do we have for their effectiveness for pain. In addition, just how safe are they?

Tom Moore of ISMP shares the results of the latest QuarterWatch on dangerous adverse effects of these medications. Call in your questions and stories about gabapentin or pregabalin: 888-472-3366 between 7 and 8 am EDT, 4/13/19. Or send us email: radio@peoplespharmacy.com

This Week’s Guests:

Thomas Moore is a senior scientist with the non-profit Institute for Safe Medication Practices and a lecturer at George Washington University School of Public Health. The most recent QuarterWatch was published on March 27, 2019.

Aaron Carroll, MD, is a Professor of Pediatrics and Associate Dean for Research Mentoring at Indiana University’s School of Medicine, and Director of the Center for Pediatric and Adolescent Comparative Effectiveness Research. His research focuses on the study of information technology to improve pediatric care, health care policy, and health care reform.

In addition to his scholarly activities, he has written about health, research, and policy for CNN, Bloomberg News, the JAMA Forum, and the Wall Street Journal. The photograph is copyright Marina Waters.

He has co-authored three popular books debunking medical myths, has a popular YouTube show called Healthcare Triage, and is a regular contributor to the New York Times’ The Upshot. Dr. Carroll’s most recent book is The Bad Food Bible: How and Why to Eat Sinfully.

Listen to the Podcast:

The podcast of this program will be available the Monday after the broadcast date. The show can be streamed online from this site and podcasts can be downloaded for free. CDs may be purchased at any time after broadcast for $9.99.

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About the Author
Terry Graedon, PhD, is a medical anthropologist and co-host of The People’s Pharmacy radio show, co-author of The People’s Pharmacy syndicated newspaper columns and numerous books, and co-founder of The People’s Pharmacy website. Terry taught in the Duke University School of Nursing and was an adjunct assistant professor in the Department of Anthropology. She is a Fellow of the Society of Applied Anthropology. Terry is one of the country's leading authorities on the science behind folk remedies. .
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I’ve long been a believer that salt is not the enemy , but efforts to convince others – especially Drs -have been fruitless. My Father , who ate a large amount of salt and suffered from hypertension ( hereditary) tried reducing or eliminating salt with no effect on his blood pressure. He resumed his normal , high salt Meat , eggs, , potatoes , and dessert , diet. He lived to be 87 but never stopped working ( physically and mentally). Perhaps , that is more significant than diet . I read long ago in National Geographic , about a remote tribe of people who had the highest consumption of salt ( by far !) in the world … and the greatest longevity ( by far !).

To capture some of the anti-salt history requires looking back to the 70s. The population getting attention from researchers was Japanese – who ate lots of salted fish. Now, they had high rates of hypertension, smoked more than Americans – but took their meds which were ahead of the US meds and lived longer than Americans. Smokers also salted food more because their taste was impaired.

I have seen no study showing improvements in morbidity or mortality from less than a 2.5 g Sodium intake.
BTW, I switched my goats to ancient sea salt but needed to add iodized salt back to their diet when they developed goiters.

I was interested in your discussion of lipoprotein (a) today. My mother died of a heart attack when she was 54. My primary physician tested me for lp (a) and decided I should take 1000 mg of Niacin every day. He continues to test my lp (a) levels and says it’s helping. My maternal Aunt and Uncle also have the same high levels of lp (a). I have low LDL levels and normal HDL levels. This is a very important topic I’d like to know more about.

The last time I checked with the NIH the test results regarding the affects of salt on blood pressure and they were minimal (2 to 6 points out of say 150 systolic). To me that isn’t proof enough that there is a strong relationship between salt and BP.

About ten years ago I was having a lot of dizziness upon standing up either from a chair or after bending down (no fun in the supermarket when I needed something on a low shelf!). At that time I had cut way back on salt because my spouse had high blood pressure and was on a low-salt diet.

My doctor told me to eat more salt, which I was happy to do and still do, and this completely cured the dizziness episodes. My blood pressure has remained at a healthy low-normal rate. Cutting back on salt can be dangerous!

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