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WellnessAlerts UC Berkeley

From the editors oF the Wellness letter

WellnessAlerts UC Berkeley

The Truth About Salt And Your Health

And Why Potassium May Be the Antidote

TABLE OF CONTENTS
Salt: What Should You Believe? .............................. 1 Salt Tips ............................. 3 Potassium Power ............... 4 Making It Add Up: A Sample Menu ................. 5

Salt: What Should You Believe?

high salt intake and high blood pressure (hypertension) have been linked for many years, not only by scientific research but in the minds of many health-conscious people. However, the furor about trans fat and carbs has moved salt way down on the list of our dietary villains. Only a few people (7%, according to one survey) ever bother to check labels for salt anymore. As concern has faded, people have been eating more salt. Since the early 1980s, U.S. per capita salt intake has risen by about 50%. In large part, this is because Americans have turned increasingly toward takeout and restaurant meals, fast foods, prepared foods, and snacking. Low-sodium foods dont sell well. Most packaged foods and restaurant meals are saltynot just at McDonalds, but also elegant meals on white tablecloths. Portion sizes have increased dramatically, along with the prevalence of obesity and high blood pressure. No connection with salt intake, says the Salt Institute, which looks after the interests of this billion-dollar industry. But we think there is. The U.S. Dietary Guidelines recommend an upper limit of 2,300 milligrams of sodium daily for young people, and no more than 1,500 milligrams for the middle-aged and older, for blacks (who are more prone to hypertension), and for people who already have hypertension. Table salt is actually 40% sodium and 60% chlorine. A teaspoon of salt contains about 2,300 milligrams of sodium, so 1,500 milligrams is only about two-thirds of a teaspoon. However, Americans consume, on average, about 3,400 milligrams of sodium a day, and many eat much more. Health Canada (the Canadian equivalent of the U.S. FDA) is in favor of limiting salt, too; its upper daily limit is also 2,300 milligrams. The American Medical Association is campaigning to lower Amer-

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The Truth About Salt and Your Health

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icans salt intake; for example, it wants restaurants and food manufacturers to reduce salt levels voluntarily. It also wants the government to reclassify salt as a food additive so it can be regulated. The Salt Institute is fighting this, claiming health authorities are acting without solid evidence. One thing is clear: A low-salt diet benefits many people with hypertension. But do other people need to cut back on salt?

In Finland, salt consumption has fallen by one-third in 30 years accompanied by a large decrease in average blood pressure and a 75 to 80% decrease in deaths from strokes and heart disease. Is the salt decrease responsible?

What the Studies Show Many large observational studies over the years have linked a high sodium intake to high blood pressure and increased deaths from heart attacks and strokes. For example, the Intersalt study looked at 10,000 people in 32 countries and concluded that high salt intake was directly related to hypertension and deaths from stroke. But according to critics, these big population studies do not prove much. Most relied on personal recallpeople reported what they thought they ate, which may have been different from what they did eat. It is much harder to dismiss the research on the DASH (Dietary Approaches to Stop Hypertension) diet, which consists of fruits, vegetables, and whole grains, plus small servings of meat and dairy. It also provides a lot of potassium, magnesium, and other minerals that help control blood pressure. DASH comes in two versionsone with 2,300 milligrams of sodium a day, the other with 1,500. Both diets lower blood pressure in healthy people, but most dramatically in those with hypertension. The lower-sodium version lowers blood pressure even more. If your blood pressure is normal, and you keep your sodium intake moderate, will that prevent hypertension? We have to admit that nobody knows for sure. But think of this: A 2007 study in Progress in Cardiovascular Diseases from researchers at the University of Helsinki reports that thanks to consistent efforts in Finland, salt consumption has fallen by onethird in 30 yearsaccompanied by a large decrease in average blood pressure and a 75 to 80% decrease in deaths from strokes and heart disease. Is the salt decrease responsible? The pro-salt faction would say no, but we think it played a role. If you want to avoid cardiovascular disease, salt reduction is a very good bet. Advice, and More Advice Heres what the salt industry advises: Theres no ironclad evidence a high salt intake is bad, so dont worry. Eat what you want, and enjoy yourself. Help us make a lot of money out of salt. Heres our advice: Hypertension and heart disease are highly complex disorders. Nobody has yet pinned down a high salt intake as
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A Few Tips Always read labels. Buy reduced-sodium products. Avoid highly processed foods. Pick a plain turkey breast or
pork tenderloin rather than one packaged with a marinade or sauce.

Beware of canned or packaged soups, broths, and stocks. Soy sauce, tamari sauce, and most sauces used in Asian cookNobody has yet pinned down a high salt intake as the chief or only villain behind hypertension and
ing are salt bombs.

Watch out for canned vegetable juices, usually very salty. Drain and rinse canned goods, such as beans, to remove most
salt.

If your food is being prepared to order, ask the server to ask

the cook not to add salt.

heart disease. But what you can achieve by cutting down on salt is a better diet.

Reducing portion sizes also reduces sodium intake.

the chief or only villain. It may turn out that salt is just some kind of fellow-traveler. That is, salty foods like French fries, fast-food sandwiches, pizza, TV dinners, and canned soups are usually also high in calories and bad fats and low in nutrients. You get a lot of salt, but not much potassium, magnesium, or other nutrients that help keep blood pressure normal and that constitute healthy eating. What you can achieve by cutting down on salt is a better diet. Bottom line: Everyone should try to consume no more than 2,300 milligrams of sodium a day. However, if youre middle-aged or older, black, or have hypertension (thats about 70% of the population), 1,500 milligrams is a better goal. In addition, if you have pre-hypertension (120/80 to 139/89), you should also aim for a maximum of 1,500 milligrams a day. If you dont know your blood pressure, get it checked. Fresh fruits, vegetables, whole grains, fish, and meats are naturally low in sodium. You dont need to add lots of salt. But your salt shaker is the least of your worries. To really cut down on sodium, youll need to limit or avoid most processed foods and restaurant meals, or at least choose carefully among them, since they provide about three-quarters of the sodium consumed in this country. Most people can quickly get used to a lower-sodium diet by using pepper, herbs, spices, lemon juice, garlic, vinegar, and other flavoring

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Salt Mines
If you knew that a meal at a restaurant contained a days worth of sodium, would you still order it? According to a report from the Center for Science in the Public Interest, which looked at complete meals at 17 chain restaurants, its actually very easy to get at least this much sodium. For example, if you order the Buffalo Chicken Fajitas at Chilis, with tortillas and condiments, youll get close to 7,000 milligrams of sodium. Thats three days worth of sodium for healthy people, who should limit their intake to 2,300 milligrams a day. And its close to five days worth for those who should limit sodium to 1,500 milligrams a day. This is alarming news for anyone who frequents chain restaurants. Regularly consuming large amounts of sodium increases the lifetime risk of high blood pressure and other health problems. And a single large load of sodium can precipitate heart failure in some susceptible people. Children who eat a lot of sodium (and childrens meals were found to have as much as 2,400 milligrams) are also at risk for high blood pressure and early cardiovascular disease.

While Americans consume far too much sodium, they get too little potassium (Canadians do only a little better). That may be one reason why most people here eventually develop high blood pressure.

agents. After a short time, youll begin to appreciate the flavors of foods, and salty things wont taste as good.

Potassium Power
If sodium is a bad guy, then potassium is a good guy. While sodium is linked to hypertension, potassium helps lower blood pressure. Sodium tends to be found in junk food, while potassium is mostly found in very nutritious foods. In fact, a recent Canadian study suggested that a simple test for urinary potassium level (which closely follows dietary potassium intake) provides an accurate picture of how good someones diet is. It found that the higher the potassium level, the better the diet tends to be (accompanied by lower blood pressure and body weight as well). If other research confirms these findings, such a test would be a good way for doctors to assess their patients eating habits, always a tricky matter. Like sodium, potassium helps control blood pressure, among other vital functions. While Americans consume far too much sodium, they get too little potassium (Canadians do only a little better). That may be one reason why most people here eventually develop high blood pressure. But in the developing world, where

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The Truth About Salt and Your Health

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diets tend to be relatively rich in potassium and low in sodium, high blood pressure is nearly nonexistent. When people move from developing to industrialized countries, however, their blood pressure tends to rise, and the change in diet may be a factor in this.

How can you possibly get 4,700 milligrams of potassium a day, as recommended? Actually, potassium is found in many foods, even tea and coffee. So it usually isnt hard to reach that goal, especially if your diet is semi-vegetarian.

A Mineral Seesaw The U.S. government recommends at least 4,700 milligrams of potassium a daytwice as much potassium as sodium. Thats what the anti-hypertension DASH diet provides. However, most Americans get only half that much potassium, and many consume less potassium than sodium. An easy way to cut down on sodium is to choose more potassiumrich foods. As one mineral goes up in the diet, the other tends to go down. Vegetables (especially leafy greens and potatoes), bananas, citrus fruits, and beans are rich in potassium. Dairy products, fish, and nuts are also good sources. These foods help keep us healthy in other ways, too. Dont take potassium supplements, unless your doctor has recommended them. Potassium supplements can supply dangerous amounts, resulting in abnormal heart rhythms; theres little or no potassium in multivitamin/mineral pills. In any case, the beneficial effects appear to come mainly from the form of potassium found in foods, not the type in most supplements. Keep in mind: Potassium is not great for everyone. People who have impaired kidney function or are taking certain medications may need to limit their intake in order to prevent potentially dangerous arrhythmias. This is especially true for those taking ACE inhibitors or potassium-sparing diuretics. Potassium: Making It Add Up You may have wondered, if you consume 1,500 to 2,000 calories a day, how can you possibly get 4,700 milligrams of potassium, as recommended? Actually, potassium is found in many foods, even tea and coffee. So it usually isnt hard to reach 4,700 milligrams, especially if your diet is semi-vegetarian. Obviously, if you are a man who consumes, say, 2,700 calories a day, the 4,700-milligram goal is easier. However, if you take in just 1,500 calories, it can be harder. Like most dietary guidelines for vitamins and minerals, this advice is one-size-fits-all. If you are small and consume relatively few calories, you probably need less potassium. In addition, sodium intake also affects potassium needs. Thus, if your diet is low in sodium, you may need less than 4,700 milligrams of potassium.
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Below is a menu that provides 4,700 milligrams of potassium a day. Though we chose these foods only because of their potassium, all together they supply just 1,700 milligrams of sodium and 1,957 calorieseven with a deli sandwich for lunch.

A Sample Daily Menu

meal Breakfast Food Shredded wheat, 1 cup Milk, nonfat, 1 cup Cantaloupe, cubed, 1/2 cup Orange juice, 6 oz Coffee, black, 6 oz Banana Sandwich (turkey, swiss, tomato, lettuce, mayo, on whole wheat) Baby carrots, 8 Fig bar cookies, 2 Iced tea, 8 oz, unsweetened Almonds, unsalted, 1 oz Raisins, 1 oz Milk, nonfat, 1 cup Baked salmon, 3 oz Brown rice, 1/2 cup Tossed salad, low-fat dressing Spinach, cooked, 1/2 cup Angel food cake with strawberries, 1 slice Wine, red, 4 oz Coffee, decaf, black, 6 oz Total Calories 183 80 27 82 6 105 395 28 110 3 170 84 80 150 108 100 20 110 110 6 1,957 Potassium (mg) 248 380 215 375 85 490 500 190 66 88 210 200 380 257 42 350 420 140 125 85 4,846

Snack Lunch

Snack

Dinner

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The Truth About Salt and Your Health

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About Us
The Berkeley Wellness Alerts are a service of University Health Publishing, a division of Remedy Health Media, publisher of the acclaimed UC Berkeley Wellness Letter, Wellness Reports, and other health resources. We rely on the expertise of the School of Public Health and other researchers at the University of California, Berkeley, as well as other top scientists from around the world. Our publications translate this leading-edge research into practical advice for daily livingat home, at work, while exercising, and in the supermarket or health-food store. The Berkeley Wellness Alerts website provides valuable free information about healthy living in an easy-to-read format. On the website you can read free health alerts and special reports in six topic areashealthy diet, dietary supplements, mens health, womens health, healthy heart, and lifelong wellness. If you would like to read more publications like this, visit us at www.BerkeleyWellnessAlerts.com/bookstore.

Wellness Disclaimer:
This Bulletin is not intended to provide advice on personal medical matters or to substitute for consultation with a physician. Copyright 2011 Remedy Health Media All rights reserved. Remedy Health Media 500 Fifth Avenue Suite 1900 New York, NY 10110

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Mens Health
By many measures, men are at a health disadvantage compared with womenthey have a greater incidence of cancer and heart disease, for example, and are less likely to seek medical help. But there is much a man can do now to take charge of his well-being. Among the topics in this report: The PSA test for prostate cancer: Should you have it? The critical risk factors associated with heart attacks in men

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and the evidence-based strategies to cut those risks. Bone loss can impact men as well as womensee the new recommendations for screening men for U C p s osteoporosis. If youre fretting about hair loss, we tell you what works and what doesntbased on the latest evidence.
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One of the most respected educational institutions in the world, the University of California, Berkeley, has, for over a century, built an extraordinary record of achievement. Its faculty has produced 21 Nobel laureates, Five Pulitzer Prize winners, 135 appointees to the National Academy of Sciences, and 30 Steve McConnell / UC Berkeley winners of the National Medal of Science. For nearly 60 years, the School of Public Health at UC Berkeley has helped promote and protect the health of Americans. It is one of the nations leading research and teaching institutions in this field. Its internationally renowned faculty includes physicians, educators, psychologists, nutrition experts, epidemiologists, and public health professionals. Among its areas of research: the control of cancer, the relationship between diet and disease prevention, occupational health, the link between social support and good health, and environmental health.

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HIGHLIGHTS

John Edward Swartzberg, M.D., F.A.C.P. Editor-in-Chief, Wellness Reports Dr. Swartzberg is Chair of the Editorial Board of the University of California, Berkeley, Wellness Letter. An internist and infectious disease specialist with more than 25 years of experience as a primary-care physician, he is Clinical Professor of Medicine at the School of Public Health at UC Berkeley and at the School of Medicine at UC San Francisco. Currently, he is Director of the UCB-UCSF Joint Medical Program, an innovative cross-disciplinary medical school program.

Eating for Optimal Health

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Womens Health

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John edward swartzBerg, M.d., f.a.C.p. williaM a. pereira, M.d., M.p.h.

niversity of alifornia, Berkeley Chool of UBliC health

and the Editors of the UC Berkeley Wellness Letter

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Womens Health
How should a woman live to assure that she will be healthy, active, and productive? Here are important new findings and recommendations on diet, exercise, cancer, heart disease, bone health, and more. Among the topics: A guide to recommended screening tests for preventive care: who needs them and how often. Carbs, fat, and gender: special dietary advice for women. How to assess a womans lifetime risk of heart disease. Re-evaluating the health risks of hormone therapywith expert advice on the alternatives. Steps you can take when your sex drive is on underdrive.

Controlling Your Cholesterol

This report brings you up to date on how to evaluate and better manage unhealthy cholesterol levels, and also provides you with additional potentially life-saving tools for reducing your risk of a heart attack. Sample topics: The finer points of cholesterol screeningand how to weigh your results with other risk factors for heart disease. The latest research into HDL (good) cholesteroland five strategies to raise your HDL levels. A cholesterol-lowering action planwith dietary measures that research shows will have the biggest impact. Statin drugs: the facts about their effectiveness and safety, and determining if a statin is right for you.

Dietary Supplements
Are you a big believer in taking nutritional supplements? Or are you skeptical, but considering trying supplements to improve your health? This report will tell you what we know, whats still a mysteryand how to look, beyond the hype, at supplements that have made news, including: Promising new research on fish oil and St. Johns Wort. The latest evidence on glucosamine, selenium, ginkgo, creatine, and vitamin Ewith bottom-line recommendations. Should you consider taking a multivitamin? Yes, if you fall into one of these six groups. 11 dietary supplements known to be hazardous to human health.

Eating for Optimal Health

This report on the latest findings in nutrition provides 15 keys to a healthy diet along with other disease-protecting nutrition essentialsand presents new insights and recommendations on current nutritional fads and concerns. Youll get expert advice on such topics as: The top 14 foods for obtaining antioxidants. How much should you focus on the ratio of heart-protective omega-3 and omega-6 fatty acids? The results of a new study on three popular dietsand what this tells you about weight loss. A complete guide to vitamins and minerals: benefits, recommended intakes, and the best sources.

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