Sweet and Salty

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 Hypertension is defined as a systolic blood pressure of 140 or greater and a diastolic BP of 90 or greater. Recently, hypertension has been ranked as one of the leading causes of worldwide disability. It is estimated that one billion adults worldwide (25 percent of the population) have hypertension and this number is expected to rise. Traditional advice to those who have an elevated blood pressure has been to reduce dietary salt intake. In general, dietary salt intake is more than six grams (2400 mg) with 95 percent of the global population consuming between 7.5 and 12.5 grams of salt per day. Recent evidence has begun to cast doubt on the traditional advice to reduce salt intake to lower blood pressure.

In India, most people consume about 11 grams of salt per day, but because of the hot, dry climate they may lose six grams a day through sweating. Hypertension is a serious health concern there and accounts for 24 percent of heart disease and 57 percent of all stroke deaths. Despite the Indian government’s efforts to reduce salt intake, the incidence of hypertension continues to rise. Health experts in India have begun to realize that salt may simply come along with added sugars. In other words, salt may be an “innocent bystander.” Traditional advice here and elsewhere has been to reduce salt intake and increase exercise, yet these two recommendations may be contradictory because exercise or physical work, especially in a warm or hot environment, and a reduced salt diet may increase the risk of heat exhaustion and prostration. Plus, reduced salt intake may predispose a person to have a negative calcium and magnesium balance, which may lead to osteoporosis, hypertension, adverse heart events, arrhythmias, and sudden death. Like in India, recent studies done here suggest that sugar, not salt, is the likely dietary culprit causing hypertension.

Many believe that salting food leads to overeating and its related complications. However adding salt to bitter or bland foods, like vegetables or nuts, will probably increase their consumption because salt enhances flavor. In addition, a higher intake of vegetables and nuts leads to reductions in risk of hypertension and heart disease. Salt “appetite” is an evolutionary conserved mechanism that is approximately 100 million years old. It drives us to seek out and obtain salt when we need it. Salt is needed for basic bodily metabolic functions.

More and more evidence and studies are pointing to sugar, not salt, as the cause of hypertension and heart disease. Daily consumption of fruit juice (composed mostly of free sugars) is associated with higher blood pressure. Recent controlled studies have shown that a diet high in sugar, as compared to a low-sugar diet, for just a few weeks causes an increase in blood pressure. All this evidence is suggesting that clinicians should advise their hypertensive patients to cut down on the intake of added sugars (sucrose, high fructose corn syrup, starches, and especially bleached [white] rice and flour) and make dietary salt less of an issue.

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