Does Sodium Intake Affect Mortality and CV Event Risk?

Sodium intake may not be associated with mortality or incident cardiovascular events in older adults, according to a study published Jan. 19 in the JAMA: Internal Medicine.

In the Health, Aging and Body Composition (Health ABC) Study, initiated in 1997, researchers assessed self-reported sodium intake from 2,642 Medicare beneficiaries, ages 71-80 years old. Participants were excluded for difficulties with walking or activities of daily life, cognitive impairment, inability to communicate, and previous heart failure (HF). At the first annual follow-up visit, researchers recorded food intake as reported by participants, specifically examining sodium intake. After 10 years, 34 percent of patients had died, while 29 percent and 15 percent had developed cardiovascular disease and HF, respectively.

The results of the study showed that there was no association between participant-reported sodium intake and 10-year mortality, incident HF or incident cardiovascular disease. Further, there was no indication that consuming less than 1,500 mg/d of sodium benefitted participants any more than consuming the recommended amount (1,500-2,300 mg/d). However, the study showed a slight potential for harm when participants had a sodium intake of greater than 2,300 mg/d, especially in women and African Americans.

The authors note that while the food frequency questionnaire used by participants at the first annual follow-up has limitations in its accuracy, “self-reported adoption of a low-salt diet was not associated with significantly higher risk for [any] events.” They conclude that moving forward, there is a need for further research and stronger evidence in order to create better recommendations for older adults.

– See more at:

Myths About High Blood Pressure.

1) Myth. High blood pressure runs in my family. There is nothing I can do. I will get it too.

High blood pressure can run in families. If your parents or close blood relatives have had high blood pressure, you are more likely to develop it, too. However, lifestyle choices have allowed many people with a family history of high blood pressure to avoid it themselves. Lifestyle changes you can make to prevent it include:

  • Eat a better diet, which may include reducing sodium.
  • Enjoy regular physical activity.
  • Maintain a healthy weight.
  • Manage stress.
  • Avoid tobacco smoke.
  • Comply with medication prescriptions.
  • If you drink, limit alcohol.

2) Myth. I don’t use table salt, so I’m in control of my sodium intake and my blood pressure isn’t affected.

In some people, sodium can increase blood pressure. But controlling sodium means more than just putting down the salt shaker. It also means checking labels, because up to 75 percent of the sodium we consume is hidden in processed foods like tomato sauce, soups, condiments, canned foods and prepared mixes. When buying prepared and prepackaged foods, read the labels. Watch for the words “soda” and “sodium” and the symbol “Na” on labels; these words show that sodium compounds are present.

3) Myth. I use kosher or sea salt when I cook instead of regular table salt. They are low-sodium alternatives.
Chemically kosher salt and sea salt are the same as table salt – 40 percent sodium – and count the same toward total sodium consumption. Table salt is a combination of the two minerals sodium (Na) and chloride (Cl). Learn more about Sea Salt Vs. Table Salt.

4) Myth. I feel fine. I don’t have to worry about high blood pressure.

More than 76 million U.S. adults have high blood pressure – and many of them don’t know it or don’t experience typical symptoms. High blood pressure is serious. If uncontrolled, high blood pressure can lead to severe health problems. High blood pressure is also the No. 1 cause of stroke.

5) Myth. People with high blood pressure have nervousness, sweating, difficulty sleeping and their face becomes flushed. I don’t have those symptoms so I must not have high blood pressure.

Many people have high blood pressure for years without knowing it. High blood pressure is often called “the silent killer” because it has no symptoms, so you may not be aware that it’s damaging your arteries, heart and other organs. Don’t make the mistake of assuming symptoms will alert you to the problem of high blood pressure. Everybody needs to know their blood pressure numbers. Diagnosis should only be made by a healthcare professional.

6) Myth. I read that wine is good for the heart, so I can drink as much of it as I want.

If you drink alcohol, including wine, do so in moderation. Heavy and regular use of alcohol can increase blood pressure dramatically. It can also cause heart failure, lead to stroke and produce irregular heartbeats. Too much alcohol can contribute to high triglycerides, cancer, obesity, alcoholism, suicide and accidents, and it can be highly addictive. If you drink, limit consumption to no more than two drinks per day for men and one drink per day for women. Generally, one drink equals a 12-ounce beer, a four-ounce glass of wine, 1.5 ounces of 80-proof liquor, or one ounce of hard liquor (100-proof).

7) Myth. I have high blood pressure and my doctor checks it for me so I don’t need to check it at home, too.

Because blood pressure can fluctuate, home monitoring and recording of blood pressure readings can provide your healthcare provider with valuable information to determine whether you really have high blood pressure and, if you do, whether your treatment plan is working. It’s important to take the readings at the same time each day, such as morning and evening, or as your healthcare professional recommends.

8) Myth. I was diagnosed with high blood pressure and I have been maintaining lower readings, so I can stop taking my medication.

High blood pressure can be a lifelong disease. Follow your healthcare professional’s recommendations carefully, even if it means taking medication every day for the rest of your life. By partnering with your healthcare team, you can successfully reach your treatment goals and enjoy the benefits of better health.

Does Potassium Lower Blood Pressure?

It’s not groundbreaking news that high blood pressure and diet are related. Even when you go the medical doctor route, one of the first things your doctor will suggest is lowering your salt intake to help control your blood pressure. But what else can help? Does potassium lower blood pressure? Often, one important nutritional catalyst is overlooked; and yes, it is indeed potassium.

bananaeaten 235x147 Does Potassium Lower Blood Pressure?

Does Potassium Lower Blood Pressure?

Potassium has several functions in the body, aiding with the proper workings of the heart, kidneys, nerves, muscles and the digestive system. A lack of potassium can manifest itself in many ways, including high blood pressure.

Researchers have looked at the connection between high blood pressure and potassium for decades, determining that simply increasing your potassium intake while lowering your sodium intake is enough to get your blood pressure back under control.

Our friends over at NaturalNews have compiled some pretty telling statements from experts in the medical and nutritional community on the power of potassium in helping control blood pressure.

Sodium and potassium play related role in controlling fluid balance in the body. Without sufficient potassium to help the body secrete sodium, sodium builds up and exerts its harmful effects. Thus, to reduce high blood pressure most people need not only to lower sodium intake but also to increase potassium consumption. Indeed, some studies indicate that potassium intake is a stronger factor in determining blood pressure than is sodium intake. Various population studies confirm a beneficial effect on blood pressure from increases in potassium consumption.

– Off-the-Shelf Natural Health by Mark Mayell

The sudden death that can occur in fasting, anorexia nervosa, or starvation is often a result of heart failure caused by potassium deficiency. Many population studies have found links between low potassium intakes and an increased risk of high blood pressure and death from stroke. Increasing the amount of potassium-rich foods in the diet can lead to a reduction in high blood pressure. The ratio of sodium to potassium in the diet appears to play an important role in the development of high blood pressure. The typical Western diet is low in potassium relative to sodium.

– The New Encyclopedia of Vitamins, Minerals, Supplements and Herbs by Nicola Reavley

One study conducted from St. George’s Medical School in London and published in the April 2005 issue of Hypertension, found that potassium citrate can lower blood pressure just as well as potassium chloride – which has been shown to lower blood pressure. Potassium chloride must be taken in supplement form, while potassium citrate can be attained through foods.

After comparing the blood-pressure-lowering effects of potassium chloride against the effects of potassium citrate, researchers found that each one has similarly positive effects. Adults starting at 151/93 on average found their blood pressure reduced to 140/88 while using potassium chloride, and 138/88 when taking potassium citrate.

Potassium Food Sources

Sure, you could take a potassium supplement. But, why pop a pill when you can get plenty of potassium through healthy food choices. You can get about the same potassium from one bite of a banana as you can from one 99 mg supplement. The following foods are rich in potassium. By cutting down on sodium and eating several of these foods each day, you can combat high blood pressure naturally:



Sodium Reduction in PopulationsInsights From the Institute of Medicine Committee.

The recent Institute of Medicine (IOM) report regarding dietary sodium1 has generated considerable interest and debate, as well as misinterpretation by advocates on both sides. Further discussion is necessary to inform the public and the health care community and to inform public health strategies for sodium reduction.


Dietary sodium intake averages approximately 3400 mg/d in US adults, far in excess of the Dietary Guidelines for Americans (DGA) recommendation of less than 2300 mg/d for those older than 2 years and less than 1500 mg/d for certain high-risk subgroups, including African Americans, individuals with hypertension, diabetes, or chronic kidney disease (CKD), or those older than 50 years.2 In contrast, the 2005 IOM Panel on Dietary Reference Intakes (DRI) for Water, Potassium, Sodium, Chloride, and Sulfate3 found insufficient evidence to derive a “recommended dietary allowance” for sodium. Instead, an “adequate intake” of 1500 mg/d of dietary sodium was determined, reflecting the minimum needed to achieve a diet adequate in essential nutrients and to cover sweat losses. Additionally, the 2005 IOM panel established a “tolerable upper intake level,” using projections from available data on the effects on blood pressure, that consumption up to 2300 mg/d was unlikely to cause harm.

Based on the strength of the blood pressure data, various US (eg, American Heart Association [AHA]) and international (eg, World Health Organization [WHO]) organizations published recommendations for sodium consumption.4– 5 Although these recommendations were somewhat different from the DGA, there was general agreement that sodium consumption is excessive worldwide and should be reduced. Despite these recommendations, more than 90% of US adults consume more than 2300 mg of sodium per day, and among the high-risk subgroups more than 98% consume more than 1500 mg of sodium per day.6

A substantial body of evidence supports efforts to reduce sodium intake. This evidence links excessive dietary sodium to high blood pressure, stroke, and cardiovascular disease (CVD).1However, effects of sodium on blood pressure cannot always be disentangled from effects of total dietary modification, and effects of other electrolytes on blood pressure remain unresolved.7Concerns have been raised that a very low sodium intake may adversely affect lipids, insulin resistance, renin, and aldosterone levels and potentially may increase risk of CVD and stroke. Some studies link sodium intakes of less than 2300 mg/d to increased risk of CVD, at least in subpopulations. Thus, debate emerged about the sodium intake target that best improves health outcomes.

In response, the US Centers for Disease Control and Prevention commissioned the IOM to convene an expert committee to examine the designs, methods, and conclusions of literature published since the 2005 DRI report.3 Specifically, the committee was asked to review and assess potential benefits and adverse outcomes of reducing sodium intake in the population, particularly in the range of 1500 to 2300 mg/d, with emphasis on the high-risk subgroups. The committee was asked to focus on studies of direct health outcomes (vs surrogate end points such as blood pressure), to comment on implications for population-based strategies to reduce sodium intake, and to identify methodologic gaps and ways to address them. The committee’s full report is published elsewhere.1


The committee searched literature published through 2012 for relevant publications. Information also was gathered from an open public workshop. Although not its primary emphasis, the committee summarized studies published since 2003 evaluating intermediate markers, particularly blood pressure. Focusing on CVD outcomes, the committee’s assessment of evidence was guided by factors such as study design, quantitative measures of dietary sodium intake, confounder adjustment, and number and consistency of available studies.


General US Population. Studies linking dietary sodium intake with direct health outcomes were highly variable in methodological quality; limitations included overreporting or underreporting of sodium intake. However, when considered collectively, the evidence on direct health outcomes indicates a positive relationship between higher levels of sodium intake and risk of CVD, consistent with the known effects of sodium intake on blood pressure. Furthermore, in some studies, the association between sodium and CVD outcomes persisted after adjusting for blood pressure, suggesting that associations between sodium and CVD may be mediated through other factors (eg, effects of other electrolytes) or through pathways other than blood pressure.

Studies evaluating sodium intake in the range of 1500 to 2300 mg/d demonstrate evidence of blood pressure lowering, but no studies have examined sodium intake in that range in the general population and direct CVD outcomes. The committee found that studies on direct health outcomes were of inconsistent quality and insufficient quantity to conclude whether sodium intake of less than 2300 mg/d was associated with either a greater or lesser risk of CVD.

Population Subgroups. The committee reviewed multiple randomized trials conducted by a single team that indicated low sodium intake (up to 1840 mg/d) may lead to greater risk of adverse events in patients with heart failure (HF) with reduced ejection fraction who received aggressive therapeutic regimens. Because these therapeutic regimens were different from standard US practice, trials using regimens that more closely resemble standard US clinical practice are needed. Of note, due to allegations of duplicate publication in 2 of these trials, a meta-analysis including them was recently retracted, after the IOM report’s completion.8 Another recently published small randomized trial involving patients with acute decompensated HF showed no benefit on weight or clinical stability from a combination of sodium and fluid restriction.9

The committee reviewed 2 related studies in individuals with prehypertension that suggested benefit from lowering sodium intake to 2300 mg/d and perhaps lower, although these studies were based on small numbers of persons with sodium intake in the less than 2300 mg/d range. In contrast, for patients with diabetes, CKD, or preexisting CVD, the committee found no evidence of benefit and some evidence suggesting risk of adverse health outcomes at sodium intake of 1500 to 2300 mg/d. In studies that explored statistical interactions, race, age, hypertension, and diabetes did not modify associations of sodium with health outcomes. The committee concluded that, with the exception of heart failure, evidence of both benefit and harm is not strong enough to indicate that these subgroups should be treated differently from the general US population. Thus, the committee also concluded that evidence on direct health outcomes does not support recommendations to lower sodium intake within these subgroups to or even less than 1500 mg/d.


Although not asked to specify targets for dietary sodium, the committee noted factors that precluded establishing these targets. These include lack of consistency in methods for defining sodium intakes at both high and low ends of typical intakes and extreme variability in intake levels across studies. The committee could only consider sodium intake levels within the context of each individual study because there were impediments to calibrating sodium assessment measures across studies.

After release of the IOM report, several news outlets highlighted disagreement among health agencies about targets for dietary sodium intake and reported that experts disagreed about the importance of blood pressure. Focusing the debate on specific targets misses the larger conclusion with which all are in agreement and may hinder implementation of important public health policy. Rather than focusing on disagreements about specific targets that currently affect less than 10% of the US population (ie, sodium intake of <2300 mg/d vs <1500 mg/d), the IOM, AHA, WHO, and DGA are congruent in suggesting that excess sodium intake should be reduced, and this is likely to have significant public health effects. Accomplishing such a reduction will require efforts to decrease sodium in the food environment10 and provide individual consumers more choice in their dietary consumption of sodium.



Institute of Medicine.  Sodium Intake in Populations: Assessment of Evidence. Washington, DC: National Academies Press. May 2013. Accessed June 4, 2013


US Department of Agriculture and US Department of Health and Human Services.  Dietary Guidelines for Americans, 2010. 7th ed. Washington, DC: US Government Printing Office; 2010


Institute of Medicine.  Dietary Reference Intakes for Water, Potassium, Sodium, Chloride, and Sulfate. Washington, DC: National Academies Press; 2005


Appel LJ, Frohlich ED, Hall JE,  et al.  The importance of population-wide sodium reduction as a means to prevent cardiovascular disease and stroke: a call to action from the American Heart Association.  Circulation. 2011;123(10):1138-1143
PubMed   |  Link to Article


World Health Organization.  Guideline: Sodium Intake for Adults and Children. Geneva, Switzerland: World Health Organization; 2012


Cogswell ME, Zhang Z, Carriquiry AL,  et al.  Sodium and potassium intakes among US adults: NHANES 2003-2008.  Am J Clin Nutr. 2012;96(3):647-657
PubMed   |  Link to Article


US Department of Agriculture and US Department of Health and Human Services.  Report of the Dietary Guidelines Advisory Committee on the Dietary Guidelines for Americans, 2010, to the Secretary of Agriculture and the Secretary of Health and Human Services. Washington, DC: USDA/ARS; 2010


Low sodium versus normal sodium diets in systolic heart failure: systematic review and meta-analysis [retraction]. Accessed May 23, 2013


Aliti GB, Rabelo ER, Clausell N, Rohde LE, Biolo A, Beck-da-Silva L. Aggressive fluid and sodium restriction in acute decompensated heart failure: a randomized clinical trial.  JAMA Intern Med
PubMed  |  Link to Article


Institute of Medicine.  Strategies to Reduce Sodium Intake in the United States. Washington, DC: National Academies Press; 2010

Source: JAMA

Salt Intake in Kids Associated with Hypertension .

Increased sodium intake among children and adolescents is associated with greater risk for hypertension — significantly so among the overweight and obese — according to a Pediatrics study.

Researchers studied some 6200 participants in U.S. NHANES surveys taken between 2003 and 2008; all were between the ages of 8 and 18, and about one third were overweight or obese. Mean sodium consumption was roughly 3400 mg/day, as determined by dietary recalls. (National guidelines call for intake under 2300 mg in children.)

Mean systolic blood pressures rose with increasing quartiles of sodium consumption. Higher levels of sodium intake were significantly associated with pre-high blood pressure and high blood pressure among the overweight and obese, but not normal-weight participants.

The authors note that on average, these children consumed about as much sodium as adults. They point out that given the observational nature of their study, “a large randomized controlled trial would be needed” to confirm the results.

Source: Pediatrics



Preoperative Hyponatremia May Heighten Mortality Risk .

The presence of even mild hyponatremia before surgery is associated with increased perioperative mortality, according to a cohort study in the Archives of Internal Medicine.

Nearly 1 million U.S. adult patients in a surgical-quality registry had their sodium levels measured within 90 days before surgery. About 8% of patients had hyponatremia (defined as a serum sodium level under 135 mEq/L), with most of these being only mildly hyponatremic (values ranging from 130 to 134 mEq/L).

The study’s primary outcome, mortality within 30 days after surgery, was higher in those with hyponatremia than in those with normal sodium levels (5.2% vs. 1.3%); the difference remained significant even after adjustment for other risk factors such as smoking and functional health status.

Editorialists comment that the findings are not surprising, given the comorbidities associated with hyponatremia. They say it remains an open question whether elective surgery should be postponed in the face of mild hyponatremia, “but the diagnosis should contribute to the informed consent process.”

Source:Archives of Internal Medicine